一般的な食物アレルギーの診断と管理:体系的なレビュー
Jennifer J Schneider Chafen1, Sydne J Newberry, Marc A Riedl
1VA Palo Alto Healthcare System, Palo Alto, California, USA. jjschnei@stanford.edu
JAMA
|May 13, 2010
まとめ
食物アレルギーの診断には一貫した基準が欠け,その影響は流行率と管理の理解に影響する. 効果的な食物アレルギーの診断と治療戦略のために,さらなる研究が必要である.
科学分野:
- アレルギーと免疫学
- クリニカル・メディシン 臨床医学
- 公衆衛生は公衆衛生である.
背景:
- 食物アレルギーに対する世界的な関心が高まっていることは,その流行と最適な診断/管理戦略に関するコンセンサスの欠如と対照的です.
- 既存の研究は,食物アレルギーの発生率と効果的な介入に関する様々な発見を提示しています.
研究 の 目的:
- 食物アレルギーの流行,診断,管理,予防に関する既存の証拠を体系的に検討する.
- 食品アレルギーの現在の理解と証拠基盤のギャップを特定する.
主な方法:
- 主要な医療データベース (PubMed,Cochrane) で1988年1月から2009年9月にかけて出版された英語の論文について,包括的な電子検索を行った.
- 将来の集団と食品の挑戦を基準基準として診断研究,体系的レビュー,ランダム化統制試験 (RCT) を含む.
- 既定の基準 (AMSTAR,QUADAS,Jadad) を用いて含まれた研究の質を評価した.
主要な成果:
- 食物アレルギーの罹患率は人口の1~2%~10%と推定され,増加傾向は不明である.
- 皮膚の刺さる検査と血清の食品特異性IgEは,診断のための食品チャレンジよりも統計的優位性を示しませんでした.
- 排除ダイエットは主要な治療法ですが,堅実な研究が欠けている. 免疫療法は有望ですが,より多くのデータが必要です. 水解された配方剤は,高リスクの乳児の牛乳アレルギーを予防することができますが,定義は標準化されていません.
結論:
- 診断基準の均一性が著しく欠如しているため,食品アレルギーの発生率と効果的な管理戦略の信頼性の高い評価を妨げています.
- 標準化された診断基準を用いたさらなる研究は,食品アレルギーの分野を前進させるために不可欠です.
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