飲食中提早攝取蛋類並不會降低過敏風險


  【24drs.com】一篇新研究的作者們報告指出,從4-6個月大開始規律食用蛋類,相較於延後開始吃蛋者,並不會改變1歲之後的蛋過敏風險。
  
  他們指出,不過,得自「Starting Time of Egg Protein (STEP)」這篇隨機雙盲試驗的某些研究結果,暗示提早開始吃蛋製品可能有好處。
  
  Crawley Western Australia大學小兒科暨兒童健康學院Debra J. Palmer博士等人寫道,STEP研究的研究對象在納入時沒有過敏症狀,但是他們有遺傳性的過敏風險,這使得STEP研究與「Learning Early About Peanut Allergy (LEAP)」等試驗有所不同,LEAP試驗的先決條件是:一個現有的過敏性疾病如濕疹,LEAP試驗中,提早且持續攝取花生製品與花生過敏發生率顯著降低有關。
  
  作者們結論指出,對於納入研究時沒有濕疹症狀、但有過敏疾病遺傳風險的嬰兒,我們並未發現從4-6.5個月規律攝取蛋類可明顯改變1歲時之蛋過敏風險的證據。實際上,對於沒有濕疹的嬰兒,在開始給予固態食品、加入蛋類與含蛋食品時,並不需要例行性檢測蛋過敏狀態。
  
  這篇研究線上發表於8月21日過敏與臨床免疫學期刊。
  
  STEP研究納入的孩童年齡為4-6.5個月,他們的母親有遺傳性過敏症,但是這些孩童本身沒有濕疹或過敏性疾病、未曾吃過蛋類。將他們隨機分組為介入組(有含蛋類)或對照組(沒有蛋類),於他們的食物中分別加入含蛋或不含蛋的粉末。這兩個配方的顏色、味道、外觀與口感相似,從隨機分組開始,每天給予一次,直到孩童10個月大為止。10個月大時,兩組的家長在所有研究對象孩童的飲食中都加入蛋類烹調製品。
  
  原本的820名研究對象中,748人在12個月大時進行了皮膚點刺試驗與蛋類挑戰。介入組的371名孩童中有26人 (7%)診斷有IgE相關的蛋過敏,對照組則是377人中有39人(10.3%)發生。
  
  校正居住城市、嬰兒性別、哺餵母乳狀態、家長的過敏疾病史等因素之後,相對風險(aRR)為0.75 (95%信賴區間[CI], 0.48 - 1.17; 校正P = .20),但是,作者們寫道,雖然樣本規模足以排除蛋過敏風險大幅增加,我們並無法排除潛在的重要效益。
  
  觀察發現,食用蛋類組的孩童有10.8%對蛋敏感,對照組則是有15.1%(aRR, 0.77; 95% CI, 0.54 - 1.10; P = .15),在隨機分組起到1歲之間,食用蛋類組的孩童有10.7%發生濕疹、對照組有11.9% (aRR, 0.84; 95% CI, 0.57 - 1.23; P = .37)。
  
  12個月大、進行生雞蛋挑戰時,食用蛋類組有2名嬰兒、對照組有1名嬰兒發生嚴重過敏反應,不過,他們對於研究使用的含蛋粉末並無過敏反應。此外,生蛋挑戰發生過敏反應、兩組共65名的嬰兒中,60人吃烘焙烹煮過的蛋時沒有問題發生。這強調了一個關鍵的公衛訊息:4-6.5個月大、沒有濕疹的嬰兒,在家裡開始給予含蛋食品是安全的,不需要先進行蛋敏感檢測。
  
  符合方案分析法中,含蛋組的305名嬰兒中有9人(3%)、對照組的312名嬰兒中有31人(9.9%)在12個月大時有IgE相關的蛋過敏(aRR, 0.32; 95% CI, 0.16 - 0.65; P = .002),不過,符合方案分析法將較多含蛋組的孩童排除,因為對研究使用的粉末感知不良反應(P = .02)或確認過敏反應(P = .0004)。
  
  作者們指出,兩組導入時機(4-6個月vs 10個月)的差異不大,可能因這個時間差異太短而無法在過敏反應顯示出對比。在LEAP試驗中,在 4-11個月大時將花生導入介入組對象,對照組則是在5歲時。不過,研究者指出,他們正試著複製在大約10個月大時導入雞蛋的普遍做法。而且,稍早的一篇研究顯示,等到10個月之後,與蛋過敏的風險比較高有關。
  
  資料來源:http://www.24drs.com/
  
  Native link:Early Egg Introduction Does Not Lower Allergy Risk

Early Egg Introduction Does Not Lower Allergy Risk

By Norra MacReady
Medscape Medical News

Regular egg consumption starting at 4 to 6 months of age does not change the risk for egg allergy at 1 year of age or older, compared with delayed introduction of eggs, the authors of a new study report.

