美国花生过敏预防指南：国家过敏及传染性疾病研究所专家组报告
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2017年1月5日，美国过敏哮喘免疫学会（AAAAI）官方期刊《过敏与临床免疫学杂志》、美国过敏哮喘免疫学院（ACAAI）官方期刊《过敏、哮喘与免疫学年鉴》、美国儿科皮肤病学会（SPD）国际儿科皮肤病学会（ISPD）欧洲儿科皮肤病学会（ESPD）官方期刊《儿科皮肤病学》联合发表美国国家过敏及传染性疾病研究所（NIAID）专家组起草的美国花生过敏预防指南，建议家长可以在孩子出生后4～6个月开始喂食花生或含有花生成分的食物，降低孩子将来对花生过敏的风险。
根据2015年2月26日发表于《新英格兰医学杂志》（N Engl J Med. 2015;372:803-813）的花生过敏早期研究（Learning Early about Peanut Allergy，LEAP）结果显示，婴儿从小食用花生与避免食用花生，到5岁时对花生过敏的风险显著降低。在意向治疗人群中，皮肤针刺试验结果阴性的530例婴儿到5岁时，避免食用花生、从小食用花生的花生过敏发生率分别为13.7%、1.9%（P＜0.001）；皮肤针刺试验结果阳性的98例婴儿到5岁时，避免食用花生、从小食用花生的花生过敏发生率分别为35.3%、10.6%（P=0.004）。
资助该研究的NIAID希望通过医疗服务提供者广泛传播该信息，将来能够避免容易受影响的孩子对花生过敏，并最终减少对花生过敏的发生率。
起草该指南的作者表示：喂食花生的相关时间和方法应该根据婴儿对花生过敏的风险高低而决定。关于何时开始给婴儿吃花生的指南不断变化，新研究显示在婴儿4～6个月大时开始吃花生，搭配其他几种食物一同食用，能明显减轻花生过敏风险。这是个能够减少花生过敏案例数量的好机会，但是这也必须要有家长和医护人员的配合。
该指南表示，给予婴儿掺入有花生的食物，是可以避免对花生过敏的方法。该指南根据婴儿过敏风险，提供了给婴儿食用花生的方法：
患有严重湿疹、鸡蛋过敏或两者都有的婴儿，被认为对花生过敏有高风险，应该从4～6个月时开始食用花生，以降低过敏风险。家长也可以咨询过敏专科医师，通过皮肤点刺试验或血液检测确定是否对花生过敏。
患有轻至中度湿疹的婴儿，应该从6个月开始食用花生，以降低过敏风险。
无湿疹或食物过敏反应的婴儿，花生过敏的风险较低，可以随意地食用带有花生成分的食物。
但是，指南也提到，在任何情况下，婴儿在食用含有花生的食物之前，应该先接受其他固体食物。婴儿可能会被整个一颗花生呛到，应该采用适合不同年龄的花生喂食形式，可以将温水加入花生酱，使花生酱变软或液体化，或者食用含有花生的玉米泡芙，或者在苹果泥或者其他果泥中加入花生酱。
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