J Brandström1,2, A Nopp3, S G O Johansson3, G Lilja1,2, A-C Sundqvist1,2, M P Borres4,5, C Nilsson1,2. 1. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 2. Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden. 3. Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet, and Hospital, Stockholm, Sweden. 4. Thermo Fisher Scientific, Uppsala, Sweden. 5. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Abstract
BACKGROUND: IgE sensitization to hazelnut is common, especially in birch endemic areas. However, its clinical significance often needs to be confirmed by a food challenge. OBJECTIVE: To evaluate the clinical significance of IgE antibodies to hazelnut components and basophil allergen threshold sensitivity (CD-sens) to hazelnut, in relation to double-blind placebo-controlled food challenge (DBPCFC) in children with a suspected hazelnut allergy. METHODS:Forty children underwent aDBPCFC. CD-sens to hazelnut as well as IgE antibodies to hazelnut and its components Cor a 1, Cor a 8, Cor a 9 and Cor a 14 were analysed. Serum tryptase was measured before, during and after DBPCFC. RESULTS: Eight children had a positive DBPCFC, and all of them had a high CD-sens value to hazelnut. Of the 32 children that passed the DBPCFC, 31 were very low or negative in CD-sens. A positive DBPCFC corresponded with significantly higher CD-sens values (median 8.9, range 3.3-281) compared to children negative in challenge (median 0.05, range 0-34.7, P < 0.0001). Children positive in challenge also had higher levels of IgE-ab to Cor a 9 and Cor a 14 (P < 0.01 and P < 0.001, respectively) compared with those with a negative challenge. In relation to the results from DBPCFC, the sensitivity of CD-sens and IgE-ab to Cor a 14 was excellent (100%) and the specificity was very high (> 97% and > 94%, respectively). Five of the eight patients positive at challenge showed an increase in tryptase > 20% compared to tryptase baseline levels. CONCLUSIONS AND CLINICAL RELEVANCE: CD-sens and component-resolved diagnostics to hazelnut, used separately or in combination, may improve the diagnostic accuracy and safety and reduce overdiagnosis of hazelnut allergy.
RCT Entities:
BACKGROUND: IgE sensitization to hazelnut is common, especially in birch endemic areas. However, its clinical significance often needs to be confirmed by a food challenge. OBJECTIVE: To evaluate the clinical significance of IgE antibodies to hazelnut components and basophil allergen threshold sensitivity (CD-sens) to hazelnut, in relation to double-blind placebo-controlled food challenge (DBPCFC) in children with a suspected hazelnut allergy. METHODS: Forty children underwent a DBPCFC. CD-sens to hazelnut as well as IgE antibodies to hazelnut and its components Cor a 1, Cor a 8, Cor a 9 and Cor a 14 were analysed. Serum tryptase was measured before, during and after DBPCFC. RESULTS: Eight children had a positive DBPCFC, and all of them had a high CD-sens value to hazelnut. Of the 32 children that passed the DBPCFC, 31 were very low or negative in CD-sens. A positive DBPCFC corresponded with significantly higher CD-sens values (median 8.9, range 3.3-281) compared to children negative in challenge (median 0.05, range 0-34.7, P < 0.0001). Children positive in challenge also had higher levels of IgE-ab to Cor a 9 and Cor a 14 (P < 0.01 and P < 0.001, respectively) compared with those with a negative challenge. In relation to the results from DBPCFC, the sensitivity of CD-sens and IgE-ab to Cor a 14 was excellent (100%) and the specificity was very high (> 97% and > 94%, respectively). Five of the eight patients positive at challenge showed an increase in tryptase > 20% compared to tryptase baseline levels. CONCLUSIONS AND CLINICAL RELEVANCE: CD-sens and component-resolved diagnostics to hazelnut, used separately or in combination, may improve the diagnostic accuracy and safety and reduce overdiagnosis of hazelnut allergy.
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Authors: Lucy Duan; Alper Celik; Jennifer A Hoang; Klara Schmidthaler; Delvin So; Xiaojun Yin; Christina M Ditlof; Marta Ponce; Julia E M Upton; Jean-Soo Lee; Lisa Hung; Heimo Breiteneder; Chiara Palladino; Adelle R Atkinson; Vy H D Kim; Alireza Berenjy; Maria Asper; David Hummel; Samantha Wong; Mara Alexanian-Farr; Ahuva Magder; Sharon R Chinthrajah; Kaori Mukai; Mindy Tsai; Kari Nadeau; Stephen J Galli; Arun K Ramani; Zsolt Szepfalusi; Thomas Eiwegger Journal: Allergy Date: 2020-12-29 Impact factor: 14.710