Basophil allergen threshold sensitivity and component-resolved diagnostics improve hazelnut allergy diagnosis

Area of Science:

• Allergy and Immunology
• Pediatric Allergy
• Diagnostic Immunology

Background:

• IgE sensitization to hazelnut is common but requires confirmation via food challenge.
• Birch-endemic areas often show higher rates of hazelnut sensitization.

Purpose of the Study:

• To assess the clinical significance of IgE antibodies to hazelnut components and basophil allergen threshold sensitivity (CD-sens) in children with suspected hazelnut allergy.
• To correlate these markers with double-blind placebo-controlled food challenge (DBPCFC) results.

Main Methods:

• Forty children with suspected hazelnut allergy underwent DBPCFC.
• Analyzed CD-sens to hazelnut, IgE antibodies to hazelnut and its components (Cor a 1, 8, 9, 14), and serum tryptase levels before, during, and after DBPCFC.

Main Results:

• Eight children tested positive on DBPCFC, all with high CD-sens.
• Positive DBPCFC correlated significantly with higher CD-sens values (P < 0.0001) and elevated IgE to Cor a 9 and Cor a 14 (P < 0.01, P < 0.001).
• CD-sens and IgE to Cor a 14 demonstrated excellent sensitivity (100%) and high specificity (>97% and >94%) for predicting positive DBPCFC.

Conclusions:

• CD-sens and component-resolved diagnostics (CRD) for hazelnut improve diagnostic accuracy and safety.
• Using CD-sens and CRD, separately or combined, can reduce the overdiagnosis of hazelnut allergy.