2023年，來自另一項 研究的進一步數據建議將預防措施推廣至 所有嬰兒 [5]。與僅針對患有嚴重濕疹的高風險嬰兒能帶來 的 4.6%些微減少相比，將範圍擴大到所有嬰兒能將花生 過敏的患病率降低77%。研究還指出措拖成效會隨孩子年 齡增長而減低。這些結果或許能解釋以色列兒童的花生過 敏率比英國低十倍的原因，因為以色列家長會餵嬰兒進食 大量含花生的零食 [6]。這促使英國國民保健署（National Health Service / NHS）建議從六個月起及在嬰兒能進食固 體食物後，就應在其膳食中加入磨碎的花生或花生醬 [7, 8]。 花生過敏研究上的突破還促使一種新型藥物 Palforzia 的發展，這種藥物的對象是已被診斷為花生過敏的年輕患 者。該藥物針對四至 17歲的患者，於2020 年1 月獲美國 食品藥物管理局（US Food and Drug Administration / FDA）批准使用 [9]。Palforzia是含有花生過敏原的粉末， 可混入流質食物進食 [10]。透過逐漸增加劑量直至找到上 限，患者對花生蛋白的接受程度亦會漸漸增加，使其能接受 少量花生。在增加劑量的階段完結後，患者需要每天服用維 持劑量以維持療程效力。然而這一點，加上高昂的費用和療 程首六個月每兩週就需要就診一次的要求成為了Palforzia 未能普及的原因，尤其在推出後不久就爆發了新冠疫情，令銷 情雪上加霜。這些缺點最終導致 Palforzia 銷情慘淡，因此故 事告訴我們醫學上的突破未必等於商業上的成功 [10, 11]！ 花生過敏的研究帶出了科學的暫時性 — 當新證據出現 時，科學理論就會隨之變化。因此，保持開放和與時並進的心 態至關重要。在你分享這篇文章給花生過敏者前，請確保他 們明瞭任何新療法都應在專業醫療人員的密切監督下進行。 References 參考資料： [1] Whitsel, R. M, Bjelac, J. A., Subramanian, A., Hoyt, A. E. W., & Hong, S. J. (2021). Cleveland Clinic Journal of Medicine, 88(2), 104–109. https://doi.org/10.3949/ ccjm.88a.20130 [2] Al-Ahmed, N., Alsowaidi, S., & Vadas, P. (2008). Allergy, Asthma & Clinical Immunology, 4(4), 139–143. https://doi. org/10.1186/1710-1492-4-4-139 [3] Du Toit, G., Roberts, G., Sayre, P. H., Bahnson, H. T., Radulovic, S., Santos, A. F., Brough, H. A., Phippard, D., Basting, M., Feeney, M., Turcanu, V., Sever, M. L., Gomez Lorenzo, M., Plaut, M., Lack, G., & LEAP Study Team (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. The New England Journal of Medicine, 372(9), 803–813. https://doi.org/10.1056/NEJMoa1414850 [4] Togias, A., Cooper, S. F., Acebal, M. L., Assa'ad, A., Baker, J. R., Jr., Beck, L. A., Block, J., Byrd-Bredbenner, C., Chan, E. S., Eichenfield, L. F., Fleischer, D. M., Fuchs, G. J., III, Furuta, G. T., Greenhawt, M. J., Gupta, R. S., Habich, M., Jones, S. M., Keaton, K., Muraro, A., … Boyce, J. A. (2017). Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. Journal of allergy and clinical immunology, 139(1), 29–44. https://doi.org/10.1016/j.jaci.2016.10.010 [5] Roberts, G., Bahnson, H. T., Du Toit, G., O'Rourke, C., Sever, M. L., Brittain, E., Plaut, M., & Lack, G. (2023). Defining the window of opportunity and target populations to prevent peanut allergy. Journal of Allergy and Clinical Immunology, 151(5), 1329–1336. https://doi.org/10.1016/ j.jaci.2022.09.042 [6] Du Toit, G., Katz, Y., Sasieni, P., Mesher, D., Maleki, S. J., Fisher, H. R., Fox, A. T., Turcanu, V., Amir, T., ZadikMnuhin, G., Cohen, A., Livne, I., & Lack, G. (2008). Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. Journal of Allergy and Clinical Immunology, 122(5), 984–991. https://doi. org/10.1016/j.jaci.2008.08.039 [7] Gallagher, J. (2023, March 17). Give babies peanut butter to cut allergy by 77%, study says. BBC News. https://www.bbc.com/news/health-64987074 [8] National Health Service. (2021, November 5). Food allergies in babies and young children. https://www. nhs.uk/conditions/baby/weaning-and-feeding/foodallergies-in-babies-and-young-children/ [9] U.S. Food and Drug Administration. (2020, January 31). FDA approves first drug for treatment of peanut allergy for children. https://www.fda.gov/news-events/pressannouncements/fda-approves-first-drug-treatmentpeanut-allergy-children [10] Aimmune Therapeutics. (2022). Palforzia Treatment Handbook. https://www.palforzia.com/sites/default/ files/2022-10/treatment_handbook.pdf [11] Halpert, W. (2022, December 3). Peanut allergies: Parents worry after Palforzia drug sales flop. BBC News. https:// www.bbc.com/news/world-us-canada-63788730 [12] Speed, M. (2023, September 4). Nestlé sells peanut allergy business after insufficient demand. Financial Times. https://www.ft.com/content/436756c9-80c5-499abddf-e7f56defe844
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