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Published on: May 31, 2021
Added Diagnostic Value of Peanut Component Testing: A Cross-Sectional Study in Australian Children
Narinder Kaur1, Sam Mehr2, Constance Katelaris3
1Department of Allergy and Immunology, The Children's Hospital at Westmead, SCHN, Sydney, NSW, Australia; Sydney Child Health Program, Sydney Children's Hospitals Network, Sydney, NSW, Australia.
Insights
Peanut component testing, specifically Ara h 2 and 6, effectively predicts peanut allergy outcomes in children. Sensitization to Ara h 1, 2, and 3 combined is highly accurate for diagnosing peanut allergy.
Area of Science:
- Allergy and Immunology
- Pediatric Allergy
- Clinical Diagnostics
Background:
- Peanut component testing is used clinically, but its predictive value for challenge outcomes in Australian children (excluding infants) is not well-established.
- Understanding the utility of specific peanut components is crucial for accurate diagnosis and management of peanut allergy.
Purpose of the Study:
- To determine if peanut component testing can predict the outcome of oral food challenges in peanut-allergic children.
- To evaluate the role of specific peanut allergens (Ara h 1, 2, 3, 6, 8, 9) and peanut IgE in predicting challenge results.
Main Methods:
- Recruited children undergoing peanut challenges, irrespective of prior reactions or sensitization.
- Analyzed serum for peanut IgE and specific components (Ara h 1, 2, 3, 6, 8, 9) using ImmunoCap.
- Utilized logistic regression to assess the predictive value of component sensitization and polysensitization.
Main Results:
- Of 222 children, 89 (40%) were allergic on challenge. Ara h 2 and Ara h 6 showed similar predictive performance to peanut IgE and skin prick tests (AUC 0.84-0.87).
- Polysensitization to Ara h 1, 2, or 3 significantly increased the odds of an allergic reaction.
- All children sensitized to Ara h 1, 2, and 3 reacted to the challenge; polysensitization correlated with lower eliciting dose and increased reaction severity.
Conclusions:
- Sensitization to the combination of Ara h 1, 2, and 3 is highly predictive of peanut allergy in this cohort.
- Ara h 2 was the strongest individual predictor of reaction severity and adrenaline use.
- Ara h 8 and Ara h 9 components were not useful for predicting challenge outcomes.
Background:
Peanut components are widely used in clinical practice; however, their utility to predict challenge outcome in the Australian children, outside of infants, is not well studied.
Objective:
Can peanut component testing predict outcome of challenge in peanut-allergic children.
Methods:
All children attending peanut challenges, regardless of previous allergic reactions to peanut or sensitization (skin prick test or peanut IgE) alone, were recruited. Serum collected before the challenge was analyzed for peanut IgE and Ara h 1, 2, 3, 6, 8, and 9 (ImmunoCap).
Results:
Of the 222 children recruited, 89 (40%) were allergic on oral food challenge. Ara h 2 and 6 performed similarly to peanut IgE and skin prick test in predicting challenge outcome (area under the curve, 0.84-0.87). No baseline clinical characteristics, including past history, predicted challenge outcome. By logistic regression, degree of polysensitization to Ara h 1, 2, or 3 increased the odds of allergic reaction at oral food challenge at 0.35 and 1.0 kUA/L cutoff levels (P < .001 for both). All 11 children sensitized (>0.35 kUA/L) to Ara h 1, 2, and 3 reacted to peanut challenge. Degree of polysensitization at more than 1.0 kUA/L was associated with a lower cumulative eliciting dose (P = .016) and with severity of allergic reaction on challenge (P = .007).
Conclusions:
In our cohort, sensitization to the combination of Ara h 1, 2, and 3 was highly predictive of peanut allergy. Overall, only Ara h 2 as individual component most correlated with severity of reaction at challenge and adrenaline use. Ara h 8 and 9 were not useful in predicting challenge outcome.
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