背景:肠道微生物群的免疫调节受到生态失调的影响,可能先于食物过敏发作。先前的研究缺乏按年龄和临床表型分层的比较。
目的:主要目的是评估食物过敏儿童的微生物组(<3岁,3-18岁)与没有食物过敏的类似年龄的儿童相比。
方法:2014-2019年进行的一项真实世界前瞻性横断面研究招募了极有可能喝牛奶的儿童,鸡蛋或花生过敏由病史和血清IgE定义或通过食物挑战证实。16S核糖体RNA测序鉴定粪便微生物DNA。比较了食物过敏组和按年龄分层的健康对照组之间的α和β多样性。非先验类群的差异丰度在绝对倍数变化>2和q值<0.05时被接受。
结果:纳入70例患者(56例食物过敏;14例健康对照)。各组在年龄上没有显着差异,出生时的性别,种族,交货方式,母乳喂养持续时间,或抗生素暴露。与对照组相比,年轻的食物过敏儿童具有相似的α多样性。β多样性因年龄而异(p=0.001)。仅在年龄较小的儿童中,几种先验(p<0.05)分类群(包括梭菌)的丰度存在差异。两者都是先验的(包括球菌,梭菌属)和非先验(q<0.05)酸性细菌_Gp15,Aestuariispira,Tindallia和Desulfitispora在年龄较大的食物过敏儿童中很重要,尤其是花生过敏.
结论:菌群失调与食物过敏有关,在花生过敏的大龄儿童中最突出。有和没有食物过敏的年幼儿童在肠道微生物区系上的差异较小。这与花生过敏持续的临床观察相关,并提高了口服免疫疗法对低龄儿童的疗效和安全性。开始治疗干预时应考虑3岁以下。
BACKGROUND: Immune regulation by gut microbiota is affected by dysbiosis and may precede food allergy onset. Prior studies lacked comparisons stratified by age and clinical phenotype.
OBJECTIVE: To assess the microbiome of children with food allergy (<3 years, 3-18 years) compared with similar aged children without food allergy.
METHODS: A real-world prospective cross-sectional study performed from 2014 to 2019 recruited children highly likely to have milk, egg, or peanut allergy defined by history and serum IgE or confirmed by food challenge. 16S ribosomal RNA sequencing identified stool microbial DNA. Alpha and beta diversity was compared between groups with food allergy and healthy controls stratified by age. Differential abundance for non a priori taxa was accepted at absolute fold-change greater than 2 and q value less than 0.05.
RESULTS: A total of 70 patients were included (56 with food allergy and 14 healthy controls). Groups were not significantly different in age, gender at birth, race, mode of delivery, breastfeeding duration, or antibiotic exposure. Younger children with food allergy had similar alpha diversity compared with controls. Beta diversity was significantly different by age (P = .001). There was differential abundance of several a priori (P < .05) taxa (including Clostridia) only in younger children. Both a priori (including Coprococcus and Clostridia) and non a priori (q < 0.05) Acidobacteria_Gp15, Aestuariispira, Tindallia, and Desulfitispora were significant in older children with food allergy, especially with peanut allergy.
CONCLUSIONS: Dysbiosis associates with food allergy, most prominent in older children with peanut allergy. Younger children with and without food allergy have fewer differences in gut microbiota. This correlates with clinical observations of persistence of peanut allergy and improved efficacy and safety of oral immunotherapy in younger children. Age younger than 3 years should be considered when initiating therapeutic interventions.