給嬰兒吃花生制品能預(yù)防花生過(guò)敏

Feeding Infants Peanut Products Could Prevent Allergies, Study Suggests

給嬰兒吃花生制品能預(yù)防花生過(guò)敏

Turning what was once conventional wisdom on its head, a new study suggests that many, if not most peanut allergies can be prevented by feeding young children food containing peanuts beginning in infancy, rather than avoiding such foods.

與傳統(tǒng)觀念相反，一項(xiàng)新研究表明，與其完全避免花生，如果從嬰兒時(shí)期便開始食用含有花生的食物，反而可以防止很多——甚至大多數(shù)——花生過(guò)敏。

About 2 percent of American children are allergic to peanuts, a figure that has more than quadrupled since 1997 for reasons that are not entirely clear. There have also been big increases in other Western countries. For some people, even traces of peanuts can be life-threatening.

約2%的美國(guó)兒童對(duì)花生過(guò)敏，這個(gè)數(shù)字比1997年增長(zhǎng)了四倍多，原因不甚明確。其他西方國(guó)家的花生過(guò)敏癥也大量增多。對(duì)有些人來(lái)說(shuō)，攝入微量花生都可能致命。

An editorial published Monday in The New England Journal of Medicine, along with the study, called the results “so compelling” and the rise of peanut allergies “so alarming” that guidelines for how to feed infants at risk of peanut allergies should be revised soon.

周一，《新英格蘭醫(yī)學(xué)雜志》(The New England Journal of Medicine)發(fā)表了這項(xiàng)研究和一篇社論。社論稱，這些研究結(jié)果“十分令人信服”，花生過(guò)敏的增多“特別令人擔(dān)憂”，所以關(guān)于應(yīng)該如何喂養(yǎng)有花生過(guò)敏風(fēng)險(xiǎn)的嬰兒的指導(dǎo)準(zhǔn)則應(yīng)該立即修正。

The study “clearly indicates that the early introduction of peanut dramatically decreases the risk of development of peanut allergy,” said the editorial, by Dr. Rebecca S. Gruchalla of the University of Texas Southwestern Medical Center and Dr. Hugh A. Sampson of the Icahn School of Medicine at Mount Sinai in New York City. It also “makes it clear that we can do something now to reverse the increasing prevalence of peanut allergy.”

社論稱，這項(xiàng)研究“清楚表明，幼兒期攝入花生能極大降低患花生過(guò)敏癥的風(fēng)險(xiǎn)”。社論作者是得克薩斯大學(xué)西南醫(yī)學(xué)中心的麗貝卡·S·格魯查拉博士 (Rebecca S. Gruchalla)和紐約市芒特西奈伊坎醫(yī)學(xué)院的休·A·桑普森博士(Hugh A. Sampson)。社論稱，這項(xiàng)研究還“清楚表明，現(xiàn)在我們可以行動(dòng)起來(lái)，逆轉(zhuǎn)花生過(guò)敏的增長(zhǎng)趨勢(shì)”。

In the study, conducted in London, infants 4 to 11 months old who were deemed at high risk of developing a peanut allergy were randomly assigned either to be regularly fed food that contained peanuts or to be denied such food. These feeding patterns continued until the children were 5 years old. Those who consumed the foods that had peanuts in them were far less likely to be allergic to peanuts when they turned 5.

這項(xiàng)研究在倫敦進(jìn)行，研究者在有花生過(guò)敏高風(fēng)險(xiǎn)的4至11個(gè)月嬰兒中進(jìn)行隨機(jī)分配，其中一些定期喂食含花生的食物，其余的不喂食這種食物。這種喂養(yǎng)模式一直持續(xù)到孩子五歲。那些食用含花生食物的孩子到五歲時(shí)對(duì)花生過(guò)敏的比率大為減少。

Dr. Gideon Lack, a professor of pediatric allergy at King’s College London and the leader of the study, said the common practice of withholding peanuts from babies “could have been in part responsible for the rise in peanut allergies we have seen.”

這項(xiàng)研究的帶頭人、倫敦大學(xué)國(guó)王學(xué)院的兒科過(guò)敏教授吉迪恩·拉克博士(Gideon Lack)說(shuō)，不讓嬰兒吃花生的這種常見做法“可能是花生過(guò)敏癥增多的一個(gè)原因”。

Whether infants should be fed peanuts and other foods associated with allergies is one of the most common questions parents ask about introducing solid foods to their children, said Dr. Ruchi Gupta, associate professor of pediatrics at Northwestern University, who was not involved in the study. “And until now most of what we can say is there’s not very conclusive data.”

