BACKGROUND: Increasing data suggest that analysis of IgE to peanut components can be clinically helpful and possibly more accurate than IgE to whole peanut. Not all studies examining this topic, however, have used prospective samples, multiple components, and peanut challenges. OBJECTIVE: We sought to determine the utility of peanut component testing, using a standardized, commercially available test done before oral peanut challenge in various populations of patients with suspected peanut allergy from 2 different countries. METHODS: IgE to whole peanut and the recombinant allergen components Ara h 1, 2, 3, and 8 were analyzed from serum samples drawn before double-blind peanut challenge from 4 distinct cohorts of patients with suspected peanut allergy from 2 nations (United States and Sweden). RESULTS: Patients (n = 167; median age, 11.7 years; interquartile range, 7.0-15.0 years) had serum analyzed for peanut components and completed an oral food challenge to peanut. Although IgE to peanut was the most sensitive test (0.93), Ara h 2 was the most specific (0.92) and provided the best positive predictive value (0.94) of all the tests. Ara h 2 was also the best overall diagnostic test by receiver operating characteristic analysis (area under the curve, 0.84; P < .05). CONCLUSIONS: In patients with suspected peanut allergy, IgE to peanut is a sensitive test but is not specific. IgE to Ara h 2 is a more specific and more accurate diagnostic test in this sampling of patients with suspected peanut allergy. Given each tests attributes, a stepwise approach to testing may provide clinicians with a way to minimize the need for peanut challenges.
BACKGROUND: Increasing data suggest that analysis of IgE to peanut components can be clinically helpful and possibly more accurate than IgE to whole peanut. Not all studies examining this topic, however, have used prospective samples, multiple components, and peanut challenges. OBJECTIVE: We sought to determine the utility of peanut component testing, using a standardized, commercially available test done before oral peanut challenge in various populations of patients with suspected peanutallergy from 2 different countries. METHODS: IgE to whole peanut and the recombinant allergen components Ara h 1, 2, 3, and 8 were analyzed from serum samples drawn before double-blind peanut challenge from 4 distinct cohorts of patients with suspected peanutallergy from 2 nations (United States and Sweden). RESULTS:Patients (n = 167; median age, 11.7 years; interquartile range, 7.0-15.0 years) had serum analyzed for peanut components and completed an oral food challenge to peanut. Although IgE to peanut was the most sensitive test (0.93), Ara h 2 was the most specific (0.92) and provided the best positive predictive value (0.94) of all the tests. Ara h 2 was also the best overall diagnostic test by receiver operating characteristic analysis (area under the curve, 0.84; P < .05). CONCLUSIONS: In patients with suspected peanutallergy, IgE to peanut is a sensitive test but is not specific. IgE to Ara h 2 is a more specific and more accurate diagnostic test in this sampling of patients with suspected peanutallergy. Given each tests attributes, a stepwise approach to testing may provide clinicians with a way to minimize the need for peanut challenges.
Keywords:
Anaphylaxis; Ara h 1; Ara h 2; Ara h 3; Ara h 8; Food allergy; IQR; Interquartile range; OFC; Oral food challenge; Peanut allergy; Peanut sensitization; ROC; Receiver operating characteristic; SPT; Skin prick test
Authors: Anna Pomés; Maksymilian Chruszcz; Alla Gustchina; Wladek Minor; Geoffrey A Mueller; Lars C Pedersen; Alexander Wlodawer; Martin D Chapman Journal: J Allergy Clin Immunol Date: 2015-07 Impact factor: 10.793
Authors: Pamela A Frischmeyer-Guerrerio; Marjohn Rasooly; Wenjuan Gu; Samara Levin; Rekha D Jhamnani; Joshua D Milner; Kelly Stone; Anthony L Guerrerio; Joseph Jones; Magnus P Borres; Erica Brittain Journal: Ann Allergy Asthma Immunol Date: 2019-01-10 Impact factor: 6.347
Authors: Carolyn Word; Erin Klaffky; Christina Ortiz; Thamiris Palacios; Shawn Pelletier; Walter Oliveira; Barbara Greb; Lisa Workman; Thomas Platts-Mills; Julia Wisniewski Journal: J Allergy Clin Immunol Pract Date: 2015-04-22