早期食用花生后对避免花生过敏的影响
2016/06/20
摘要
背景：在一项随机试验中，对有花生过敏高风险的婴儿早期给予花生可以预防花生过敏。在这项后续研究中，我们调查了，与一直都避免食用花生的受试者（花生回避组）相比，在早期实验中（花生食用组）食用花生的受试者者在避免食用花生12个月后，他们花生过敏率是否仍然保持较低的水平。
方法：在首次试验结束时，我们要求所有的受试者在随后的12个月避免食用花生。首要终点是记录， 在12个月试验期结束时受试者的花生过敏率，届时受试者已72 月龄。
结果：我们从首次试验中628名受试者中招募了556名（88.5%），其中550名受试者（98.9%）获得了完整的首要终点数据。在后续研究中坚持回避的比例很高（花生回避组为90.4%，花生食用组为69.3%）。在受试者72月龄大的时候，花生回避组的花生过敏率显著高于花生食用组（18.6% [ 280个受试者中52人过敏]与4.8% [ 270个受试者中13人过敏 ]，P<0.001）。每个组中都产生了3个新的过敏案例，但在12个月的回避期后，在花生食用组中过敏的情况没有显著增加 (60月龄的过敏率为 3.6% [10/274] ，72月龄的过敏率为 4.8% [13/ 270], P=0.25). 与花生回避组相比，花生食用组中有高水平Ara h2（花生蛋白成分）-特异性IgE和高水平花生特异性IgE的受试者更少；此外，花生食用组的受试者仍有较高的花生特异IgG4水平和较高的花生特异IgG4:IgE比。
结论：在过敏高危儿童中，1岁内就食用过花生、并且一直持续到5岁者，12个月期限的花生回避和花生过敏患病率的增加无关。长期效应未知。（由美国国家过敏和传染病研究所资助）。
（杨冬 审校）
N Engl J Med. 2016 Apr 14;374(15):1435-43.doi:10.1056/NEJMoa1514209.Epub 2016 Mar 4.
Effect of Avoidance on Peanut Allergy after Early Peanut Consumption.
Du Toit G1, Sayre PH1, Roberts G1, Sever ML1, Lawson K1, Bahnson HT1, Brough HA1, Santos AF1, Harris KM1, Radulovic S1, Basting M1, Turcanu V1, Plaut M1, Lack G1; Immune Tolerance Network LEAP-On Study Team.
Collaborators (46)
Author information
Abstract
BACKGROUND:In a randomized trial, the early introduction of peanuts in infants at high risk for allergy was shown to prevent peanut allergy. In this follow-up study, we investigated whether the rate of peanut allergy remained low after 12 months of peanut avoidance among participants who had consumed peanuts during the primary trial (peanut-consumption group), as compared with those who had avoided peanuts (peanut-avoidance group).
METHODS:At the end of the primary trial, we instructed all the participants to avoid peanuts for 12 months. The primary outcome was the percentage of participants with peanut allergy at the end of the 12-month period, when the participants were 72 months of age.
RESULTS:We enrolled 556 of 628 eligible participants (88.5%) from the primary trial; 550 participants (98.9%) had complete primary-outcome data. The rate of adherence to avoidance in the follow-up study was high (90.4% in the peanut-avoidance group and 69.3% in the peanut-consumption group). Peanut allergy at 72 months was significantly more prevalent among participants in the peanut-avoidance group than among those in the peanut-consumption group (18.6% [52 of 280 participants] vs. 4.8% [13 of 270], P<0.001). Three new cases of allergy developed in each group, but after 12 months of avoidance there was no significant increase in the prevalence of allergy among participants in the consumption group (3.6% [10 of 274 participants] at 60 months and 4.8% [13 of 270] at 72 months, P=0.25). Fewer participants in the peanut-consumption group than in the peanut-avoidance group had high levels of Ara h2 (a component of peanut protein)-specific IgE and peanut-specific IgE; in addition, participants in the peanut-consumption group continued to have a higher level of peanut-specific IgG4 and a higher peanut-specific IgG4:IgE ratio.
CONCLUSIONS:Among children at high risk for allergy in whom peanuts had been introduced in the first year of life and continued until 5 years of age, a 12-month period of peanut avoidance was not associated with an increase in the prevalence of peanut allergy. Longer-term effects are not known. (Funded by the National Institute of Allergy and Infectious Diseases and others; LEAP-On ClinicalTrials.gov number, NCT01366846.).
N Engl J Med.2016Apr14;374(15):1435-43.doi:10.1056/NEJMoa1514209.Epub 2016 Mar 4.
