未经评估:牛奶过敏是婴儿中最常见的食物过敏,通常在5岁时就已过时。在某些人中,它持续到童年早期。口服免疫疗法(OIT,口服脱敏,特异性口服耐受诱导)已被提出作为持续IgE介导的牛奶过敏的有希望的治疗策略。我们先前在2010年发表了OIT对牛奶过敏(CMA)的系统评价,作为世界过敏组织(WAO)诊断和针对牛奶过敏(DRACMA)指南的一部分。
UNASSIGNED:为了系统地综合目前可用的关于IgE介导的CMA的OIT的证据,并告知更新的2022WAO指南。
UNASSIGNED:我们搜索了包括PubMed在内的电子数据库,Medline,Embase,Cochrane中央控制试验登记册(CENTRAL),和选定的过敏组织的网站。我们纳入了所有研究,无论原始出版物的语言如何。最后一次搜索是在2021年2月进行的。我们在开放科学框架(10.17605/OSF。IO/AH2DT)。
UNASSIGNED:我们确定了2010年至2021年之间发表的2147项独特记录,包括13项随机试验和109项针对牛奶OIT的观察性研究。我们发现了低确定性的证据表明OIT含有未加热的牛奶,与单独消除饮食相比,在受控环境下(风险比(RR):12.3,95%CI:5.9至26.0;风险差(RD):每100增加25毫升,95%CI11至56)以及意外摄入少量(≥5毫升)牛奶(RR:8.7,95%CI:4.7至16.1;RD:每100增加25毫升,95%CI)的可能性增加。然而,成功的OIT停止后2-8周,只有36%(范围:20%-91%)的患者对牛奶的耐受性仍然存在。OIT增加了过敏反应的频率(比率:60.0,95%CI15至244;比率差异每年每1人多5次过敏反应,95%CI:4至6;中度证据)和肾上腺素使用频率(比率:35.2,95%CI:9至136.5;比率差异每100人年增加268个事件,95%CI:203~333;确定性高)。OIT还增加了胃肠道症状(RR6.9,95%CI1.6-30.9;RD每100多28,CI3至100)和呼吸道症状(RR49.0,95%CI3.12-770.6;RD每100多77,CI62至92)的风险,与单独的避免饮食相比。单臂观察性研究表明,平均6.9%的OIT患者(95%CI:3.8%-10%)发生了嗜酸性粒细胞性食管炎(确定性非常低的证据)。我们发现了1个试验和2个小病例系列的OIT与烤牛奶。
未经评估:适度的确定性证据表明,在IgE介导的CMA患者中,使用未加热牛奶的OIT与能够喝牛奶的可能性增加有关,同时,严重不良反应的风险增加。
UNASSIGNED: Allergy to cow\'s milk is the most common food allergy in infants and it is usually outgrown by 5 years of age. In some individuals it persists beyond early childhood. Oral immunotherapy (OIT, oral desensitization, specific oral tolerance induction) has been proposed as a promising therapeutic strategy for persistent IgE-mediated cow\'s milk allergy. We previously published the systematic review of OIT for cow\'s milk allergy (CMA) in 2010 as part of the World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow\'s Milk Allergy (DRACMA)
Guidelines.
UNASSIGNED: To systematically synthesize the currently available evidence about OIT for IgE-mediated CMA and to inform the updated 2022 WAO
guidelines.
UNASSIGNED: We searched the electronic databases including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the websites of selected allergy organizations. We included all studies irrespective of the language of the original publication. The last search was conducted in February 2021. We registered the protocol on Open Science Framework (10.17605/OSF.IO/AH2DT).
UNASSIGNED: We identified 2147 unique records published between 2010 and 2021, including 13 randomized trials and 109 observational studies addressing cow\'s milk OIT. We found low-certainty evidence that OIT with unheated cow\'s milk, compared to elimination diet alone, increased the likelihood of being able to consume ≥150 ml of cow\'s milk in controlled settings (risk ratio (RR): 12.3, 95% CI: 5.9 to 26.0; risk difference (RD): 25 more per 100, 95% CI 11 to 56) as well as accidently ingest a small amount (≥5 ml) of cow\'s milk (RR: 8.7, 95% CI: 4.7 to 16.1; RD: 25 more per 100, 95% CI 12 to 50). However, 2-8 weeks after discontinuation of a successful OIT, tolerance of cow\'s milk persisted in only 36% (range: 20%-91%) of patients. OIT increased the frequency of anaphylaxis (rate ratio: 60.0, 95% CI 15 to 244; rate difference 5 more anaphylactic reactions per 1 person per year, 95% CI: 4 to 6; moderate evidence) and the frequency of epinephrine use (rate ratio: 35.2, 95% CI: 9 to 136.5; rate difference 268 more events per 100 person-years, 95% CI: 203 to 333; high certainty). OIT also increased the risk of gastrointestinal symptoms (RR 6.9, 95% CI 1.6-30.9; RD 28 more per 100, CI 3 to 100) and respiratory symptoms (RR 49.0, 95% CI 3.12-770.6; RD 77 more per 100, CI 62 to 92), compared with avoidance diet alone. Single-arm observational studies showed that on average 6.9% of OIT patients (95% CI: 3.8%-10%) developed eosinophilic esophagitis (very low certainty evidence). We found 1 trial and 2 small case series of OIT with baked milk.
UNASSIGNED: Moderate certainty evidence shows that OIT with unheated cow\'s milk in patients with IgE-mediated CMA is associated with an increased probability of being able to drink milk and, at the same time, an increased risk of serious adverse effects.