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缓解过敏的营养策略:益生菌、蛋白酶、槲皮素

时间:2021-03-30 10:07 阅读:365 来源:朴诺健康研究院

另可见: 低过敏原饮食

  1. 简介 

  2. 一览表 

  3. 症状 

  4. 治疗 

  5. 相关情况 

  6. 饮食习惯的改变

  7. 生活方式的改变

  8. 营养添加剂

  9. 草药 

  10. 整体疗法 

  11. 参考文献 


“过敏”是免疫系统对特殊食物、吸入剂 (空气中的物质)、或化学制品的反应。通常人们用“过敏” 和“敏感性” 意指同一件事,但是其实很多敏感性事件并不是真正的过敏。术语“ 敏感性” 使用普遍,包括真正的过敏、不影响免疫系统的反应(因此不是学术上所说的过敏)以及未确定起因的反应。

一些非过敏型敏感症叫做不耐受,可能是由毒素、酶的缺乏,、类药物化学反应,、心理作用以及其他机制所引起。乳糖不耐受和苯丙酮尿症是理解不耐受的很好例子。术语“环境敏感性”或“不耐受”有时用于对户内或户外的食物、水、药物、化妆用品、香水、纺织品、建筑材料和塑料等化学物质的反应。要查出过敏和其它敏感性,然后避免或减少暴露于这些敏感性源,这是一项费时和富有挑战性的任务,如果没有专家的协助是很难完成的。


过敏反应的辅助疗法

分类营养添加剂草药
次选

益生菌 (食物过敏)

胸腺提取物


其它

盐酸甜菜碱(食物过敏)

酶 (食物过敏)

类黄酮

槲皮素


另可见:过敏和敏感性的同类疗法
首选 可靠的科研数据一致证明其对健康状况有显著改善者。

次选 相关的科研结果相互矛盾、证据不充分或仅能初步表明其可改善健康状况或效果甚微者。

其它 对于草药来说,传统用法可支持其应用,但尚无或仅有少量科学证据可证明其疗效。对营养添加剂来说,尚无科学证据支持或效果甚微。


过敏的症状

普通的症状包括痒、含泪眼、喷嚏、头痛、疲劳、鼻后滴漏;流涕、嗅觉减退、鼻痒;咽喉痛;黑眼圈;口腔和咽喉发痒;腹痛;腹泻;痒同时有红色皮疹。致命的过敏并不常见,这类过敏常见于花生、坚果、贝类和一些药物。当发生致命的过敏反应时,始发症状常为呼吸困难和吞咽困难。



药物治疗

用于敏感性或过敏的非处方药物包括:抗组胺类药,如:苯海拉明(diphenhydramine)(苯海拉明Benadryl),氯雷他定( loratadine) (克拉霉素Claritin),和氯苯那敏(chlorpheniramine) (氯代屈米通Chlor-Trimeton);减充血剂伪麻黄碱( pseudoephedrine )(Sudafed);局部鼻粘膜充血消除药如羟甲唑啉(Oxymetazoline) (安福能Afrin);以及去氧肾上腺素  (Neo-Synephrine)。这些非处方药可自己使用数天而罕见毒副作用。以生理盐水为溶剂的鼻腔喷雾剂如:Ocean, Ayr, 和Dristan Saline Spray 可用于缓解过敏引起的组织炎症。鼻内溶剂色甘酸钠(cromolyn sodium) (Nasalcrom)可用于预防过敏发作。

用于敏感性或过敏的处方药包括:抗组胺类,如:非索非那定(fexofenadine)(Allegra), 西替利嗪(cetirizine) (Zyrtec), 和地氯雷他定(desloratadine) (Clarinex); 支气管扩张剂,如:沙丁胺醇(albuterol)(舒喘宁Proventil, 喘乐宁Ventolin); 鼻内用皮质激素(corticosteroids), 如:氟地松(fluticasone)(丙酸氟替卡松Flonase),曲安西龙(triamcinolone )(Nasacort AQ), 莫米松(mometasone) (Nasonex), 和氟尼缩松(flunisolide)(Nasalide); 以及每周进行一次过敏原注射法 (脱敏免疫疗法)。有过严重过敏的患者应该携带肾上腺素(epinephrine)(EpiPen?)的自动肌肉注射器,以便在过敏反应发作时注射。

