Is Ara h 2 indeed the best predictor for peanut allergy in Dutch children?

Diagnosis ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Mirjam Schots ◽  
Amerik C. de Mol ◽  
Henricus J. Vermeer ◽  
Yvonne M. Roosen ◽  
Aldonse W. Vriesman
Keyword(s):  
Prediction Model ◽  
Peanut Allergy ◽  
Immunoglobulin E ◽  
Food Challenge ◽  
Discriminative Ability ◽  
Double Blind ◽  
Ara H 2 ◽  
Receiver Operating Characteristic Curves ◽  
Specific Immunoglobulin E ◽  
Predicting Factor

AbstractSpecific immunoglobulin E to Ara h 2 (sIgE to Ara h 2) is described as an upcoming predicting factor for diagnosing peanut allergy in children. The gold standard for diagnosing peanut allergy is a double blind placebo controlled food challenge, however this is time consuming and potentially harmful. We investigate Ara h 2 as a preliminary less invasive diagnostic tool for diagnosing peanut allergy in a general population of peanut sensitized children.Children (n=52) with peanut sensitization were retrospectively included. An oral food challenge (OFC) confirmed peanut allergy or tolerance, as primary outcome. Individual candidate predictors were identified by univariate regression analysis and used in a prediction model. Different cut-off values were obtained and receiver operating characteristic curves were plotted.Multivariate analyses resulted in Ara h 2 as best predictor, with a discriminative ability of 0.87 (95% confidence interval, 0.77–0.97). Sensitivity and specificity of 55% and 95%, respectively, were found for a sIgE to Ara h 2 cut-off value of 4.25 kU/L. The highest positive predictive value of 100% was reached at 5.61 kU/L. No absolute relation was found between the value of Ara h 2 and the severity of the reaction during OFC.This study developed a prediction model in which sIgE to Ara h 2 was the best predictor for peanut allergy in sensitized children in a general hospital. Therefore depending on the history and the Ara h 2 results, an OFC is not always needed to confirm the diagnosis.

Challenge-confirmed peanut allergy in older patients: Performance of skin tests, specific immunoglobulin E, and ara h 2

2018 ◽  
Vol 120 (3) ◽  
pp. 334-335
Author(s):  
Philip H. Li ◽  
Krzysztof Rutkowski ◽  
Lucinda Kennard ◽  
Priya Sellaturay ◽  
Timothy J. Watts ◽  
...  
Keyword(s):  
Older Patients ◽  
Peanut Allergy ◽  
Immunoglobulin E ◽  
Skin Tests ◽  
Ara H 2 ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin

scholarly journals White paper peanut allergy—part 2: Diagnosis of peanut allergy with special emphasis on molecular component diagnostics

2021 ◽  
Author(s):  
Lea Alexandra Blum ◽  
Birgit Ahrens ◽  
Ludger Klimek ◽  
Kirsten Beyer ◽  
Michael Gerstlauer ◽  
...  
Keyword(s):  
Gold Standard ◽  
Peanut Allergy ◽  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Systemic Reaction ◽  
Food Challenge ◽  
Clinical History ◽  
Double Blind ◽  
Skin Reactions ◽  
Diagnostic Algorithms

Summary Background Peanut allergy is an immunoglobulin E (IgE)-mediated immune response that usually manifests in childhood and can range from mild skin reactions to anaphylaxis. Since quality of life maybe greatly reduced by the diagnosis of peanut allergy, an accurate diagnosis should always be made. Methods A selective literature search was performed in PubMed and consensus diagnostic algorithms are presented. Results Important diagnostic elements include a detailed clinical history, detection of peanut-specific sensitization by skin prick testing and/or in vitro measurement of peanut (extract)-specific IgE and/or molecular components, and double-blind, placebo-controlled food challenge as the gold standard. Using these tools, including published cut-off values, diagnostic algorithms were established for the following constellations: 1) Suspicion of primary peanut allergy with a history of immediate systemic reaction, 2) Suspicion of primary peanut allergy with questionable symptoms, 3) Incidental findings on sensitization testing and peanut ingestion so far or 4) Suspicion of pollen-associated peanut allergy with solely oropharyngeal symptoms. Conclusion The most important diagnostic measures in determining the diagnosis of peanut allergy are clinical history and detection of sensitizations, also via component-based diagnostics. However, in case of unclear results, the gold standard—an oral food challenge—should always be used.

scholarly journals Legume and sesame oral food challenge outcomes

2021 ◽  
Vol 3 (2) ◽  
pp. 42-49 ◽  
Author(s):  
Jacob J. Pozin ◽  
Ashley L. Devonshire ◽  
Kevin Tom ◽  
Melanie Makhija ◽  
Anne Marie Singh
Keyword(s):  
Regression Models ◽  
Operating Characteristic ◽  
Immunoglobulin E ◽  
Gastrointestinal Symptoms ◽  
Food Challenge ◽  
Logistic Regression Models ◽  
Receiver Operating Characteristic Curves ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin ◽  
Food Challenges

