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Updated: Sep 24, 2025
Basophil Activation Test for Allergy Diagnosis
Published on: May 31, 2021
Real world use of peanut component testing among children in the Chicago metropolitan area
Abigail Lang1, Lauren C Balmert2, Mitchell Weiss3
1From the Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Insights
Peanut component tests (PCT) show Ara h 2 sensitization is linked to peanut allergy reactions. However, many patients sensitized to Ara h 2 still tolerate peanuts, highlighting the importance of oral food challenges (OFC).
Area of Science:
- Allergy and Immunology
- Clinical Pediatrics
- Diagnostic Testing
Background:
- Peanut component tests (PCT) are increasingly used for peanut allergy evaluation.
- Limited research exists on PCT utility in US clinical practice alongside current standards.
- This study addresses the need to understand PCT performance in real-world settings.
Purpose of the Study:
- Evaluate the performance of PCT in clinical practice.
- Analyze peanut sensitization patterns using PCT.
- Assess the association between PCT results and oral food challenge (OFC) outcomes.
Main Methods:
- Retrospective chart review of 184 children with PCT and OFC data (2012-2017).
- Logistic regression to analyze associations between PCT and OFC outcomes.
- Receiver operator characteristic curves and predicted probability curves for Ara h 2.
Main Results:
- Ara h 2 was the most common sensitization detected by PCT.
- 61 patients (33%) reacted during OFC.
- Ara h 2 specific immunoglobulin E (sIgE) ≥ 0.35 kUA/L increased odds of reaction (OR 5.91), but 37% of these patients tolerated peanut.
- Specific thresholds for Ara h 2 sIgE predicted 50% (0.49 kUA/L) and 90% (4.58 kUA/L) probabilities of reaction.
- Sensitization only to Ara h 8 or 9 showed high tolerance (86% no reaction).
- No significant association found between polysensitization to Ara h 1, 2, and 3 and OFC outcome.
Conclusions:
- Ara h 2 sIgE levels correlate with clinical reactivity in peanut allergy.
- A substantial number of patients sensitized to Ara h 2 can tolerate peanut ingestion.
- Oral food challenge (OFC) remains crucial for accurately diagnosing peanut allergy.
Abstract:
Background: Peanut component tests (PCT) have become important in the evaluation of peanut allergy. There remains a paucity of research across the United States in investigating the utility of PCT in clinical practice in conjunction with current standards of care. Objective: The primary aims were to evaluate the performance and sensitization patterns of PCT in clinical practice when first available at our institution. Methods: We performed a retrospective chart review of 184 children with PCT and oral food challenge (OFC) results between 2012 and 2017. Simple logistic regression models assessed the associations between PCT and OFC outcomes. Receiver operator characteristic curves were constructed, and a predicted probability curve was derived for Ara h2. Results: The median (interquartile range [IQR]) age at OFC was 4 years (2-7 years), and 111 patients (60%) were boys. Ara h 2 was the most commonly sensitized PCT. Sixty-one patients (33%) reacted at OFC. Ara h 2 specific immunoglobulin E (sIgE) ≥ 0.35 kUA/L was associated with increased odds of reacting at OFC (odds ratio 5.91 95% confidence interval, 2.93-11.89; p < 0.001); however, 19 patients (37%) positive for Ara h 2 did not react. Ara h 2 sIgE of 0.49 kUA/L and 4.58 kUA/L were associated with 50% and 90% probability, respectively, of reacting at OFC. Among those sensitized only to Ara h 8 or 9 (n = 21), 86% had no reaction. There was no statistically significant association with polysensitization to Ara h 1, 2, and 3, and peanut OFC outcome. Conclusion: Although the Ara h 2 sIgE value was associated with clinical reactivity, a significant proportion of the patients sensitized to Ara h 2 tolerated peanut. OFC remains an important tool in the evaluation of peanut allergy.
