BACKGROUND: Component-resolved diagnostics offers a modern tool in peanut allergy, but studies applying consistently double-blind placebo-controlled challenges are lacking. We aimed to optimize diagnostics for moderate-to-severe peanut allergy in a birch-endemic region and to create an oral-peanut challenge with its allergen activity characterized. METHODS: We performed double-blind placebo-controlled peanut challenges for a referred sample of 6- to 18-year-olds with peanut sensitization or a high suspicion of peanut allergy, including anaphylaxis. We measured specific IgE (sIgE) to Ara h 1, 2, 3, 6, 8, and 9. Testing of allergen activity of the challenge products was by IgE microarray inhibition. RESULTS: Of the 102 patients, 69 were challenge positive: 25 (36%) had severe, 36 (52%) moderate, and 8 (12%) mild symptoms; 38 (37%) received adrenalin. SIgE to Ara h 6 AUC 0.98 (95%CI, 0.96-1.00) was the best marker of moderate-to-severe allergy. When sIgE to Ara h 2 and Ara h 6 was measured together, all (100%) severe reactions at low doses were successfully diagnosable. SIgE to Ara h 8 had no diagnostic value, AUC 0.42 (95%CI, 0.30-0.52). Both nonroasted and roasted peanut inhibited 100% of IgE binding to Ara h 1, 2, 3, and 6. Nonroasted peanut inhibited 87% of IgE binding to Ara h 8, roasted inhibited 30%. The products lacked Ara h 9 activity. CONCLUSION: Co-sensitization to Ara h 2 and Ara h 6 was associated with severe reactions distinguishing severe allergy from mild symptoms. SIgE to Ara h 8 added no diagnostic value. Component-resolved diagnostics reduce the need for oral challenges in peanut allergy.
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BACKGROUND: Component-resolved diagnostics offers a modern tool in peanutallergy, but studies applying consistently double-blind placebo-controlled challenges are lacking. We aimed to optimize diagnostics for moderate-to-severe peanutallergy in a birch-endemic region and to create an oral-peanut challenge with its allergen activity characterized. METHODS: We performed double-blind placebo-controlled peanut challenges for a referred sample of 6- to 18-year-olds with peanut sensitization or a high suspicion of peanutallergy, including anaphylaxis. We measured specific IgE (sIgE) to Ara h 1, 2, 3, 6, 8, and 9. Testing of allergen activity of the challenge products was by IgE microarray inhibition. RESULTS: Of the 102 patients, 69 were challenge positive: 25 (36%) had severe, 36 (52%) moderate, and 8 (12%) mild symptoms; 38 (37%) received adrenalin. SIgE to Ara h 6 AUC 0.98 (95%CI, 0.96-1.00) was the best marker of moderate-to-severe allergy. When sIgE to Ara h 2 and Ara h 6 was measured together, all (100%) severe reactions at low doses were successfully diagnosable. SIgE to Ara h 8 had no diagnostic value, AUC 0.42 (95%CI, 0.30-0.52). Both nonroasted and roasted peanut inhibited 100% of IgE binding to Ara h 1, 2, 3, and 6. Nonroasted peanut inhibited 87% of IgE binding to Ara h 8, roasted inhibited 30%. The products lacked Ara h 9 activity. CONCLUSION: Co-sensitization to Ara h 2 and Ara h 6 was associated with severe reactions distinguishing severe allergy from mild symptoms. SIgE to Ara h 8 added no diagnostic value. Component-resolved diagnostics reduce the need for oral challenges in peanutallergy.
Authors: Stephen C Dreskin; Matthew Germinaro; Dominik Reinhold; Xueni Chen; Brian P Vickery; Michael Kulis; A Wesley Burks; Surendra S Negi; Werner Braun; Jeffery M Chambliss; Spodra Eglite; Caitlin M G McNulty Journal: Pediatr Allergy Immunol Date: 2019-10-21 Impact factor: 6.377
Authors: Nandinee Patel; Daniel C Adelman; Katherine Anagnostou; Joseph L Baumert; W Marty Blom; Dianne E Campbell; R Sharon Chinthrajah; E N Clare Mills; Bushra Javed; Natasha Purington; Benjamin C Remington; Hugh A Sampson; Alexander D Smith; Ross A R Yarham; Paul J Turner Journal: J Allergy Clin Immunol Date: 2021-02-09 Impact factor: 10.793
Authors: Ramona A Hoh; Shilpa A Joshi; Ji-Yeun Lee; Brock A Martin; Sushama Varma; Shirley Kwok; Sandra C A Nielsen; Parastu Nejad; Emily Haraguchi; Priya S Dixit; Swetha V Shutthanandan; Krishna M Roskin; Wenming Zhang; Dana Tupa; Bryan J Bunning; Monali Manohar; Robert Tibshirani; Nielsen Q Fernandez-Becker; Neeraja Kambham; Robert B West; Robert G Hamilton; Mindy Tsai; Stephen J Galli; Rebecca S Chinthrajah; Kari C Nadeau; Scott D Boyd Journal: Sci Immunol Date: 2020-03-06
Authors: Stephen C Dreskin; Stef J Koppelman; Sandra Andorf; Kari C Nadeau; Anjeli Kalra; Werner Braun; Surendra S Negi; Xueni Chen; Catherine H Schein Journal: J Allergy Clin Immunol Date: 2020-11-18 Impact factor: 10.793