Background: Legume and sesame are emerging food allergens. The utility of specific immunoglobulin E (sIgE) testing to predict clinical reactivity to these allergens is not well described. Objective: To describe clinical outcomes and sIgE in sesame and legume oral food challenges (OFC). Methods: We performed a retrospective review of 74 legume and sesame OFCs between 2007 and 2017 at the Ann and Robert H. Lurie Children’s Hospital of Chicago. Clinical data, OFC outcome, and sIgE to legume and sesame were collected. Receiver operating characteristic curves and logistic regression models that predicted OFC outcome were generated. Results: Twenty-eight patients (median age, 6.15 years) passed legume OFC (84.9%), and 25 patients (median age, 5.91 years) passed sesame OFC (61.0%). The median sIgE to legume was 1.41 kUA/L and, to sesame, was 2.34 kUA/L. In patients with failed legume OFC, 60.0% had cutaneous symptoms, 20.0% had gastrointestinal symptoms, and 20.0% had anaphylaxis. Of these reactions, 80.0% were controlled with antihistamine alone and 20.0% required epinephrine. In patients for whom sesame OFC failed, 50.0% had cutaneous symptoms, 12.5% had gastrointestinal symptoms, and 37.50% had anaphylaxis. Of these reactions, 6.3% required epinephrine, 31.3% were controlled with diphenhydramine alone, and 63.50% required additional epinephrine or prednisone. Conclusion: Most OFCs to legumes were passed and reactions to failed legume OFCs were more likely to be nonsevere. Sesame OFC that failed was almost twice as likely compared with legume OFC that failed, and reactions to sesame OFC that failed were often more severe. Sesame sIgE did not correlate with OFC outcome.

Prevention of food allergy

2019 ◽  
Vol 40 (6) ◽  
pp. 450-452 ◽  
Author(s):  
Ashley L. Devonshire ◽  
Rachel Glick Robison
Keyword(s):  
Food Allergy ◽  
Peanut Allergy ◽  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Clinical Manifestations ◽  
Conclusive Evidence ◽  
Severe Atopic Dermatitis ◽  
Early Introduction ◽  
Infant Diet ◽  
Specific Immunoglobulin E

Primary prevention and secondary prevention in the context of food allergy refer to prevention of the development of sensitization (i.e., the presence of food-specific immunoglobulin E (IgE) as measured by skin-prick testing and/or laboratory testing) and sensitization plus the clinical manifestations of food allergy, respectively. Until recently, interventions that target the prevention of food allergy have been limited. Although exclusive breast-feeding for the first 6 months of life has been a long-standing recommendation due to associated health benefits, recommendations regarding complementary feeding in infancy have significantly changed over the past 20 years. There now is evidence to support early introduction of peanut into the diet of infants with egg allergy, severe atopic dermatitis, or both diagnoses, defined as high risk for peanut allergy, to try to prevent development of peanut allergy. Although guideline-based recommendations are not available for early introduction of additional allergenic foods, this topic is being actively studied. There is no evidence to support additional dietary modification of the maternal or infant diet for the prevention of food allergy. Similarly, there is no conclusive evidence to support maternal avoidance diets for the prevention of food allergy.

scholarly journals Oral immunotherapy for treatment of peanut allergy

2020 ◽  
Vol 68 (6) ◽  
pp. 1152-1155
Author(s):  
Joan H Dunlop
Keyword(s):  
Food Allergy ◽  
Peanut Allergy ◽  
Food Challenge ◽  
Oral Immunotherapy ◽  
Peanut Protein ◽  
Subcutaneous Immunotherapy ◽  
Double Blind ◽  
The Us ◽  
Allergy Prevalence

The US Food and Drug Administration’s approval of a peanut oral immunotherapy product in January 2020 is a landmark development in the field of food allergy therapy. While food allergy prevalence has been increasing, this product is the first approved therapy for food allergy. Oral immunotherapy has many similarities to subcutaneous immunotherapy and drug desensitization protocols, but does not lead to sustained unresponsiveness. The studies leading to approval of the Palforzia product demonstrated increase in the amount of peanut protein able to be consumed, with 67% of subjects randomized to the treatment arm able to consume 600 mg of peanut protein in double-blind placebo-controlled food challenge at study exit. However, side effects are an important consideration, and dropout rates in studies of Palforzia ranged from 11% to 21%. Postmarketing surveillance of this product will be critical in assessing its long-term risks and benefits.

Sign in / Sign up

Export Citation Format

Share Document