Sakihara Tetsuhiro
Department of Pediatrics, Heartlife Hospital, Okinawa, Japan.
Curr Opin Allergy Clin Immunol. 2024 Jun 1;24(3):160-165. doi: 10.1097/ACI.0000000000000983. Epub 2024 Apr 9.
Over the past two decades, food allergy prevention strategies have shifted from 'delayed introduction' to 'no delayed introduction' to 'early introduction' of allergenic foods. This article reviews important research in this field published in the early 2020s to support future strategies for food allergy prevention.
Recent randomized controlled trials (RCTs), systematic reviews, meta-analyses, and real-world studies have reported that early allergenic food introduction, especially peanut and egg, are effective for preventing food allergies. However, there are also reports that food-induced anaphylaxis admission rates in infants are increasing.
Early allergenic food introduction by itself is not sufficient to prevent the development of food allergies. Recent RCTs (SPADE study and COMEET study) have demonstrated that continued regular cow's milk consumption after early introduction is important for preventing the onset of cow's milk allergy. Furthermore, an RCT (PACI study) reported that early and aggressive anti-inflammatory topical therapy for eczema can contribute to the prevention of egg allergy by suppressing percutaneous sensitization. Food allergies may be prevented through a combination of early food introduction, regular consumption, and active eczema treatment. Further research is needed to develop well tolerated, effective, and practical strategies to prevent food allergies.
在过去二十年中,食物过敏预防策略已从“延迟引入”转变为“无延迟引入”,再到“早期引入”致敏食物。本文回顾了2020年代初发表的该领域重要研究,以支持未来的食物过敏预防策略。
近期的随机对照试验(RCT)、系统评价、荟萃分析和真实世界研究报告称,早期引入致敏食物,尤其是花生和鸡蛋,对预防食物过敏有效。然而,也有报告称婴儿因食物诱发的过敏反应住院率正在上升。
仅早期引入致敏食物不足以预防食物过敏的发生。近期的随机对照试验(SPADE研究和COMEET研究)表明,早期引入后持续规律饮用牛奶对预防牛奶过敏的发作很重要。此外,一项随机对照试验(PACI研究)报告称,对湿疹进行早期积极的抗炎局部治疗可通过抑制经皮致敏来预防鸡蛋过敏。食物过敏可通过早期引入食物、规律食用和积极治疗湿疹相结合的方式来预防。需要进一步研究以制定耐受性良好、有效且实用的食物过敏预防策略。