美國(guó)西北大學(xué)兒科學(xué)副教授魯奇· 古普塔博士(Ruchi Gupta，她沒有參與這項(xiàng)研究)說(shuō)，嬰兒是否應(yīng)該吃花生或其他與過(guò)敏癥相關(guān)的食物是父母在給孩子添加固體食物時(shí)經(jīng)常詢問(wèn)的一個(gè)問(wèn)題，“直到現(xiàn)在，我們能說(shuō)的大致上還是，還沒有非常確定的數(shù)據(jù)”。

The American Academy of Pediatrics, in guidelines released in 2000, recommended that peanuts be withheld from children at risk of developing allergies until they were 3 years old.

美國(guó)兒科學(xué)會(huì)在2000年發(fā)布的指導(dǎo)準(zhǔn)則中建議，為了防范過(guò)敏，三歲前不要給孩子吃花生。

In 2008, the academy revised its stance, saying there was no conclusive evidence that avoidance of certain foods beyond 4 to 6 months of age helped stave off allergies, but stopped short of recommending that parents give their young children such foods.

2008年，該學(xué)會(huì)改變了立場(chǎng)，稱沒有明確證據(jù)證明，在四至六個(gè)月年齡段后不食用某些食物能幫助防止過(guò)敏，但是也沒有建議父母給幼兒喂食這種食物。

“There was no study showing that that was the right thing to do,” said Dr. Wesley Burks, chairman of pediatrics at the University of North Carolina, who was not involved in the new research. Now, with the new study, he said, there is such evidence.

“當(dāng)時(shí)沒有任何研究表明，在幼兒時(shí)期喂食含花生的食物是正確的，”北卡羅來(lái)納大學(xué)兒科學(xué)主任韋斯利·伯克斯博士(Wesley Burks，他沒有參與這項(xiàng)新研究)說(shuō)。他說(shuō)，現(xiàn)在這項(xiàng)新研究提供了證據(jù)。

The results of the study were presented on Monday at the annual meeting of the American Academy of Allergy, Asthma and Immunology in Houston.

周一，這項(xiàng)研究的結(jié)果在休斯頓的美國(guó)過(guò)敏、哮喘和免疫學(xué)會(huì)(American Academy of Allergy, Asthma and Immunology)年度大會(huì)上公布。

Pediatricians caution that parents should not feed whole peanuts to infants because of the choking risk, but rather peanut butter or other foods.

兒科醫(yī)生警告父母?jìng)儾灰o嬰兒喂整顆花生，因?yàn)橛兄舷L(fēng)險(xiǎn)，而要喂花生醬或其他花生制品。

Dr. Lack said he first began to question the conventional wisdom about 15 years ago when he gave a talk in Tel Aviv and asked doctors in the audience how many had patients with peanut allergy. Only three hands went up. “In the U.K., if you had asked that question, every single member of the audience would have put up their hand,” he said.

拉克說(shuō)，他第一次質(zhì)疑傳統(tǒng)觀點(diǎn)是在約15年前，當(dāng)時(shí)他在特拉維夫作報(bào)告，他問(wèn)聽眾中的醫(yī)生有多少遇到過(guò)花生過(guò)敏癥病人。只有三個(gè)人舉手。“在英國(guó)，如果你問(wèn)那個(gè)問(wèn)題，所有聽眾都會(huì)舉手，”他說(shuō)。

So Dr. Lack and colleagues conducted a survey, published in 2008, that found the rate of peanut allergy in Israeli children was only about one-tenth that of Jewish children in Britain. The best explanation, they concluded, was that Israeli infants consumed high amount of peanut protein in the first year of life while parents in Britain avoided giving such foods.

所以，拉克和同事們進(jìn)行了一項(xiàng)調(diào)查，調(diào)查結(jié)果于2008年發(fā)表。他們發(fā)現(xiàn)，以色列兒童的花生過(guò)敏癥比率只有英國(guó)猶太兒童的約十分之一。他們推斷，最可能的原因是，以色列嬰兒在頭一年中攝入了大量花生蛋白質(zhì)，而英國(guó)父母不給嬰兒吃這種食物。

Some other studies have also found that earlier feeding of allergy-inducing foods was associated with lower allergy rates. But such observational studies are not definitive because there could be unexplored factors that account for the differences.

其他一些研究也發(fā)現(xiàn)，在幼兒期喂食致敏食物與過(guò)敏癥比率較低有關(guān)。但是這樣的觀察性研究不具有確定性，因?yàn)檫@種差異可能是其他未知因素造成的。

The new study, by contrast, was a randomized trial in which the only difference between two groups of children was whether they were fed peanut protein. The study, sponsored by the National Institutes of Health and other organizations in the United States and Britain, involved infants 4 to 11 months old deemed to have a high risk of peanut allergy because they already had severe eczema or were allergic to eggs.

