在儿科三级保健中心的开放式食品挑战期间使用紧急备用资源

Samantha M. Knox, J. Bjelac, Wei Liu, B. Schroer
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摘要

背景:口腔食物激发(OFC)仍然是食物过敏的标准诊断程序。尽管对OFCs的需求有所增加,但由于不良事件的风险和缺乏备用资源,一些过敏专科医生可能不会执行OFCs。目的:本研究旨在阐明在三级儿科医院使用应急备用资源和报告各种挑战结果的反应频率。方法:我们回顾性分析了2013 - 2018年在克利夫兰诊所儿童医院完成OFCs的儿童和年轻人(年龄,0 - 21岁)。收集和分析人口统计、特应性史、罪魁祸首食物、反应史、诊断测试以及挑战细节和结果。结果:共回顾了812例5个月至21岁的独特患者的1269例挑战。超过一半的挑战是在挑战前有反应史和阳性检测结果的患者中进行的。过敏结果比例最高的食物是鸡蛋、芝麻和烤鸡蛋。当使用食物诱发的过敏反应分级量表时,超过三分之一的攻击反应为3级或4级过敏反应。在所有挑战中,有7.2%的反应使用肾上腺素。对五个挑战的反应(0.4%)促使使用备用应急资源。结论:在对近1300例OFCs的审查中,尽管有很大比例的中度至重度反应,但很少使用应急备用资源。在食物挑战期间对备用资源的需求是罕见的,这表明大多数典型的过敏办公室都能够治疗OFC反应。
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Use of emergency backup resources during open food challenges at a pediatric tertiary care center
Background: Oral food challenge (OFC) remains the criterion standard diagnostic procedure for food allergy. Although the need for OFCs has increased, some allergists may not perform them due to the risk for adverse events and lack of backup resources. Objective: The study aimed to elucidate the frequency of reactions in which emergency backup resources were used and reported on various challenge outcomes at a tertiary pediatric hospital. Methods: We retrospectively reviewed children and young adults (ages, 0‐21 years) who completed OFCs in 2013‐2018 at Cleveland Clinic Children’s Hospital. Demographics, atopic history, culprit food, reaction history, and diagnostic testing as well as challenge details and outcomes were collected and analyzed. Results: A total of 1269 challenges of 812 unique patients ages 5 months to 21 years were reviewed. More than half of challenges were performed in patients with a history of a reaction and positive testing result before challenge. The foods with the highest proportion of allergic outcomes were egg, sesame, and baked egg. More than one-third of challenge reactions were grade 3 or 4 anaphylaxis when using a food-induced anaphylaxis grading scale. Epinephrine was used for reactions in 7.2% of all challenges. Reactions in five challenges (0.4%) prompted utilization of backup emergency resources. Conclusion: On review of nearly 1300 OFCs, emergency backup resources were rarely used, despite a large proportion of moderate-to-severe reactions. The need for backup resources during food challenges is rare, which suggests that most typical allergy offices are able to treat OFC reactions.
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