However, some of the findings, which come from the Starting Time of Egg Protein (STEP) randomized, double-blind trial, do hint at a possible benefit of early egg introduction, they point out.

STEP participants had no allergic symptoms at the time of enrollment, although they had a hereditary risk for allergies, Debra J. Palmer, PhD, from the School of Paediatrics and Child Health, The University of Western Australia in Crawley, and colleagues write. This distinguishes STEP from studies such as the Learning Early About Peanut Allergy (LEAP) trial, for which an existing allergic disease, such as eczema, was a prerequisite. In LEAP, early and sustained consumption of peanut products was associated with a significant decrease in the incidence of peanut allergy.

"We found no evidence that regular egg intake from 4 to 6.5 months of age substantially alters the risk of egg allergy by 1 year of age, in infants who are at hereditary risk of allergic disease and had no eczema symptoms at study entry," the authors conclude. "There is no need for routine testing of infants without eczema in the community to determine egg sensitization status prior to the introduction of egg and egg-containing foods when solids are introduced."

The study was published online August 21 in the Journal of Allergy and Clinical Immunology.

Children were enrolled in STEP between the ages of 4 and 6.5 months. Their mothers had atopy, but the children themselves had no eczema or allergic illness and no previous consumption of egg. They were randomly assigned to receive an intervention (egg) or control (no egg) powder that was mixed into their food. The two preparations were similar in color, smell, texture, and taste and were administered once a day from the time of randomization until the children were 10 months of age. At 10 months of age, parents introduced cooked egg into the diets of all children in both trial groups.

Of the 820 original participants, 748 had the skin prick test and egg challenge at the 12-month examination. IgE-mediated egg allergy was diagnosed in 26 of 371 (7%) children in the intervention group and 39 of 377 (10.3%) in the control group.

The relative risk, adjusted for city, infant sex, breast-feeding status, and paternal history of allergic disease (aRR), was 0.75 (95% confidence interval [CI], 0.48 - 1.17; adjusted P = .20). But while "the sample size was sufficient to rule out large increases in egg allergy risk…we cannot rule out potentially important benefits," the authors write.

Sensitization to egg was observed in 10.8% of the children in the egg group vs 15.1% of the controls (aRR, 0.77; 95% CI, 0.54 - 1.10; P = .15). Between randomization and 1 year of age, eczema occurred in 10.7% of the children in the egg group and 11.9% of the controls (aRR, 0.84; 95% CI, 0.57 - 1.23; P = .37).

Two infants in the egg group and one in the control group developed anaphylaxis in response to the raw egg challenge at 12 months. However, there were no anaphylactic responses to the egg powder used in the study. In addition, of all 65 infants in either group who had an allergic response to raw egg challenges, 60 were consuming baked or cooked eggs with no problems. "This highlights a key public health message: that egg introduction at 4-6.5 months of age for infants without eczema is safe to do so at home without the need for prior egg sensitization testing."

In a per-protocol analysis, 9 of 305 infants in the egg group (3%) and 31 of 312 infants in the control group (9.9%) had IgE-mediated egg allergy at 12 months of age (aRR, 0.32; 95% CI, 0.16 - 0.65; P = .002). However, more children in the egg group than the control group were excluded from the per-protocol analysis because of a perceived adverse reaction (P = .02) or a confirmed allergic reaction (P = .0004) to the study powder.

The authors note that the small difference in the timing of introduction between the two groups (4 to 6 months vs 10 months) may have been too short to show a contrast in allergic response. In the LEAP trial, peanuts were introduced to the intervention group at 4 to 11 months of age, compared with 5 years of age for the control group. However, the researchers note they were trying to reproduce the common practice of introducing eggs at about 10 months of age. Also, an earlier study showed that waiting until after 10 months of age was associated with a higher risk for egg allergy.

The authors have disclosed no relevant financial relationships.

J Allergy Clin Immunol. Published online August 21, 2016.

    
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