{"title":"牛乳特异性免疫球蛋白 E 抗体水平低者口服食物挑战的安全性。","authors":"Takanobu Yoshida, Jun Kido, Mika Ogata, Suguru Watanabe, Natsuko Nishi, Sachiko Shimomura, Nami Hirai, Kenichi Tanaka, Masaaki Yanai, Tomoyuki Mizukami, Kimitoshi Nakamura","doi":"10.1159/000541840","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Cow's milk (CM) is one of the most common food allergens in Japan. The oral food challenge (OFC) of CM is important for the definite diagnosis of children with CM allergy, and it is recommended to be actively and safely performed in individuals with low CM-sIgE levels. This study aimed to investigate the safety of low-dose CM-OFC in individuals with low CM-sIgE levels and discuss the prognostic factors and appropriate approaches for assessing the starting doses of CM-OFC in these individuals.</p><p><strong>Methods: </strong>We retrospectively analyzed 6,929 OFC tests conducted between January 1, 2017, and December 31, 2021; of which, 1,390 were CM-OFC tests. The characteristics, OFC-positive rates, CM loading, and related factors were analyzed in 138 cases involving low CM-sIgE levels. Stepwise OFC tests were conducted according to the food allergies guidelines in Japan using an open and unblinded method.</p><p><strong>Results: </strong>Among 138 individuals with low CM-sIgE levels, 110 (79.7%) passed the OFC test without any symptoms. Among the cases with OFC-positive status, 50.0% (14/28) cases showed symptoms with low-dose OFC (30-105 mg CM protein). Moreover, complete CM elimination was associated with a significantly high OFC-positive rate, and 60.0% (12/20) of the cases involving complete CM elimination showed symptoms with low-dose OFC.</p><p><strong>Conclusion: </strong>Eighty percent of the patients with low CM-sIgE levels safely completed the OFC test. Nevertheless, careful observation is essential during low-dose OFC test in cases with low CM-sIgE levels, especially in the cases with complete elimination. The starting dose of the OFC test should be reevaluated, and modified using baked milk or a lower dose of CM to ensure safety and early outgrowth of CM allergy.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-8"},"PeriodicalIF":2.5000,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety of Oral Food Challenges for Individuals with Low Levels of Cow's Milk-Specific Immunoglobulin E Antibodies.\",\"authors\":\"Takanobu Yoshida, Jun Kido, Mika Ogata, Suguru Watanabe, Natsuko Nishi, Sachiko Shimomura, Nami Hirai, Kenichi Tanaka, Masaaki Yanai, Tomoyuki Mizukami, Kimitoshi Nakamura\",\"doi\":\"10.1159/000541840\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Cow's milk (CM) is one of the most common food allergens in Japan. The oral food challenge (OFC) of CM is important for the definite diagnosis of children with CM allergy, and it is recommended to be actively and safely performed in individuals with low CM-sIgE levels. This study aimed to investigate the safety of low-dose CM-OFC in individuals with low CM-sIgE levels and discuss the prognostic factors and appropriate approaches for assessing the starting doses of CM-OFC in these individuals.</p><p><strong>Methods: </strong>We retrospectively analyzed 6,929 OFC tests conducted between January 1, 2017, and December 31, 2021; of which, 1,390 were CM-OFC tests. The characteristics, OFC-positive rates, CM loading, and related factors were analyzed in 138 cases involving low CM-sIgE levels. Stepwise OFC tests were conducted according to the food allergies guidelines in Japan using an open and unblinded method.</p><p><strong>Results: </strong>Among 138 individuals with low CM-sIgE levels, 110 (79.7%) passed the OFC test without any symptoms. Among the cases with OFC-positive status, 50.0% (14/28) cases showed symptoms with low-dose OFC (30-105 mg CM protein). Moreover, complete CM elimination was associated with a significantly high OFC-positive rate, and 60.0% (12/20) of the cases involving complete CM elimination showed symptoms with low-dose OFC.