门诊环境中的儿科口服食物挑战:一个单一中心的体验
Nicole Koutlas1, Amy Stallings1, Geoffrey Hall1
1Department of Pediatrics, Division of Allergy and Immunology, Duke University Medical Center, Durham, NC.
The journal of allergy and clinical immunology. Global
|January 8, 2024
概括
使用2kU/L以下的特定IgE水平和5mm以下的皮肤刺伤测试来选择患者进行口服食物挑战 (OFCs),导致常见食物过敏的失败率为13%. 过敏反应史增加了OFC失败的风险.
科学领域:
- 过敏和免疫学 过敏和免疫学
- 儿科过敏 儿科过敏
- 临床诊断 临床诊断 临床诊断
背景情况:
- 口服食物挑战 (OFC) 是诊断食物过敏 (FA) 的黄金标准.
- 确定OFC的最佳患者选择标准对于准确的诊断和管理至关重要.
- 目前缺乏OFC候选人选择的指导方针,需要对预测参数进行研究.
研究的目的:
- 描述OFC对常见食物过敏原的结果.
- 为了确定OFC中IgE介导的食物过敏的成功或失败的预测因素.
- 为OFC候选人选择标准建立一个基准.
主要方法:
- 从2017年6月到2022年5月,对663个IgE介导的儿童患者的OFC进行了回顾性图表审查.
- 已确立的资格标准:特定IgE ≤2kU/L和皮肤刺伤测试 (SPT) 牛奶,蛋和坚果OFC的小麦面粉大小 ≤5mm.
- 收集关于患者人口统计,过敏原测试,OFC结果和反应特征的数据.
主要成果:
- 花生,普通蛋,烤蛋和牛奶是最常见的挑战过敏原,通过率分别为84%,88%,62%和84%.
- 在没有OFC的患者中,84%出现了客观症状,23%出现了多系统反应,15%需要上腺素.
- 过敏反应史与OFC失败的风险增加有关,而阿托皮史或以前失败的OFC并不是显著的预测因素.
结论:
- 特定IgE ≤ 2kU/L和SPT ≤ 5mm,在非烤牛奶,蛋和坚果OFC中产生大约13%的失败率.
- 蛋OFC的较高失败率可能是由于选择偏差,并突出了卵样检测的低负预测值.
- 该研究为在缺乏共识指南的情况下建立OFC候选人选择基准提供了有价值的数据.
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