一项通过饮食实现食物过敏一级预防的共识：来自美国过敏、哮喘和免疫学学会；美国过敏、哮喘和免疫学学会；以及加拿大过敏和临床
2020/12/17
一项通过饮食实现食物过敏一级预防的共识：来自美国过敏、哮喘和免疫学学会；美国过敏、哮喘和免疫学学会；以及加拿大过敏和临床免疫学学会的指南
摘要
最近发表的高影响力随机对照试验数据表明，预防高危人群食物过敏的饮食策略具有很强的潜力，但美国目前的指南仅限于预防花生过敏的策略，尽管有其他数据和其他一些国家提倡尽早摄入鸡蛋和花生。虽然湿疹被认为是发生IgE介导的食物过敏的最主要危险因素，但没有危险因素的儿童仍然会发生食物过敏。为了防止花生和/或鸡蛋过敏，花生和鸡蛋都应该在出生6个月左右但不早于4个月时摄入。摄入前一般不需要进行筛查，但有些家庭是需要优先考虑的。其他易过敏食物也应该在这个时候摄入。在摄入辅食时，婴儿应该吃多种食物，因为这有助于预防食物过敏。在儿童1岁前使用水解配方奶粉对食物过敏或食物致敏没有保护作用。不建议母亲在怀孕和/或哺乳期排除常见过敏原，以防止食物过敏。虽然全世界都建议进行纯母乳喂养，但是完全母乳喂养和特定食物过敏一级预防之间没有特定的联系。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2020 Nov 26;S2213-2198(20)31211-3. doi: 10.1016/j.jaip.2020.11.002.)
(J Allergy Clin Immunol Pract. 2020 Nov 26;S2213-2198(20)31211-3. doi: 10.1016/j.jaip.2020.11.002.)
A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology
David M Fleischer, Edmond S Chan, Carina Venter, Jonathan M Spergel, Elissa M Abrams, David Stukus, Marion Groetch, Marcus Shaker, Matthew Greenhawt
Abstract
Recently published data from high-impact randomized controlled trials indicate the strong potential of strategies to prevent the development of food allergy in high-risk individuals, but guidance in the United States at present is limited to a policy for only the prevention of peanut allergy, despite other data being available and several other countries advocating early egg and peanut introduction. Eczema is considered the highest risk factor for developing IgE-mediated food allergy, but children without risk factors still develop food allergy. To prevent peanut and/or egg allergy, both peanut and egg should be introduced around 6 months of life, but not before 4 months. Screening before introduction is not required, but may be preferred by some families. Other allergens should be introduced around this time as well. Upon introducing complementary foods, infants should be fed a diverse diet, because this may help foster prevention of food allergy. There is no protective benefit from the use of hydrolyzed formula in the first year of life against food allergy or food sensitization. Maternal exclusion of common allergens during pregnancy and/or lactation as a means to prevent food allergy is not recommended. Although exclusive breast-feeding is universally recommended for all mothers, there is no specific association between exclusive breast-feeding and the primary prevention of any specific food allergy.