有过敏或敏感性的人应避免接触特殊过敏原,比如草木的花粉、尘螨、霉菌、特殊食物、胶乳这些环境或家庭中的刺激物。有过严重反应的人应携带医疗警示标签标明过敏原。


与过敏相关的状况

根据《食物过敏原理》一书的作者J. C. Breneman博士的理论,很多健康状况与过敏有关,并且已经成为独立的研究课题。尽管如此,医生需要有目的性的考虑健康状况和过敏之间的可能关系。在下面的文章中可以得到有关特定健康情况和过敏之间关系以及其他敏感性的更多信息。

  1. 关节炎(风湿样)[3 ,4 ,5 ,6 ,7]

  2. 哮喘[8, 9, 10]

  3. 注意力缺乏-亢进紊乱[11, 12, 13] 

  4. 膀胱感染 (泌尿道感染)[14, 15, 16] 

  5. 念珠菌病(阴道)[17 ,18] 

  6. 足部溃疡[19 ,20 ,21, 22] 

  7. 腹腔疾病[23, 24 ,25 ,26, 27]

  8. 急腹痛[28, 29 ,30, 31 ,32]

  9. 便秘[33, 34 ,35] 

  10. 克隆氏病[36] 

  11. 抑郁[37, 38] 

  12. 腹泻[39] 

  13. 耳部感染 (复发的)[40 ,41, 42] 

  14. 湿疹(包括特异反应性皮炎)[43, 44, 45, 46 ,47 ]

  15. 胆囊炎发作[48] 

  16. 胃食管返流症 (GERD)[49 ,50, 51, 52 ,53, 54 ,55 ,56] 

  17. 青光眼[57, 58]

  18. 花粉症[59, 60 ,61] 

  19. 高血压[62] 

  20. 荨麻疹[63 ,64, 65 ,66 ,67 ,68, 69] 

  21. 低血糖[70] 

  22. 感染[71, 72 ,73 ,74, 75, 76] 

  23. 肠应激综合症 (IBS)[77 ,78] 

  24. 偏头痛[79 ,80, 81, 82] 

  25. 味精敏感[83 ,84, 85] 

  26. 肥胖[86] 

  27. 银屑病[87] 

  28. 鼻窦炎[88, 89, 90 ,91, 92] 

  29. 鼻窦充血[93 ,94 ,95, 96] 

  30. 十二指肠溃疡 [97 ,98] 


以下的情况也可能与过敏和其他敏感性有关:

尿床(夜间遗尿症)

如果出现非已知医学原因引起的尿床,就应该考虑过敏。几位研究者已经报道了过敏是引起尿床的一个重要原因。[99 ,100]

周期性呕吐综合征

对食物尤其是牛奶过敏,可能在周期性呕吐综合症中起作用,此病症的呕吐以反复、不可预测、突发且难以解释为特征。

胃肠道症状

一些不特异的胃肠道症状(如腹痛、腹胀、排气和腹泻),如果不是由于严重的疾病引起,也需考虑是否食物敏感性触发。在一项双盲试验中,给那些被认为存在牛奶引起的不特异胃肠问题的人饮用牛奶,观察他们的身体反应的情况[103] 。这些人并非乳糖不耐受。不同的免疫指标随牛奶的激发而改变,这显示他们的身体以一种不寻常的方式对牛奶起反应。然而,这些人当中,绝大多数人的真正牛奶过敏指标是正常的。这项研究指出与严重疾病无关的不特异胃肠症状可由食物敏感性引起,这些食物敏感性既不反映乳糖不耐受也不反映真正的过敏。

