柳叶刀子刊:这种免疫治疗,有望解决食物过敏症
2017/08/22
近日,发表在《柳叶刀》子刊上的一篇研究发现:把少剂量的花生粉掺入一种高剂量鼠李糖乳杆菌的口服免疫治疗(PPOIT)能够使80%以上的儿童可以随便吃含花生的食物而不过敏。经过持续四年的观察,这些儿童中有70%不会对花生过敏。据悉,这种免疫疗法在患者中产生了耐受性,从而允许他们在某些情况下长时间吃花生后不会产生过敏反应。

全球2.5亿过敏人群,90%死亡由花生导致

近几十年来,食物过敏急剧上升,花生过敏是最致命的疾病之一。据统计,全球过敏人数在近20年上升了3倍,高达2.5亿人群。中国食物过敏患者中也有约4%为花生过敏。

世界范围内每20名儿童中有一人对食物过敏,而成年人中食物过敏的比例为50:1,主要过敏原除花生外还包括海鲜、牛奶及蛋类等,其中因食物过敏引发的死亡中有90%都是由花生导致的。

花生是常见的食物过敏原,一些人食用花生后会引起极其严重的过敏症,例如出现血压降低、面部和喉咙肿胀等症状,这些都会阻碍呼吸,甚至导致休克。花生过敏常在儿童时期引发,并伴随终生。

为使更多人不再受花生“折磨”,墨尔本默多克儿童研究中心(Murdoch Childrens Research Institute in Melbourne)的研究人员将益生菌与花生蛋白相结合,开发出一种名为“益生菌和花生口服免疫治疗(PPOIT)”的疗法。

口服免疫治疗,效果持续4年

近日,发表在《柳叶刀》子刊The Lancet Child& Adolescent Health杂志上的一项研究揭示了墨尔本默多克儿童研究中心在治疗花生过敏症上所取得的研究成果。


据悉这个团队在8年前开始相关研究,最终有56名对花生过敏的儿童完成了为期18个月的临床试验治疗,其中一半人群采用安慰剂疗法,另一半人群采用益生菌免疫疗法(把少剂量的花生粉,掺入一种高剂量的鼠李糖乳杆菌的益生菌当中),并在随后的治疗中逐渐加大花生剂量。试验期间他们不接触任何其它益生菌和花生制品。18个月疗程结束后,所有儿童参与了随机双盲的食物过敏测试。结果发现:在2013年实验结束时,采用益生菌免疫疗法的儿童中有80%以上可以随便吃含花生的食物而不过敏。经过持续4年的观察,这些儿童中仍有70%不会对花生过敏。

研究中所用的鼠李糖乳杆菌(L.rhamnosus),从属于乳杆菌属,是人体正常菌群之一,肠道黏着率高,定植能力强,并具有高效降胆固醇,促进细胞分裂,可起到调节肠道菌群、预防和治疗腹泻、排除毒素、预防龋齿、提高机体免疫力及抗癌等重要的生理保健功能。

有望治疗其它食物过敏症

墨尔本默多克儿童研究所的首席研究员Mimi Tang教授表示,有一半的孩子经常吃花生,而有些孩子很少吃花生。这一发现的重要性在于,能够使对花生过敏的孩子向普通孩子一样吃花生,并且仍然保持他们的耐受状态。这种益生菌和花生混合口服免疫治疗可有效诱导长期的耐受性,使得治愈花生过敏已成为可能。这意味着,未来可通过增加耐受性来治疗食物过敏,有望治疗其它食物引起的过敏症。

目前,默多克儿童研究中心正计划与风险投资公司合作开发相关药物,以期为全球对花生过敏的人提供治疗。Mimi Tang教授的研究团队为这一人群带来了福音,不过她也表示,距离正式推出相关治疗药物还需时日,团队下一步将选取200名儿童参与扩大实验,以进一步验证疗效。

如同其他的临床前研究,尽管已被证实的不错疗效,但还必须扩大实验范围以进一步确认,在正式被批准用于老百姓身上还需数年的时间。

小贴士:什么时候摄入花生是安全的?

怀孕期间摄入花生是安全的;

如果没有过敏或湿疹家族史,6个月后可以添加花生酱和其他碾碎的坚果;

如果父母中有过敏高风险,应该咨询医生;

儿童食用花生等坚果时,应在父母的正确引导下;

任何五岁以下的孩子应该多吃坚果。

参考资料:

Peanut allergy treatment 'lasts up to four years'

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  • Long-term clinical and immunological effects of probiotic and peanut oral immunotherapy after treatment cessation: 4-year follow-up of a randomised, double-blind, placebo-controlled trial

    Background Oral immunotherapy has attracted much interest as a potential treatment for food allergy, yet little is known about its long-term effects. We aimed to assess long-term outcomes in participants who completed a randomised, double-blind, placebo-controlled trial of combined probiotic and peanut oral immunotherapy (PPOIT), which was previously shown to induce desensitisation and 2-week sustained unresponsiveness. Methods All participants who completed the PPOIT randomised trial were eligible to participate in this follow-up study 4 years after treatment cessation. Peanut intake and adverse reactions to peanut in the 4 years after treatment cessation were systematically documented with a structured questionnaire administered by allergy nurses. Additionally, participants were invited to undergo peanut skin prick tests, measurement of peanut sIgE and sIgG4 concentrations, and double-blind placebo-controlled peanut challenge to assess 8-week sustained unresponsiveness. Findings 48 (86%) of 56 eligible participants were enrolled in the follow-up study. Mean time since stopping treatment was 4·2 years in both PPOIT (SD 0·6) and placebo (SD 0·7) participants. Participants from the PPOIT group were significantly more likely than those from the placebo group to have continued eating peanut (16 [67%] of 24 vs one [4%] of 24; absolute difference 63% [95% CI 42–83], p=0·001; number needed to treat 1·6 [95% CI 1·2–2·4]). Four PPOIT-treated participants and six placebo participants reported allergic reactions to peanut after intentional or accidental intake since stopping treatment, but none had anaphylaxis. PPOIT-treated participants had smaller wheals in peanut skin prick test (mean 8·1 mm [SD 7·7] vs 13·3 mm [7·6]; absolute difference −5·2 mm [95% CI −10·3 to 0·0]; age-adjusted and sex-adjusted p=0·035) and significantly higher peanut sIgG4:sIgE ratios than placebo participants (geometric mean 67·3 [95% CI 10·3–440·0] vs 5·2 [1·2–21·8]; p=0·031). Seven (58%) of 12 participants from the PPOIT group attained 8-week sustained unresponsiveness, compared with one (7%) of 15 participants from the placebo group (absolute difference 52% [95% CI 21–82), p=0·012; number needed to treat 1·9 [95% CI 1·2–4·8]). Interpretation PPOIT provides long-lasting clinical benefit and persistent suppression of the allergic immune response to peanut. Funding Murdoch Childrens Research Institute and Australian Food Allergy Foundation.

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