</p><p><strong>Conclusion: </strong>Eighty percent of the patients with low CM-sIgE levels safely completed the OFC test. Nevertheless, careful observation is essential during low-dose OFC test in cases with low CM-sIgE levels, especially in the cases with complete elimination. The starting dose of the OFC test should be reevaluated, and modified using baked milk or a lower dose of CM to ensure safety and early outgrowth of CM allergy.</p>\",\"PeriodicalId\":13652,\"journal\":{\"name\":\"International Archives of Allergy and Immunology\",\"volume\":\" \",\"pages\":\"1-8\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-11-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Archives of Allergy and Immunology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000541840\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ALLERGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Archives of Allergy and Immunology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000541840","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ALLERGY","Score":null,"Total":0}
引用次数: 0
摘要
简介牛奶(CM)是日本最常见的食物过敏原之一。牛乳口服食物挑战(OFC)对于明确诊断儿童牛乳过敏非常重要,建议对牛乳-SIgE水平低的个体积极、安全地进行OFC。本研究旨在调查低剂量 CM-OFC 在 CM-sIgE 水平低的个体中的安全性,并讨论这些个体的预后因素和评估 CM-OFC 起始剂量的适当方法:我们回顾性分析了2017年1月1日至2021年12月31日期间进行的6929次OFC检测,其中1390次为CM-OFC检测。分析了138例低CM-sIgE水平病例的特征、OFC阳性率、CM负荷及相关因素。根据日本 FA 指南,采用开放和非盲法进行了逐步 OFC 检测:在 138 例 CM-sIgE 水平较低的患者中,有 110 例(79.7%)通过了 OFC 测试,且未出现任何症状。在 OFC 阳性的病例中,50.0%(14/28)的病例在服用低剂量 OFC(30-105 毫克 CM 蛋白)后出现症状。此外,完全清除 CM 与 OFC 阳性率显著增高有关,在完全清除 CM 的病例中,60.0%(12/20)的病例在低剂量 OFC 测试中出现症状:结论:80%的低 CM-sIgE 水平患者安全地完成了 OFC 试验。尽管如此,在对 CM-sIgE 水平较低的病例进行小剂量 OFC 试验时,尤其是在 CM 完全清除的病例中,仔细观察是必不可少的。应重新评估和调整 OFC 试验的起始剂量,使用烘焙牛奶或较低剂量的中药,以确保安全和及早出现中药过敏。
Safety of Oral Food Challenges for Individuals with Low Levels of Cow's Milk-Specific Immunoglobulin E Antibodies.
Introduction: Cow's milk (CM) is one of the most common food allergens in Japan. The oral food challenge (OFC) of CM is important for the definite diagnosis of children with CM allergy, and it is recommended to be actively and safely performed in individuals with low CM-sIgE levels. This study aimed to investigate the safety of low-dose CM-OFC in individuals with low CM-sIgE levels and discuss the prognostic factors and appropriate approaches for assessing the starting doses of CM-OFC in these individuals.
Methods: We retrospectively analyzed 6,929 OFC tests conducted between January 1, 2017, and December 31, 2021; of which, 1,390 were CM-OFC tests. The characteristics, OFC-positive rates, CM loading, and related factors were analyzed in 138 cases involving low CM-sIgE levels. Stepwise OFC tests were conducted according to the food allergies guidelines in Japan using an open and unblinded method.
Results: Among 138 individuals with low CM-sIgE levels, 110 (79.7%) passed the OFC test without any symptoms. Among the cases with OFC-positive status, 50.0% (14/28) cases showed symptoms with low-dose OFC (30-105 mg CM protein). Moreover, complete CM elimination was associated with a significantly high OFC-positive rate, and 60.0% (12/20) of the cases involving complete CM elimination showed symptoms with low-dose OFC.
Conclusion: Eighty percent of the patients with low CM-sIgE levels safely completed the OFC test. Nevertheless, careful observation is essential during low-dose OFC test in cases with low CM-sIgE levels, especially in the cases with complete elimination. The starting dose of the OFC test should be reevaluated, and modified using baked milk or a lower dose of CM to ensure safety and early outgrowth of CM allergy.
期刊介绍:
''International Archives of Allergy and Immunology'' provides a forum for basic and clinical research in modern molecular and cellular allergology and immunology. Appearing monthly, the journal publishes original work in the fields of allergy, immunopathology, immunogenetics, immunopharmacology, immunoendocrinology, tumor immunology, mucosal immunity, transplantation and immunology of infectious and connective tissue diseases.