早期花生导入预防过敏：儿科实践中的证据和实际实施
Early Peanut Introduction for Allergy Prevention: Evidence and Practical Implementation in Pediatric Practice.
摘要(中文译文)
花生过敏是儿童中最常见且可能危及生命的食物过敏之一。它常常持续至成年期，并给受累家庭带来沉重负担，包括饮食上的高度警惕、社交限制以及持续存在的过敏性休克风险。多年来，临床指南建议在婴儿期推迟引入致敏性食物，其假设是限制早期暴露可降低致敏及随后发生过敏的风险。然而，不断积累的流行病学观察和严格的临床试验数据已从根本上逆转了这一范式，证明在婴儿期的关键窗口期内早期经口暴露于花生蛋白可促进免疫耐受而非致敏。本叙述性综述综合了支持这一范式转变的关键证据，从促成相关研究的流行病学观察开始，并以具有里程碑意义的“早期了解花生过敏”（Learning Early About Peanut Allergy）随机对照试验为核心，该试验证明在高风险婴儿中，从婴儿早期至幼儿期规律摄入花生可显著降低花生过敏的相对风险。本综述还审视了至青春期的长期随访数据，证实了这种保护效应的持久性，以及“询问耐受性”（Enquiring About Tolerance）试验和汇总分析的支持性证据，并阐述了早期经口诱导耐受的生物学原理。最后，本综述提供了与国立过敏与感染性疾病研究所、美国儿科学会及其他主要医学组织现行建议相一致的可操作、按风险分层的指导，涉及临床实施策略、安全性考量以及在常规儿科诊疗中推广应用的障碍。
Abstract
Peanut allergy is one of the most common and potentially life-threatening food allergies in children. It frequently persists into adulthood and imposes significant burdens on affected families, including dietary vigilance, social restrictions, and the constant risk of anaphylaxis. For many years, clinical guidelines recommended delaying the introduction of allergenic foods during infancy, based on the assumption that limiting early exposure would reduce the risk of sensitization and subsequent development of allergy. However, accumulating epidemiological observations and rigorous clinical trial data have fundamentally reversed this paradigm, demonstrating that early oral exposure to peanut protein during a critical window in infancy promotes immune tolerance rather than sensitization. This narrative review synthesizes the key evidence underpinning this paradigm shift, beginning with the epidemiological observations that prompted investigation and centering on the landmark Learning Early About Peanut Allergy randomized controlled trial, which demonstrated a substantial relative risk reduction in peanut allergy among high-risk infants who consumed peanut regularly during early infancy through early childhood. The review also examines long-term follow-up data through adolescence confirming the durability of this protective effect, supporting evidence from the Enquiring About Tolerance trial and pooled analyses, and the biological rationale for early oral tolerance induction. Finally, it provides practical, risk-stratified guidance aligned with current recommendations from the National Institute of Allergy and Infectious Diseases, the American Academy of Pediatrics, and other major medical organizations, addressing clinical implementation strategies, safety considerations, and barriers to adoption in routine pediatric care.
如何引用
AMA
Delete Ebere-Bank, Kenneth Soyemi, Rosibell Arcia-Diaz. Early Peanut Introduction for Allergy Prevention: Evidence and Practical Implementation in Pediatric Practice.. Cureus. 2026; doi:10.7759/cureus.111378.
APA
Delete Ebere-Bank, Kenneth Soyemi, Rosibell Arcia-Diaz (2026). Early Peanut Introduction for Allergy Prevention: Evidence and Practical Implementation in Pediatric Practice.. Cureus. https://doi.org/10.7759/cureus.111378
GB/T 7714
Delete Ebere-Bank, Kenneth Soyemi, Rosibell Arcia-Diaz. Early Peanut Introduction for Allergy Prevention: Evidence and Practical Implementation in Pediatric Practice.[J]. Cureus, 2026 doi:10.7759/cureus.111378.
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