相比之下，這項(xiàng)新研究是隨機(jī)試驗(yàn)，這兩組兒童之間的唯一區(qū)別是是否食用花生蛋白質(zhì)。這項(xiàng)研究由美國(guó)國(guó)家衛(wèi)生研究院以及美國(guó)和英國(guó)的其他一些組織贊助。研究對(duì)象是有花生過(guò)敏高風(fēng)險(xiǎn)的4至11個(gè)月大的嬰兒，因?yàn)樗麄円呀?jīng)出現(xiàn)嚴(yán)重濕疹或者對(duì)雞蛋過(guò)敏。

The infants were given skin-prick tests for peanut allergy. Those already allergic to peanuts were excluded from the study.

研究者對(duì)這些嬰兒進(jìn)行了花生過(guò)敏皮試。那些已經(jīng)對(duì)花生過(guò)敏的嬰兒被排除在研究之外。

Some 530 children were did not have peanut allergy on that initial test. Parents of half of them were told to avoid peanuts. The other half were told to feed their children at least six grams of peanut protein per week, the equivalent of about 24 peanuts, spread over three or more meals. The preferred food was Bamba, an Israeli snack made of puffed corn and peanut butter.

約有530名嬰兒在初次皮試中沒有出現(xiàn)花生過(guò)敏。研究者要求其中一半嬰兒的父母不要給孩子喂食花生制品，要求另一半父母每周至少給孩子喂食六克花生蛋白質(zhì)，大約相當(dāng)于24顆花生，分散在三餐(或更多頓)中食用。研究者推薦的食物是Bamba，它是一種用爆米花和花生醬做成的以色列零食。

The children were given another allergy test when they turned 5. Only 1.9 percent of those who were fed peanuts were allergic to them, compared with 13.7 percent of the children in the group that avoided peanuts.

這些孩子長(zhǎng)到五歲時(shí)，又進(jìn)行了一次過(guò)敏測(cè)試。吃花生的嬰兒中只有1.9%對(duì)花生過(guò)敏，而不吃花生的那組中有13.7%對(duì)花生過(guò)敏。

An additional 98 infants had a weakly positive test when the study began, suggesting they were on their way to developing a full-fledged allergy. Among those children, only 10.6 percent of those fed food containing peanuts developed that allergy by age 5, far less than the 35.3 percent rate for children whose parents avoided feeding them peanuts.

另有98名嬰兒在初次皮試中表現(xiàn)為弱陽(yáng)性，說(shuō)明他們正在向全面過(guò)敏癥發(fā)展。在這些孩子中，食用含花生食物的孩子只有10.6%在五歲時(shí)出現(xiàn)花生過(guò)敏癥，這個(gè)比率遠(yuǎn)遠(yuǎn)低于不吃含花生食物的孩子，后者的比率是35.3%。

“You got a definitive outcome, which I think is a very important thing,” said Dr. James R. Baker Jr., chief executive of FARE, or Food Allergy Research and Education, an advocacy group that helped pay for the study.

“我們得到了確定的結(jié)果，我覺得這很重要，”食物過(guò)敏研究和教育組織(Food Allergy Research and Education)的負(fù)責(zé)人小詹姆斯·R·貝克博士(Dr. James R. Baker Jr.)說(shuō)。該組織是資助這項(xiàng)研究的一個(gè)倡議組織。

There are some caveats. Parents knew which group they were in. And the study was done at a single site in London with 75 percent white children. However, the results were the same for the small number of children of other ethnic groups in the study, the researchers said.

其他需要說(shuō)明的情況是：父母?jìng)冎雷约涸谀膫€(gè)組。這項(xiàng)研究是在倫敦的單個(gè)地方進(jìn)行的，其中75%是白人兒童。不過(guò)，研究者說(shuō)，這項(xiàng)研究中的其他少量族群的結(jié)果也是一樣的。

Moreover, it is still unknown whether allergies might yet develop if the regular feeding of peanuts stopped. To test this, the children in the study were taken off peanuts after they turned 5 and are being followed for a year.

另外，目前仍不明確的是，如果常規(guī)的花生喂養(yǎng)中斷，是否仍會(huì)發(fā)展成過(guò)敏癥。為了測(cè)試這一點(diǎn)，這項(xiàng)研究中的孩子們五歲后中止食用花生，繼續(xù)觀察了一年。

It is also unknown if the same strategy would work with other foods or for children not considered at a high risk of getting a peanut allergy. Some pediatricians said that if feeding peanut foods to children at risk was beneficial, there would be no reason to withhold such food from children not prone to allergies.

還有一點(diǎn)不確定的是，同樣的策略是否適用于其他致敏食物或沒有花生過(guò)敏高風(fēng)險(xiǎn)的兒童。有些兒科醫(yī)生說(shuō)，如果給有風(fēng)險(xiǎn)的孩子喂食花生制品是有益的，那么沒理由不給不易過(guò)敏的兒童吃這些食物。