原標(biāo)題：對(duì)花生敏感兒童表現(xiàn)出過敏還是耐受：用組份診斷方法進(jìn)行區(qū)分及流行情況分析
　　并非所有對(duì)花生敏感的兒童在接觸花生后都會(huì)產(chǎn)生過敏反應(yīng)。
　　在經(jīng)皮膚點(diǎn)刺試驗(yàn)和/或特異性IgE檢測(cè)被認(rèn)為對(duì)花生敏感的兒童中通過食物挑戰(zhàn)試驗(yàn)來確定臨床花生過敏兒童所占的比例，并探討使用微陣列的組份診斷是否可以區(qū)分花生過敏和耐受。
　　在以普通人群為基礎(chǔ)的出生隊(duì)列中，我們?cè)?歲時(shí)通過皮膚點(diǎn)刺試驗(yàn)和特異性IgE檢測(cè)確定了對(duì)花生的敏感性。在這些敏感兒童中，我們通過食物挑戰(zhàn)試驗(yàn)來確定對(duì)花生的過敏或耐受。我們對(duì)一部分人(n = 45)用開放式食物挑戰(zhàn)的方法;另外一些人接受了雙盲安慰劑對(duì)照的食物挑戰(zhàn)試驗(yàn)(n = 34)。我們使用含有12種組分的微陣列(主要的花生成分和潛在的交叉反應(yīng)成分，包括草變應(yīng)原)，比較了花生過敏兒童和花生耐受兒童的致敏特性。
　　933名兒童中，110名(11.8%)對(duì)花生敏感。19人沒有接受挑戰(zhàn)(17人沒有同意)。12人有確證的接觸反應(yīng)病史,且IgE≥15Ku/ L和/或皮膚測(cè)試≥8毫米被認(rèn)為過敏，而未進(jìn)行挑戰(zhàn)試驗(yàn)。對(duì)剩余的79名兒童進(jìn)行了挑戰(zhàn)試驗(yàn),7人有大于等于2項(xiàng)的客觀體征而被指定為花生過敏。我們估計(jì)臨床花生過敏的患病率為22.4% (95% CI, 14.8%到32.3%)。通過組份診斷，我們發(fā)現(xiàn)花生過敏兒童組(n = 29;含12例牛奶過敏)和花生耐受組兒童(n = 52)之間在組份識(shí)別模式上存在顯著差異?；ㄉ煞諥ra h2是臨床過敏最重要的預(yù)測(cè)因子。
　　大多數(shù)在標(biāo)準(zhǔn)測(cè)試的基礎(chǔ)上被認(rèn)為對(duì)花生敏感的兒童其實(shí)并不存在花生過敏。組份診斷有助于花生過敏的診斷。
延伸閱讀
JACI
Allergy or tolerance in children sensitized to peanut: Prevalence and differentiation using component-resolved diagnostics
https://doi.org/10.1016/j.jaci.2009.10.008
Abstract:
Not all peanut-sensitized children develop allergic reactions on exposure.
Objective
To establish by oral food challenge the proportion of children with clinical peanut allergy among those considered peanut-sensitized by using skin prick tests and/or IgE measurement, and to investigate whether component-resolved diagnostics using microarray could differentiate peanut allergy from tolerance.
Methods
Within a population-based birth cohort, we ascertained peanut sensitization by skin tests and IgE measurement at age 8 years. Among sensitized children, we determined peanut allergy versus tolerance by oral food challenges. We used open challenge among children consuming peanuts (n = 45); others underwent double-blind placebo-controlled challenge (n = 34). We compared sensitization profiles between children with peanut allergy and peanut-tolerant children by using a microarray with 12 pure components (major peanut and potentially cross-reactive components, including grass allergens).
Results
Of 933 children, 110 (11.8%) were peanut-sensitized. Nineteen were not challenged (17 no consent). Twelve with a convincing history of reactions on exposure, IgE ≥15 kUa/L and/or skin test ≥8mm were considered allergic without challenge. Of the remaining 79 children who underwent challenge, 7 had ≥2 objective signs and were designated as having peanut allergy. We estimated the prevalence of clinical peanut allergy among sensitized subjects as 22.4% (95% CI, 14.8% to 32.3%). By using component-resolved diagnostics, we detected marked differences in the pattern of component recognition between children with peanut allergy (n = 29; group enriched with 12 children with allergy) and peanut-tolerant children (n = 52). The peanut component Ara h 2 was the most important predictor of clinical allergy.
Conclusion
The majority of children considered peanut-sensitized on the basis of standard tests do not have peanut allergy. Component-resolved diagnostics may facilitate the diagnosis of peanut allergy.
First Author:
lNicolaosNicolaouMD, MPhilaMaryamPoorafsharPhDbClareMurrayMDaAngelaSimpsonMDaHenricWinellMScbGinaKerryRNaAnnikaH?rlinMScbAshleyWoodcockMD, FMedSciaStaffanAhlstedtPhDcAdnanCustovicMD, PhD, FRCPa
　　創(chuàng)建過敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。