IgA肾病(自身免疫性肾病)

在一个小型初步试验中,患IgA肾病的人坚持14至23周食用低变应原食物(大米、橄榄油、火鸡、兔肉、羊肉、青菜、土豆、梨、苹果、盐和水)。肾功能的参数明显改善,所有参与者在保持这种饮食的情况下肾病均未复发。

婴儿的多食物蛋白不耐受(MFPI)

研究发现对一种食物不耐受的婴儿很多同时对其他一些食物蛋白也不耐受,包括大豆和广泛的水溶蛋白。最近称这种综合征为婴儿多食物蛋白不耐受(MFPI)。作为一个组,这些婴儿趋向于出现严重的急腹痛、胃食管返流和食管炎(反复发作的胃酸返流刺激食管引起食管发的炎症)这些症状,或是异位性皮炎(湿疹)。高达30%的婴儿出现了这些症状,但是并不清楚他们中有多少患此综合征。

多化学物质敏感症

多化学物质敏感症亦称原发性环境不耐受,是一种了解甚少又具争议的慢性疾病,患此病的人可能有多种复发症状,人们认为这些症状源于人体对环境中少量物质的反应。[106, 107, 108]虽然避免接触这些物质通常很困难,有报道显示此法至少可以部分缓解症状,还有报道显示心理咨询是有用的。[110]

肌肉骨骼痛(包括背痛)

据报道,吞食变应原食物可引起易感人群的多种肌肉骨骼痛症状。

肾病综合征

一些研究发现了肾病综合征(一种肾脏疾病)和过敏之间的联系。在一项研究中,肾病综合症患者在进食去除过敏原的食物时出现反应;[112] 反而,在另一项研究中,患者并不出现反应。[113]

肠漏综合征

食物的过敏与小肠的通透性增加有关,也可说成是与小肠的“泄漏程度”有关。[114, 115]一些替代医学开业医生认为这种通透性增加,有时称其为“肠漏综合征”,是食物过敏可以治疗的重要原因。然而,反过来也是可能的。肠道的过敏反应趋向于引起通透性的暂时增加,[116, 117]这可以解释两者的表象联系。要更好的了解小肠通透性在食物过敏的发展及治疗中的作用还需要更多的研究。


可能有益的饮食习惯

低过敏原食谱,也称为剔除食谱或低变应原食谱。常向那些怀疑有食物过敏的人推荐这种食谱,通过此法来观察避免接触这些常能引起过敏的食物能否起到缓解症状的作用。[118]这个食谱剔除了被认为是常见过敏原的食物以及食物添加剂,诸如小麦、牛奶及奶制品、蛋类、玉米、大豆、柑橘属水果、坚果类、花生、西红柿、食用色素和防腐剂、咖啡以及巧克力。部分通俗读物为愿意尝试此种饮食的人提供了指导。[119 ,120] 然而低过敏原食谱并不是食物过敏患者的治疗方法,更恰当的说,它是用于发现患者致敏食物的诊断手段。该剔除食谱必须被坚持直至导致过敏反应的某种或某些食物被确认,或者该食物可确定与患者的过敏无关。一旦食物过敏反应被确认,那些致敏食物随即被排除,所有其他之前食用过的食物再次被添加进食谱。关于低过敏原食谱应当坚持多久的问题,个体化的推荐一般在5天到3周之间,不过很多营养专业的医师相信2周的试验足以满足诊断食物过敏的目的。

严格避免致敏食物一段时间(通常是几个月到几年)有时可导致该食物不再对该患者致敏。[121] 限制的剔除饮食和食物的再引入必须由有资格的医疗专业人员指导实施。


可能有益的生活方式

通常建议有吸入性过敏的人减少普通家庭过敏原的暴露,这些过敏原包括尘土、霉菌和动物皮屑,希望通过这种方式可以减轻症状,即使人们不可能完全避免家庭过敏原。[122]具体的对策包括诸如不使用地毯、经常清洁和使用真空吸尘器、在家庭供暖系统使用特殊空气滤过器、选用低过敏原的床及床上用品,以及限制家养宠物接近寝区等。


