Clinical value of component‐resolved diagnostics in peanut‐allergic patients

Introduction As replacement for the oral food challenge, decision‐points for sensitization test have been established, but suboptimal sensitivity and/or specificity, as well as regional differences, have reduced the clinical usability. IgE toward specific peanut protein components has been reported...

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Veröffentlicht in:Allergy (Copenhagen) Jg. 68; H. 2; S. 190 - 194
Hauptverfasser: Eller, E., Bindslev‐Jensen, C.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Denmark Blackwell Publishing Ltd 01.02.2013
Schlagworte:
Adolescent
Adult
Allergens
Antigens, Plant - immunology
Ara h 2
Ara h 2 antigen
Arachis - immunology
Arachis hypogaea
Case-Control Studies
Child
Child, Preschool
Confidence Intervals
Diagnostic tests
diagnostic values
Female
Food allergies
Humans
Immune Tolerance - physiology
Immunization
Immunoglobulin E - immunology
Immunoglobulins
Infant
Male
peanut
Peanut Hypersensitivity - diagnosis
Peanut Hypersensitivity - immunology
Peanuts
Reference Values
Retrospective Studies
sensitization
Severity of Illness Index
Statistics, Nonparametric
Young Adult
ISSN:0105-4538, 1398-9995, 1398-9995
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Zusammenfassung:Introduction As replacement for the oral food challenge, decision‐points for sensitization test have been established, but suboptimal sensitivity and/or specificity, as well as regional differences, have reduced the clinical usability. IgE toward specific peanut protein components has been reported to be of value, but data on correlation with clinical data are sparse. Our aim was to correlate IgE values with the outcome of peanut challenges. Method Data from 175 positive and 30 negative peanut challenges in patients aged 1–26 years were retrospectively correlated with the levels of specific IgE to peanut and peanut components (Ara h 1–3, h 8, and h 9). Result The best correlation between IgE and clinical thresholds was found for Ara h 2 (ρs = −0.30, P < 0.01). A cutoff of Ara h 2 > 1.63 kU/l yielded a specificity = 1.00, with a corresponding sensitivity of 0.70. Symptom severity elicited during challenge correlated significantly with the levels of Ara h 2 (ρs = 0.60, P < 0.0001), but large individual variation was found. Conclusion The level of IgE toward Ara h 2 can improve diagnostic accuracy by introducing a more clear‐cut decision‐point with an optimal specificity maintaining a high sensitivity. In our study, this would have reduced the necessary number of challenges to be performed from 205 to 92. Extrapolation between centers is difficult and decision‐points need to be addressed in relation to settings and population. Further component‐resolved diagnostic cannot replace oral challenge neither in determining thresholds nor in the assessment of severity of symptoms elicited during challenge.
Bibliographie:Edited by: Antonella Muraro
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ISSN:0105-4538
1398-9995
1398-9995
DOI:10.1111/all.12075