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Phenotypical characterization of peanut allergic children with differences in cross-allergy to tree nuts and other
Mathias Cousin1,2, Stéphane Verdun3, Maxime Seynave1
1Service d'Allergologie et d'Education Thérapeutique, Hôpital Saint-Vincent de Paul, Lille Cedex, France.
Insights
This study identified three distinct phenotypes in children with peanut allergy, aiding in early identification of those at high risk for cross-allergic reactions to tree nuts and legumes.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Immunology
- Molecular Allergology
Background:
- Peanut allergy (PA) in children frequently co-occurs with allergies to tree nuts (TN) and legumes.
- Understanding cross-reactivity is crucial for managing pediatric food allergies.
- Identifying distinct patient phenotypes can improve clinical management.
Purpose of the Study:
- To analyze a cohort of children with peanut allergy.
- To assess cross-reactivity to tree nuts and legumes.
- To identify distinct phenotypes within this cohort using cluster analysis.
Main Methods:
- Retrospective analysis of 317 children with peanut allergy evaluated over 12 years.
- Comprehensive allergy workup for peanut, tree nuts, and legumes.
- Hierarchical agglomerative clustering to identify patient subgroups.
Main Results:
- 43.2% of children showed cross-allergy to tree nuts and/or legumes; atopic dermatitis was a significant risk factor.
- Cluster analysis revealed three phenotypes: Cluster 1 (high rAra h 2, low reactive dose, asthma), Cluster 2 (high reactive dose, low cross-allergy), and Cluster 3 (high cross-allergy risk, eczema).
- Phenotypes differed in allergen sensitization profiles and clinical manifestations.
Conclusions:
- Three distinct phenotypes of peanut allergy were identified in children.
- These phenotypes can help identify children at high risk for cross-allergic reactions to tree nuts and legumes.
- Early identification of these phenotypes may guide personalized management strategies.
Background:
Peanut allergy in children is often associated with allergies to tree nuts and/or legumes. The aim of this study was to analyze in cluster a cohort of children allergic to peanuts and assessed for cross-reactivity to nuts and legumes and to identify different phenotypes.
Methods:
We included retrospectively 317 children with peanut allergy evaluated at the Allergy Unit of the Saint Vincent Hospital of Lille in the last 12 years. A complete workup for peanut allergy and nuts and legumes was carried out for each patient. A hierarchical agglomerative clustering method was used to search for clusters of individuals in the evaluated cohort.
Results:
Cross-allergy to TN and/or other legumes was identified in 137 patients (43.2%), atopic dermatitis being a major risk factor (adjusted OR = 16 [95% CI: 7.4-37]; p < 0.001). Three phenotypes emerged from cluster analysis. Cluster 1 (72 patients) is characterized by high level of rAra h 2, low threshold reactive doses for peanut and high proportion of asthma; Cluster 2 (93 patients) is characterized by high threshold reactive doses for peanut and the lowest proportion of cross-allergy to TN and/or legumes; Cluster 3 (152 patients) has a high risk of cross-allergy to TN and/or legumes and most patients suffer from eczema.
Conclusions:
The three phenotypes highlighted by this study could be useful to identify children with high risk of cross-allergic reaction to TNs and legumes early after PA diagnosis.
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