可能有益的营养补充剂

益生菌具有改善消化的能力,因此在控制食物过敏中起重要作用,它可以通过帮助肠道控制食物过敏原的吸收,还可以通过(或)改变免疫系统对食物的反应来控制食物过敏。[123, 124, 125]一组研究者报道了应用益生菌成功治疗有食物过敏的婴儿的两项试验:一项婴儿配方中使用乳酸杆菌GG菌的双盲试验,另一项初步试验给予婴儿母亲同种细菌。[126]益生菌还可能在正常肠道菌群失衡引起的非过敏型食物不耐受中发挥重要作用。[127]

Thymomodulin是从牛犊胸腺中提取的特殊制剂。在一项双盲试验中,一组成功地完成了剔除食谱的过敏儿童,每天摄入120毫克 thymomodulin 可抑制皮肤过敏,并可降低这些食物的相关抗体在血液中的水平含量。[128]这些结果证实了早期的一项对照试验中的相似发现。

一种理论指出,过敏由局部未消化的蛋白质触发。蛋白水解酶可以通过进一步将未消化的蛋白质分解成小到不能引起过敏的片断来减少过敏反应症状。[130]人类一些初步的证据支持这一理论。

胃分泌的盐酸也有助于蛋白质的消化,另外,初步研究指出一些发生过敏的人或许不能产生足够的胃酸。[132, 133 ,134]但是,至今没有一项对照试验是研究将酶的补充使用改善消化作为食物免疫反应的一种治疗方法的。

过敏反应的许多作用是由组胺的释放引起的,这正是过敏患者使用抗组胺药疗法的原因。一些天然物质,如维他命C[135 ,136]和黄酮类,[137]包括槲皮素,[138, 139]在试管试验、动物试验和其他初步试验中都显示了抗组胺的作用。但是,还没有研究调查这些物质在人体是否能够特异的减少过敏反应。

有无副作用及药物之间相互作用?

请参考各种补充的副作用及相互作用。


可能有益的草药

阅读上文中所列特殊健康状况中每种情况的草药作用。

有无副作用及药物之间相互作用?

请参考各种草药的副作用及相互作用。


可能有益的整体方法

针灸在治疗有些类型的过敏中可能是有益的。针灸治疗大鼠的试验提供了与糖皮质激素(可的松类似药物)治疗结果相似的抗过敏效果的证据。[140 ,141, 142]一项初步试验发现,经针灸治疗后,过敏症状显著下降。人们发现症状的下降与过敏的试验与测量的下降相一致。症状缓解可保持到治疗后的两个月。[143]其他初步试验同样证实了正性结果。[144]一项对照试验报道,在针灸治疗后,过敏症状减轻,但是结果并无统计学意义。[145]在以后,具有更大数量被试的对照试验或许有助于最终决定过敏是否能用针灸疗法成功治疗。

激发-中和法是过敏测试与治疗中有争论的方法。治疗包括向前层皮肤中注射微小稀释食物、吸入剂,或(在某些情况下)化学制剂。这种方法与医学过敏专家使用的传统脱敏注射不同。虽然存在负双盲试验,初步试验[146]与双盲[148, 149]试验仍然表明激发-中和法治疗过敏或许是有效的。[150]

一些“替代疗法”的专业医生推荐的口服过敏原提取物来治疗过敏是另一种有争论的方法。[151]大多数研究发现,这种方法对室内粉尘过敏有效。[151,152, 153, 154, 155, 156 ,157]并且,试验还发现,此方法对治疗其他过敏也很有效。[158, 159, 160 ,161]

