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Published on: May 31, 2021
Risk Factors for Anaphylaxis in Children Allergic to Peanuts
Tadej Petek1, Mija Lajhar2, Blažka Krašovec2
1Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
Insights
Predicting peanut allergy severity in children is challenging. Standard allergy tests, including specific IgE to Ara h2, are poor predictors of severe reactions like anaphylaxis.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Immunology
- Food Allergy Research
Background:
- Peanut allergy is a leading cause of anaphylaxis in children.
- Risk factors for severe peanut allergic reactions remain poorly defined.
- Accurate prediction of anaphylaxis severity is crucial for patient management.
Purpose of the Study:
- To identify epidemiological, clinical, and laboratory factors predicting peanut allergy severity in children.
- To evaluate the predictive value of allergy testing, including component diagnostics, for anaphylaxis.
- To assess the need for oral food challenges in diagnosing peanut allergy severity.
Main Methods:
- Cross-sectional study of 94 children with diagnosed peanut allergy.
- Allergy assessment included skin prick testing and specific IgE to peanut and Ara h2.
- Oral food challenges were performed for discordant cases.
Main Results:
- Anaphylaxis occurred in 35.1% of children; moderate reactions in 31.9%; mild in 33.0%.
- Severity weakly correlated with peanut quantity consumed (p=0.04).
- Specific IgE to Ara h2 showed limited predictive value (cutoff 0.92 IU/mL, 90% sensitivity, 47.5% specificity for anaphylaxis).
Conclusions:
- Patient history and standard allergy tests, including component diagnostics, are insufficient predictors of peanut allergy severity.
- Current diagnostic tools have limitations in predicting anaphylaxis.
- Novel predictive models and diagnostic tools are needed to improve risk assessment and reduce oral food challenges.
Abstract:
Background and Objectives: A peanut allergy is the most common single cause of anaphylaxis in children. The risk factors for anaphylaxis in children with a peanut allergy are not well defined. Therefore, we aimed to identify epidemiological, clinical, and laboratory characteristics of children with a peanut allergy that may predict the severity of the allergic reaction and anaphylaxis. Materials and Methods: We conducted a cross-sectional study and included 94 children with a peanut allergy. Allergy testing was performed, including skin prick testing and the determination of specific IgE levels to peanuts and their Ara h2 component. In case of discordance between patient history and allergy testing, an oral food challenge with peanuts was performed. Results: Anaphylaxis and moderate and mild reactions to peanuts occurred in 33 (35.1%), 30 (31.9%), and 31 (33.0%) patients, respectively. The severity of the allergic reaction was only weakly correlated (p = 0.04) with the amount of peanuts consumed. The median number of allergic reactions to peanuts was 2 in children with anaphylaxis compared to 1 in other patients (p = 0.04). The median level of specific IgE to Ara h2 was 5.3 IU/mL in children with anaphylaxis compared to 0.6 IU/mL and 10.3 IU/mL in children with mild and moderate peanut allergies (p = 0.06). The optimal cutoff for distinguishing between anaphylaxis and a less severe allergic reaction to peanuts was a specific IgE Ara h2 level of 0.92 IU/mL with 90% sensitivity and 47.5% specificity for predicting anaphylaxis (p = 0.04). Conclusions: Epidemiological and clinical characteristics of the patient cannot predict the severity of the allergic reaction to peanuts in children. Even standard allergy testing, including component diagnostics, is a relatively poor predictor of the severity of an allergic reaction to peanuts. Therefore, more accurate predictive models, including new diagnostic tools, are needed to reduce the need for oral food challenge in most patients.
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