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2017年1月5日，美國(guó)過(guò)敏哮喘免疫學(xué)會(huì)（AAAAI）官方期刊《過(guò)敏與臨床免疫學(xué)雜志》、美國(guó)過(guò)敏哮喘免疫學(xué)院（ACAAI）官方期刊《過(guò)敏、哮喘與免疫學(xué)年鑒》、美國(guó)兒科皮膚病學(xué)會(huì)（SPD）國(guó)際兒科皮膚病學(xué)會(huì)（ISPD）歐洲兒科皮膚病學(xué)會(huì)（ESPD）官方期刊《兒科皮膚病學(xué)》聯(lián)合發(fā)表美國(guó)國(guó)家過(guò)敏及傳染性疾病研究所（NIAID）專家組起草的美國(guó)花生過(guò)敏預(yù)防指南，建議家長(zhǎng)可以在孩子出生后4～6個(gè)月開(kāi)始喂食花生或含有花生成分的食物，降低孩子將來(lái)對(duì)花生過(guò)敏的風(fēng)險(xiǎn)。
根據(jù)2015年2月26日發(fā)表于《新英格蘭醫(yī)學(xué)雜志》（N Engl J Med. 2015;372:803-813）的花生過(guò)敏早期研究（Learning Early about Peanut Allergy，LEAP）結(jié)果顯示，嬰兒從小食用花生與避免食用花生，到5歲時(shí)對(duì)花生過(guò)敏的風(fēng)險(xiǎn)顯著降低。在意向治療人群中，皮膚針刺試驗(yàn)結(jié)果陰性的530例嬰兒到5歲時(shí)，避免食用花生、從小食用花生的花生過(guò)敏發(fā)生率分別為13.7%、1.9%（P＜0.001）；皮膚針刺試驗(yàn)結(jié)果陽(yáng)性的98例嬰兒到5歲時(shí)，避免食用花生、從小食用花生的花生過(guò)敏發(fā)生率分別為35.3%、10.6%（P=0.004）。
資助該研究的NIAID希望通過(guò)醫(yī)療服務(wù)提供者廣泛傳播該信息，將來(lái)能夠避免容易受影響的孩子對(duì)花生過(guò)敏，并最終減少對(duì)花生過(guò)敏的發(fā)生率。
起草該指南的作者表示：喂食花生的相關(guān)時(shí)間和方法應(yīng)該根據(jù)嬰兒對(duì)花生過(guò)敏的風(fēng)險(xiǎn)高低而決定。關(guān)于何時(shí)開(kāi)始給嬰兒吃花生的指南不斷變化，新研究顯示在嬰兒4～6個(gè)月大時(shí)開(kāi)始吃花生，搭配其他幾種食物一同食用，能明顯減輕花生過(guò)敏風(fēng)險(xiǎn)。這是個(gè)能夠減少花生過(guò)敏案例數(shù)量的好機(jī)會(huì)，但是這也必須要有家長(zhǎng)和醫(yī)護(hù)人員的配合。
該指南表示，給予嬰兒摻入有花生的食物，是可以避免對(duì)花生過(guò)敏的方法。該指南根據(jù)嬰兒過(guò)敏風(fēng)險(xiǎn)，提供了給嬰兒食用花生的方法：
患有嚴(yán)重濕疹、雞蛋過(guò)敏或兩者都有的嬰兒，被認(rèn)為對(duì)花生過(guò)敏有高風(fēng)險(xiǎn)，應(yīng)該從4～6個(gè)月時(shí)開(kāi)始食用花生，以降低過(guò)敏風(fēng)險(xiǎn)。家長(zhǎng)也可以咨詢過(guò)敏?？漆t(yī)師，通過(guò)皮膚點(diǎn)刺試驗(yàn)或血液檢測(cè)確定是否對(duì)花生過(guò)敏。
患有輕至中度濕疹的嬰兒，應(yīng)該從6個(gè)月開(kāi)始食用花生，以降低過(guò)敏風(fēng)險(xiǎn)。
無(wú)濕疹或食物過(guò)敏反應(yīng)的嬰兒，花生過(guò)敏的風(fēng)險(xiǎn)較低，可以隨意地食用帶有花生成分的食物。
但是，指南也提到，在任何情況下，嬰兒在食用含有花生的食物之前，應(yīng)該先接受其他固體食物。嬰兒可能會(huì)被整個(gè)一顆花生嗆到，應(yīng)該采用適合不同年齡的花生喂食形式，可以將溫水加入花生醬，使花生醬變軟或液體化，或者食用含有花生的玉米泡芙，或者在蘋果泥或者其他果泥中加入花生醬。
Pediatr Dermatol. 2017 Jan;34(1):5-12.
