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　　原标题：对花生敏感儿童表现出过敏还是耐受：用组份诊断方法进行区分及流行情况分析
　　并非所有对花生敏感的儿童在接触花生后都会产生过敏反应。
　　在经皮肤点刺试验和/或特异性IgE检测被认为对花生敏感的儿童中通过食物挑战试验来确定临床花生过敏儿童所占的比例，并探讨使用微阵列的组份诊断是否可以区分花生过敏和耐受。
　　在以普通人群为基础的出生队列中，我们在8岁时通过皮肤点刺试验和特异性IgE检测确定了对花生的敏感性。在这些敏感儿童中，我们通过食物挑战试验来确定对花生的过敏或耐受。我们对一部分人(n = 45)用开放式食物挑战的方法;另外一些人接受了双盲安慰剂对照的食物挑战试验(n = 34)。我们使用含有12种组分的微阵列(主要的花生成分和潜在的交叉反应成分，包括草变应原)，比较了花生过敏儿童和花生耐受儿童的致敏特性。
　　933名儿童中，110名(11.8%)对花生敏感。19人没有接受挑战(17人没有同意)。12人有确证的接触反应病史,且IgE≥15Ku/ L和/或皮肤测试≥8毫米被认为过敏，而未进行挑战试验。对剩余的79名儿童进行了挑战试验,7人有大于等于2项的客观体征而被指定为花生过敏。我们估计临床花生过敏的患病率为22.4% (95% CI, 14.8%到32.3%)。通过组份诊断，我们发现花生过敏儿童组(n = 29;含12例牛奶过敏)和花生耐受组儿童(n = 52)之间在组份识别模式上存在显著差异。花生成分Ara h2是临床过敏最重要的预测因子。
　　大多数在标准测试的基础上被认为对花生敏感的儿童其实并不存在花生过敏。组份诊断有助于花生过敏的诊断。
延伸阅读
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, MPhilaMaryamPoorafsharPhDbClareMurrayMDaAngelaSimpsonMDaHenricWinellMScbGinaKerryRNaAnnikaHärlinMScbAshleyWoodcockMD, FMedSciaStaffanAhlstedtPhDcAdnanCustovicMD, PhD, FRCPa
　　创建过敏性疾病的科研、科普知识交流平台，为过敏患者提供专业诊断、治疗、预防的共享平台。