Related Experiment Video

Updated: Jun 20, 2026

Basophil Activation Test for Allergy Diagnosis
07:22

Basophil Activation Test for Allergy Diagnosis

Published on: May 31, 2021

Clinical and immunological markers of peanut allergy severity and tolerance in children

Tadej Petek1, Brigita Koren1, Maja Tomazin1

  • 1Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia.

Frontiers in Allergy
|June 19, 2026
PubMed

Insights

Biomarkers like peanut skin prick tests (SPT), specific IgE (sIgE), and basophil activation tests (BAT) can help predict severe peanut allergy reactions and tolerance. These tools may reduce the need for oral food challenges (OFCs).

Area of Science:

  • Allergy and Immunology
  • Clinical Diagnostics
  • Peanut Allergy Research

Background:

  • Improved diagnostic tools are crucial for assessing severe peanut allergy (PA) risk and predicting its resolution.
  • Current diagnostic methods for PA may require enhancement to accurately stratify patient risk and outcomes.

Purpose of the Study:

  • To evaluate the diagnostic performance of various biomarkers in distinguishing between mild and severe peanut allergic reactions.
  • To identify biomarkers that can predict clinical tolerance to peanuts, potentially reducing the need for oral food challenges (OFCs).
  • To assess the utility of basophil activation testing (BAT) and component-resolved diagnostics in managing peanut allergy.

Main Methods:

  • Prospective, multicenter study (2020-2024) involving children (3 months-18 years) with confirmed peanut allergy (PA).
  • Diagnosis confirmed via clinical history, skin prick tests (SPT), peanut specific IgE (sIgE), and/or oral food challenges (OFC).
  • Comparison of children with mild (World Allergy Organization-WAO grade 1) versus severe (WAO grade ≥2) reactions; BAT and component-resolved diagnostics performed on all participants.

Main Results:

  • Children experiencing anaphylaxis had significantly larger SPT wheals and higher peanut sIgE levels compared to those with milder reactions.
  • Anaphylaxis was associated with greater sensitization to specific peanut allergens (Ara h 1, Ara h 2, Ara h 6) and higher BAT responses.
  • Receiver operating characteristic (ROC) curve analyses indicated moderate discrimination (AUC 0.75-0.8) for SPT, sIgE, specific Ara h components, and BAT.
  • Clinical tolerance to peanuts was associated with lower sIgE, Ara h 2, and Ara h 6 levels, and a trend towards lower BAT responses.

Conclusions:

  • Peanut SPT, sIgE, Ara h sensitization, and BAT demonstrate moderate ability to differentiate between severe and mild allergic reactions.
  • Peanut sIgE, Ara h 2, and Ara h 6 levels are associated with clinical tolerance, suggesting their potential role in predicting resolution.
  • These biomarkers may help optimize diagnostic strategies, potentially reducing the necessity for OFCs in select peanut-allergic children.
Abstract

Keywords:
basophil activation testchildrencomponent-resolved diagnosticspeanut allergyseveritytolerance

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