现已有使用每日加量的小剂量真实食物治疗食物过敏的报道,[162]在一项对照试验中14名患者中有12名成功完成了试验计划并且明显对过敏原食物耐受。

所有脱敏方案的实施都需要医疗专家指导完成。同时这些方法没有一项是被明确证实的,一些方法表明有过敏的人或许是可治疗的,并不一定只靠单纯的回避食物及吸入性物质来避免过敏的发生。

可以检测过敏原的试验   

医生通过一些试验或程序来检查过敏原。大部分测试仍有争论。[164]但是一些临床医生(引用如下)认为这些试验中部分有效。

划痕试验

这是最为广泛使用的一种试验。用一根带有部分被测食物、吸入剂或化学制剂的针在病人的皮肤上划一下。过一会儿就可以检查皮肤的反应了。如果有反应,说明过敏原存在。虽然绝大部分过敏专家接受这种试验,但划痕试验的不准确结果的发生率十分高,一些试验将那些不会对物质过敏的人检测为阳性(假阳性),另一些试验将那些存在过敏原的检测为阴性(假阴性)。

RAST/MAST/PRIST/ELISA(和测定免疫球蛋白的其他试验)

放射性免疫吸附试验(RAST)直接测定血液中的特殊食物抗体。很多医生都使用这种方法,并且在某种程度上已证实此法是过敏的可靠指标。[165, 166]但是,RAST并不会帮助诊断非过敏原食物的敏感性,因此出现假阴性的风险很高。为了避免这种问题的发生,出现了很多与RAST相关的替代试验(如:MAST、PRIST和ELISA)。这些改变中有些可以降低假阴性的风险,而另一些在一定程度上和可能增加假阴性率的风险。与食物敏感性相关的很多状况,如偏头痛和肠应激综合征,都明确显示RAST结果和病人真实敏感性的相关性很差。

细胞毒性试验

细胞毒性试验是在显微镜下观察病人血清是否与某种物质反应。此试验存在大量错误且普遍不可信。[167]

临床生态学(激发-中和法;终点滴定法)

这种分支治疗很有争议。本试验是向真皮内注射微量的食物、吸入剂或是(某些情况下)化学制剂的稀释物。基于多种反应,添加稀释剂。这种试验不仅能确定是否存在过敏,还能按照一种稀释度诱导一种反应而另一种稀释度抵消一种反应的理论来进行操作。初步试验显示这种方法具有良好效果,[168, 169]还有一种与之相似的方法是在舌下使用这些稀释物,从而检测过敏。[170]双盲试验没有证实这种方法有效。

消除与再引入

确定食物过敏的最可靠方法就是从病人的饮食中去除可疑食物一段时间,然后再引入这种食物。通常在去除一种食物几天到3周这段时间里,食物过敏引起的症状可能缓解或消失。之后,身体会对这种食物更敏感,因此当食物再次被引入时,症状就更容易复发。这种方法对确定哪种食物是问题食物具有高度的确定性。这项试验需要很大的耐心,和其他的过敏试验相比,在可以监控病人饮食的医生的帮助下,它是最容易执行的。[172]据报道,再引入过敏原食物有时会导致具有特定症状的病人出现危险反应,尤其是哮喘——这也是此法不能在缺乏监督的情况下进行的一个原因。

其他试验

生物电试验仍然很有争议,此法试图测定潜在过敏原进入人体时穴位上的电活动变化。一项初步试验报道EAV(依据Voll的电针疗法)装置,亦称Vega试验,有70.5%的测试结果与RAST试验确定的过敏原相同。另一项初步研究发现,66%的Vaga试验确定的抵消剂量与临床生态学试验测定结果相同。为了更好的评估这些试验技术还需要开展更多的研究。


本文提出了许多问题,这些问题可能会随着新数据的出现而发生变化。 我们建议的营养或治疗方案均不用于确保治愈或预防任何疾病。Piping Rock健康研究院没有对参考资料中包含的数据进行独立验证,并明确声明对文献中的任何错误不承担任何责任。


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