IgE介导食物过敏儿童达到开放性口服食物激发试验确认耐受时间的临床和免疫学决定因素：一项回顾性队列研究

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中文摘要

背景： 儿童IgE介导食物过敏中耐受获得的时间在临床上很重要，但相比作为二分类结局的持续存在，其研究较少。我们检查了开放性口服食物激发试验（OFC）确认耐受时间的临床和免疫学决定因素。
方法： 这项回顾性队列研究纳入了2023年1月至2026年7月期间在一家三级儿科过敏诊所评估的157名医生确诊的IgE介导食物过敏儿童。时间零点定义为开始排除饮食；耐受仅由成功的监督下开放性OFC定义。每名儿童被分配一种互斥的索引过敏原，并一致用于定义至耐受时间结局。使用Kaplan-Meier分析和参数加速失效时间模型。选择对数逻辑模型，并针对索引过敏原和预先指定的临床及免疫学协变量进行调整，用于多变量分析，并使用1,000次自助重抽样进行内部验证。
结果： 157名儿童中，120名达到OFC确认的耐受，37名被右删失。互斥索引过敏原分布为鸡蛋（n=103）、牛奶（n=35）、树坚果（n=16）、其他食物（n=2）和鱼（n=1）。在索引过敏原调整的对数逻辑AFT模型中，食物诱导的过敏反应（调整TR 2.13，95% CI 1.34-3.36；P=0.001）、过敏性鼻炎（调整TR 1.80，95% CI 1.26-2.55；P=0.001）以及总IgE每增加10倍（调整TR 1.54，95% CI 1.20-1.98；P<0.001）与更长的至耐受时间相关。树坚果索引过敏也比鸡蛋与更长的至耐受时间相关（调整TR 2.74，95% CI 1.19-6.29；P=0.018），尽管该估计基于少数耐受事件。
结论： 既往食物诱导的过敏反应、过敏性鼻炎、较高的总IgE和索引食物类型与IgE介导食物过敏儿童开放性OFC确认耐受的时间相关。常规定量IgG、IgA和IgM测量与耐受时间无独立关联。

英文摘要

BACKGROUND: The timing of tolerance acquisition in childhood IgE-mediated food allergy is clinically important but has been less well studied than persistence as a binary outcome. We examined clinical and immunological determinants of time to open oral food challenge (OFC)-confirmed tolerance.
METHODS: This retrospective cohort study included 157 children with physician-established IgE-mediated food allergy evaluated at a tertiary pediatric allergy clinic between January 2023 and July 2026. Time zero was defined as elimination-diet initiation; tolerance was defined exclusively by a successful supervised open OFC. One mutually exclusive index allergen was assigned to each child and used consistently to define the time-to-tolerance outcome. Kaplan-Meier analysis and parametric accelerated failure time models were used. The log-logistic model, adjusted for index allergen and the prespecified clinical and immunological covariates, was selected for multivariable analysis and internally validated using 1,000 bootstrap resamples.
RESULTS: Of 157 children, 120 achieved OFC-confirmed tolerance and 37 were right-censored. The mutually exclusive index-allergen distribution was hen's egg (n=103), cow's milk (n=35), tree nut (n=16), other food (n=2), and fish (n=1). In the index-allergen-adjusted log-logistic AFT model, food-induced anaphylaxis (adjusted TR 2.13, 95% CI 1.34-3.36; P=0.001), allergic rhinitis (adjusted TR 1.80, 95% CI 1.26-2.55; P=0.001), and each 10-fold increase in total IgE (adjusted TR 1.54, 95% CI 1.20-1.98; P<0.001) were associated with a longer time to tolerance. Tree-nut index allergy was also associated with longer time to tolerance than hen's egg (adjusted TR 2.74, 95% CI 1.19-6.29; P=0.018), although this estimate was based on few tolerance events.
CONCLUSIONS: Previous food-induced anaphylaxis, allergic rhinitis, higher total IgE, and index food type were associated with the timing of open OFC-confirmed tolerance in children with IgE-mediated food allergy. Routine quantitative IgG, IgA, and IgM measures were not independently associated with tolerance timing.