Addendum guidelines for the prevention of peanut allergy in the United States: Summary of the National Institute of Allergy and Infectious Diseases-sponsored expert panel.
Togias A, Cooper SF, Acebal ML, Assa'ad A, Baker JR Jr, Beck LA, Block J, Byrd-Bredbenner C, Chan ES, Eichenfield LF, Fleischer DM, Fuchs GJ 3rd, Furuta GT, Greenhawt MJ, Gupta RS, Habich M, Jones SM, Keaton K, Muraro A, Plaut M, Rosenwasser LJ, Rotrosen D, Sampson HA, Schneider LC, Sicherer SH, Sidbury R, Spergel J, Stukus DR, Venter C, Boyce JA.
National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; Food Allergy Research & Education, McLean, Virginia; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio; University of Michigan Health System, Ann Arbor, Michigan; University of Rochester Medical Center, Rochester, New York; National Eczema Association, San Rafael, California; Rutgers University, New Brunswick, New Jersey; BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; San Diego School of Medicine, Rady Children's Hospital, University of California, San Diego, California; Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Municipality in Colorado; Kentucky Children's Hospital, University of Kentucky College of Medicine, Lexington, Kentucky; Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; University of Colorado Denver School of Medicine, Aurora, Colorado; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine, Central DuPage Hospital, Winfield, Illinois; Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Metro DC Food Allergy Support Group, Rockville, Maryland; Padua University Hospital, Padua, Italy; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Icahn School of Medicine at Mount Sinai, New York, New York; Boston Children's Hospital, Boston, Massachusetts; Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington; The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania; Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Harvard Medical School, Boston, Massachusetts.
PMID: 28054718
DOI: 10.1111/pde.13092
Pediatr Dermatol. 2017 Jan;34(1):e1-e21.
Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel.
Togias A, Cooper SF, Acebal ML, Assa'ad A, Baker JR Jr, Beck LA, Block J, Byrd-Bredbenner C, Chan ES, Eichenfield LF, Fleischer DM, Fuchs GJ 3rd, Furuta GT, Greenhawt MJ, Gupta RS, Habich M, Jones SM, Keaton K, Muraro A, Plaut M, Rosenwasser LJ, Rotrosen D, Sampson HA, Schneider LC, Sicherer SH, Sidbury R, Spergel J, Stukus DR, Venter C, Boyce JA.
The National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; The Board of Directors, Food Allergy Research & Education, McLean, Virginia; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio; University of Michigan Health System, Ann Arbor, Michigan; University of Rochester Medical Center, San Rafael and San Diego, California; The National Eczema Association, San Rafael, California; Rutgers University, New Brunswick, New Jersey; BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; San Diego School of Medicine, Rady Children's Hospital, University of California, San Diego, California; Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Columbia; Kentucky Children's Hospital, University of Kentucky College of Medicine, Lexington, Kentucky; The Digestive Health Institute, Children's Hospital Colorado, Aurora, Columbia; University of Colorado Denver School of Medicine, Aurora, Columbia; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine, Central DuPage Hospital, Winfield, Illinois; Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Metro DC Food Allergy Support Group, Rockville, Maryland; Padua University Hospital, Padua, Italy; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Icahn School of Medicine at Mount Sinai, New York, New York; Boston Children's Hospital, Boston, Massachusetts; Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington; Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania; Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Harvard Medical School, Boston, Massachusetts.
BACKGROUND: Food allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institute of Allergy and Infectious Diseases, working with other organizations and advocacy groups, led the development of the first clinical guidelines for the diagnosis and management of food allergy. A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy.
OBJECTIVES: Prompted by these findings, along with 25 professional organizations, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases facilitated development of addendum guidelines to specifically address the prevention of peanut allergy.
RESULTS: The addendum provides three separate guidelines for infants at various risk levels for the development of peanut allergy and is intended for use by a wide variety of health care providers. Topics addressed include the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and the timing and approaches for introduction of peanut-containing foods in the health care provider's office or at home. The addendum guidelines provide the background, rationale, and strength of evidence for each recommendation.
CONCLUSIONS: Guidelines have been developed for early introduction of peanut-containing foods into the diets of infants at various risk levels for peanut allergy.
PMID: 28054723
DOI: 10.1111/pde.13093
Ann Allergy Asthma Immunol. 2017 Jan 5. [Epub ahead of print]
Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel.
DOI: 10.1016/j.anai.2016.10.004
J Allergy Clin Immunol. 2017 Jan;139(1):29-44.
Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel.
DOI: 10.1016/j.jaci.2016.10.010
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