儿童牛奶过敏的口服免疫疗法：一项系统评价和荟萃分析。
Oral immunotherapy for cow's milk allergy in children: a systematic review and meta-analysis.
作者信息
Wang Yan, Liu Shunli, Lu Meizhu, Guo Jingyu, Lv Can, Huang Lan
机构信息
Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
出版信息
Front Immunol. 2025 Jun 4;16:1570050. doi: 10.3389/fimmu.2025.1570050. eCollection 2025.
OBJECTIVE
Cow's milk allergy (CMA) is one of the most common causes of food allergies (FA) in children. There have been studies on the use of immunotherapy in cow's milk protein allergy, with oral immunotherapy (OIT) being the most extensively researched. We conducted a comprehensive analysis of randomized controlled trials (RCTs) to explore the efficacy and safety of OIT to manage cow's milk allergy in children.
METHODS
PubMed, EMBASE, Cochrane Library, and Scopus databases were searched from their inception until August 2024. Randomized controlled trials that reported on the efficacy or safety of IT for CMA were included. Two investigators independently extracted data on regimen of intervention, outcomes, number of cases and gender ratio. Pooled estimates of relative risks or standardized mean differences with 95% confidence intervals were calculated from the included studies for dichotomous and continuous outcomes.
RESULTS
Nineteen RCT articles (815 participants) were included. The meta-analysis indicated that oral immunotherapy significantly facilitated desensitization in patients with cow's milk allergy in children (relative risk [RR] 2.51, 95% CI: 1.54-4.09, I²=84.4%). Tolerance threshold at oral food challenges (OFC) increased following oral immunotherapy compared with a standard mean difference (SMD) of 3.58 (2.82-4.33). After oral immunotherapy, the antibody titers of cow milk protein sIgE (SMD -0.42, 95% CI: -0.72 to -0.11, I²=28.8%) and casein sIgE (SMD -0.54, 95% CI: -0.97 to -0.11, I²=0%) decreased. The risk of adverse reactions with immunotherapy was not higher than that in the control group, with an RR of 2.05 (95% CI 0.96-4.37, I²=81.5%).
CONCLUSIONS
Oral immunotherapy, is associated with desensitization to CMA in children, without increased risk of short-term adverse events, but late complications such as eosinophilic esophagitis require caution. More high-quality studies are needed to explore the long-term efficacy of OIT for CMA.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/recorddashboard, identifier CRD42024541769.
目的
牛奶过敏（CMA）是儿童食物过敏（FA）最常见的原因之一。关于牛奶蛋白过敏免疫疗法的应用已有研究，其中口服免疫疗法（OIT）研究最为广泛。我们对随机对照试验（RCT）进行了全面分析，以探讨OIT治疗儿童牛奶过敏的疗效和安全性。
方法
检索PubMed、EMBASE、Cochrane图书馆和Scopus数据库，检索时间从建库至2024年8月。纳入报告免疫疗法治疗CMA疗效或安全性的随机对照试验。两名研究者独立提取干预方案、结局、病例数和性别比的数据。根据纳入研究计算二分法和连续结局的相对风险或标准化均数差的合并估计值及95%置信区间。
结果
纳入19篇RCT文章（815名参与者）。荟萃分析表明，口服免疫疗法显著促进了儿童牛奶过敏患者的脱敏（相对风险[RR]2.51，95%CI：1.54 - 4.09，I² = 84.4%）。与标准均数差（SMD）为3.58（2.82 - 4.33）相比，口服免疫疗法后口服食物激发试验（OFC）的耐受阈值增加。口服免疫疗法后，牛奶蛋白特异性免疫球蛋白E（sIgE）（SMD -0.42，95%CI：-0.72至-0.11，I² = 28.8%）和酪蛋白sIgE（SMD -0.54，95%CI：-0.97至-0.11，I² = 0%）的抗体滴度降低。免疫疗法不良反应的风险不高于对照组，RR为2.05（95%CI 0.96 - 4.37，I² = 81.5%）。
结论
口服免疫疗法与儿童CMA脱敏相关，短期不良事件风险未增加，但嗜酸性食管炎等晚期并发症需谨慎。需要更多高质量研究来探索OIT治疗CMA的长期疗效。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/recorddashboard，标识符CRD42024541769。
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