■在过去的几年里,研究表明,大多数鸡蛋过敏儿童耐受烤鸡蛋(例如,cake),吃烤鸡蛋会加速鸡蛋过敏的解决。然而,很少有前瞻性研究表明,在培养烤蛋耐受性后,在家中逐步重新引入鸡蛋。虽然这可能对儿童的生活质量和营养产生积极影响。此外,支持理论概念的研究是有限的,在有或没有小麦的情况下加热会导致鸡蛋蛋白的致敏性降低。
■为了研究在家中烤鸡蛋耐受儿童中逐步诱导鸡蛋耐受的临床上最有利的持续时间,关于完整的生鸡蛋耐受性。
■12个月以上的耐烤蛋儿童被随机分配到短臂或长臂方案。在短手臂上,与长臂30个月相比,研究了18个月的卵耐受性诱导。孩子们被引导通过这个协议,包括逐步引入越来越多的过敏形式的鸡蛋,从作为蛋糕提供的烤鸡蛋开始,接着是煮熟的鸡蛋,煎蛋卷/华夫饼/煎饼,煮鸡蛋,最后是生鸡蛋。我们在此基于在存在或不存在小麦的情况下热加工对鸡蛋蛋白的影响来设计此协议,通过ELISA研究,SDS-PAGE,和免疫印迹。在纳入时,儿童要么通过医院蛋糕挑战,要么有卵粘骨sIgE≤1.2kUA/L,这在家里被认为是安全的。
■凝胶电泳显示卵清蛋白带随着加热变弱,而卵类粘胶带保持稳定。InAccording,IgE与卵清蛋白的结合随着大量加热而降低,与卵粘虫相反。然而,在小麦存在下加热导致IgE对卵类粘蛋白的反应性降低。在意向治疗组的78名儿童中,39人随机分配到每个手臂。58名儿童达到了生鸡蛋耐受终点,其中80%在短臂,69%在长臂。在短手臂内,长臂产卵耐受的中位时间为24个月(95%CI,21-27个月),而长臂产卵耐受的中位时间为30个月(95%CI,28-32个月)(p=0.005).未观察到IV级反应或嗜酸性粒细胞性食管炎病例。短臂被认为不低于长臂。
■我们的渐进短臂协议似乎是安全的,并允许临床医生引导烤鸡蛋耐受儿童在家中对生鸡蛋耐受。鸡蛋蛋白的致敏性受加热温度和持续时间的影响,以及小麦的存在。
UNASSIGNED: Over the last few years, studies have shown that the majority of egg allergic children tolerate baked egg (e.g., cake), and that consuming baked egg accelerates the resolution of egg allergy. However, few prospective studies demonstrate the step-wise reintroduction of egg at home after developing baked egg tolerance. Although this could have a positive impact on the children\'s quality of life and nutrition. Additionally, research supporting the theoretical concept that heating in the presence or absence of wheat causes reduced allergenicity of egg proteins is limited.
UNASSIGNED: To investigate the clinically most favorable duration of gradual egg-tolerance induction in baked egg tolerant children at home, with regard to complete raw egg tolerance.
UNASSIGNED: Baked egg tolerant children above 12 months of age were randomly assigned to a short- or long arm protocol. In the short arm, egg-tolerance induction was studied over 18 months compared to 30 months in the long arm. Children were guided through this protocol involving the step-wise introduction of increasingly allergenic forms of egg starting with baked egg offered as cake, followed by hard-boiled egg, omelet/waffle/pancake, soft-boiled egg, and finally raw egg. We hereby designed this protocol based on the influence of thermal processing in the presence or absence of wheat on egg proteins, as investigated by ELISA, SDS-PAGE, and immunoblotting. At inclusion, children either passed an in-hospital cake challenge or had ovomucoid sIgE ≤1.2 kUA/L, which was considered safe for introduction at home.
UNASSIGNED: Gel electrophoresis revealed that the ovalbumin band became weaker with heating, while the ovomucoid band remained stable. In accordance, the IgE-binding to ovalbumin decreased with extensive heating, as opposed to ovomucoid. However, heating in the presence of wheat led to a decreased IgE reactivity to ovomucoid. Of the 78 children in the intention-to-treat group, 39 were randomized to each arm. Fifty-eight children reached the raw egg tolerance endpoint, of which 80% were in the short arm and 69% in the long arm. Within the short arm, the median time to raw egg tolerance was 24 months (95% CI, 21-27 months) compared to 30 months (95% CI, 28-32 months) in the long arm (p = 0.005). No grade IV reactions or cases of eosinophilic esophagitis were observed. The short arm was considered to be non-inferior to the long arm.
UNASSIGNED: Our gradual short arm protocol appears to be safe and allows clinicians to guide baked egg tolerant children toward raw egg tolerance at home. The allergenicity of the egg proteins was affected by heating temperature and duration, as well as the presence of wheat.