牛奶口服免疫疗法的随机试验:固定低剂量与升级到中剂量
Ken-Ichi Nagakura1, Kyohei Takahashi2, Yoko Miura2
1Department of Pediatric Allergy, Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan.
The journal of allergy and clinical immunology. In practice
|February 3, 2026
概括
脱敏后的固定低剂量口服免疫疗法 (OIT) 与严重牛奶过敏的升级剂量一样有效. 这种方法提高了安全性,减少了儿童的不良反应和过敏反应.
科学领域:
- 过敏和免疫学 过敏和免疫学
- 儿科过敏 儿科过敏
- 食物过敏症 食物过敏症
背景情况:
- 在初始低剂量消除对食物过敏的敏感性后,口服免疫疗法 (OIT) 的最佳方案尚未确定.
- 建立有效和安全的OIT策略对于管理像牛奶过敏这样的严重过敏至关重要.
研究的目的:
- 为了比较固定的低剂量OIT协议与严重牛奶过敏的儿童剂量升级协议的疗效和安全性.
- 为了确定固定的低剂量方法是否可以实现相似的短期不响应 (STU) 牛奶相比升级剂量.
主要方法:
- 一项随机研究涉及严重牛奶过敏的儿童,他们最初接受了低剂量OIT.
- 参与者被随机分配到固定剂量组 (3毫升目标) 或剂量升级组 (25毫升目标).
- 对25毫升牛奶的短期不反应 (STU) 通过口服食品挑战 (OFC) 在1岁和2岁时进行评估.
主要成果:
- 这两组在1岁和2岁时的STU与25毫升牛奶的比率相似 (约为31%与28%在1岁时,47%与44%在2岁时).
- 与剂量升级组相比,固定剂量组的总症状频率 (0.9% vs. 3.8%在第一年) 和过敏反应率 (0.01% vs. 0.06%在第一年) 显著降低.
- 两组在两年OIT后,过敏原特异性IgE水平显著下降.
结论:
- 在初始无敏化后,固定的低剂量口服免疫疗法方案显示了与严重牛奶过敏的剂量升级相当的疗效.
- 固定的低剂量方法提供了显著改善的安全性,并减少了不良反应和过敏反应事件.
- 这表明固定的低剂量OIT是治疗严重牛奶过敏的可行和更安全的替代方案.
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