益生菌治疗儿童食物过敏
益生菌治疗儿童食物过敏
Probiotics as treatment for food allergies among pediatric patients: a meta-analysis
Tan-Lim et al. World Allergy Organization Journal (2018)
DOI 10.1186/s40413-018-0204-5
食物过敏被定义为“因特定免疫反应而产生的不良健康影响，该免疫反应在暴露于特定食物后可重复发生”。食物过敏原是个人免疫系统识别的特定食物成分，导致典型过敏症状发生。过敏反应包括胃肠道症状、皮肤症状和呼吸道症状。胃肠道症状包括呕吐、进食障碍、反流、腹痛、吞咽困难、腹泻、生长停滞和血便。皮肤症状包括荨麻疹、血管性水肿、潮红、瘙痒和湿疹。呼吸症状包括喘息、呼吸困难、鼻塞、打喷嚏和流鼻涕。
世界范围内食物过敏的患病率正在上升，全球患病率接近10%。不同年龄段和地理位置，食物过敏的流行病学表现不同。与成人相比，儿童的食物过敏率更高。贝类过敏在亚洲国家更常见，而花生过敏在西方国家更常见。其他常见的食物过敏原包括牛奶、鸡蛋和小麦。
虽然食物过敏会加重负担，还可能有致命的风险，但是目前仍然无法治愈。目前治疗的标准是避免接触过敏原，针对症状进行治疗。对于牛奶过敏（CMA）的患者，只能通过使用水解蛋白配方或基于氨基酸的配方，但完全消除食物过敏原往往是困难的。
益生菌被认为可有效治疗和预防食物过敏。据推测，益生菌可引起局部巨噬细胞的活化、局部和系统性IgA的产生、以及促炎和抗炎细胞因子谱的改变，进而调节机体对食物抗原反应。常用的益生菌菌株有鼠李糖乳杆菌（Lactobacillus rhamnosus）、罗伊氏乳杆菌（Lactobacillus reuteri）、双歧杆菌属（Bifidobacteria spp）、干酪乳杆菌（Bifidobacteria spp）、嗜酸乳杆菌（Lactobacillus acidophilus）、凝固剂芽孢杆菌（Bacillus coagulans）、大肠杆菌（Escherichia coli）nissle 1917菌株、粪链球菌（Enterococcus faecium）SF68和布拉迪酵母菌（Saccharomyces boulardi）。
尽管一些研究表明，益生菌有望用于食物过敏治疗，但证据仍然矛盾且不确定。大多数系统综述集中在益生菌对食物过敏的预防作用。本文旨在综合现有证据，评价益生菌对儿科患者食物过敏的治疗作用。
ABSTRACT
Background: RhiThe burden of disease of food allergy is increasing worldwide. The standard of management is allergen avoidance and symptomatic treatment. Probiotics have been proposed to be beneficial for treatment and prevention of food allergy.
Objective: To determine the effectiveness of probiotic administration in treating food allergies among pediatric patients.
Methods: A systematic search of electronic medical literature databases was conducted. Manual search of the reference lists and search for unpublished articles were also done. All randomized controlled trials available from inception until February 19, 2018 were retrieved. The primary outcome of interest was relief of allergic symptoms, while the secondary outcome of interest was inducement of tolerance. Two independent authors did the search, screening, appraisal, and data abstraction. Data analysis and synthesis were done using RevMan 5.3 software. Subgroup analysis was done based on the probiotic strains and time periods in measuring the outcome. Exclusion sensitivity analysis was also done.
Results: Nine trials involving 895 pediatric patients with cow’s milk allergy (CMA) were included in the review. The primary outcome of interest, relief of symptoms, was measured using the scoring index for eczema. Pooled results from two studies showed larger reduction in the scoring index among patients given probiotics, but this effect was imprecise (MD -1.30, 95% CI -3.88, 1.28). For the secondary outcome of interest, pooled results from four studies showed benefit of probiotics in inducing tolerance, but again this result is imprecise with significant heterogeneity (RR=0.58, 95% CI 0.34, 1.00). Subgroup analysis per probiotic strain showed benefit of Lactobacillus rhamnosus GG in inducing tolerance based on two studies involving infants with suspected cow’s milk allergy (RR = 0.41, 95% CI 0.28 to 0.62). Another subgroup analysis showed a duration-dependent effect associated with probiotic usage, with inducement of tolerance noted after at least 2 years (RR = 0.44, 95% CI 0.29 to 0.67).
Conclusion: Analysis of available evidence shows moderate certainty that the use of probiotics can relieve symptoms of children with cow’s milk allergy. The reduction in certainty is due to imprecise results. Moreover, there is low certainty that probiotics can induce tolerance among children with cow’s milk allergy, due to problems of imprecision and attrition bias. In the subgroup analysis, Lactobacillus rhamnosusGG administration likely results in inducing tolerance among infants with suspected cow’s milk allergy. Only studies on CMA were analyzed since no studies were found on probiotics as treatment for other types of food allergy among children.
关键词：食物过敏、牛奶过敏、益生菌、儿科
研究对象：9个试验共涉及895名牛奶过敏（CMA）的儿童
研究方法：
检索了2018年2月19日之前的所有随机对照试验。
研究对象为任何食物过敏的儿科患者，如牛奶过敏、鸡蛋过敏、花生过敏、鱼类过敏、贝类过敏、小麦过敏、大豆过敏。
食物过敏的诊断是通过双盲安慰剂对照食物试验来证实的。
主要结局指标为敏症状的缓解，通过特应性皮炎指数（SCORAD指数）来评估。次要结局指标为诱导耐受。
研究结果：
主要结局指标分析显示：服用益生菌的患者的特应性皮炎指数指数下降幅度更大，但这种影响并不精确（MD -1.30，95% CI -3.88，1.28）。
次要结局指标分析显示：益生菌有助于诱导耐受性，但这一结果同样不精确，具有显著的异质性（RR=0.58，95%CI 0.34-1.00）。
每种益生菌菌株的亚组分析表明，根据两项关于牛奶过敏婴儿的研究，我们发现鼠李糖乳杆菌GG有助于诱导耐受性（RR=0.41，95%CI 0.28至0.62）。
时间依赖性亚组分析显示：使用益生菌可能存在时间依赖性效应，服用益生菌至少2年可出显著增加食物过敏儿童的耐受性（RR=0.44，95% CI 0.29-0.67）。
研究结论：使用益生菌可以减轻牛奶过敏儿童的症状，该结论具有中度确定性。在亚组分析中，鼠李糖乳杆菌GG可能导致牛奶过敏的婴儿产生耐受性。
Fig. 4 Effect of probiotics compared to placebo on the mean SCORAD index
图4.与安慰剂组相比益生菌组对SCORAD指数的影响
Fig. 5 Effect of probiotics compared to placebo on failure to acquire tolerance
图5.与安慰剂组相比益生菌组对未获得耐受性的影响
知几未来研究院正在搭建一个“疾病-肠道菌群”知识库。
你可以在公众号对话框回复“IBD”或“肠易激综合征”，查看与疾病相关的菌群；
也可以回复“双歧杆菌”或“Hp”，查看与细菌相关的疾病。
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