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Resolution of peanut allergy: case-control study
J O Hourihane1, S A Roberts, J O Warner
1Child Health, University of Southampton, Southampton SO16 6YD. J.Hourihane@ich.ucl.ac.uk
Insights
Some children with a history of peanut allergy may no longer be allergic. Food challenges can identify tolerance, and these children often have fewer other food allergies.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Nutrition
- Immunology
Background:
- Peanut allergy is a common childhood condition.
- Distinguishing between persistent and resolved peanut allergy is crucial for management.
- Food challenges are a key diagnostic tool.
Purpose of the Study:
- To compare children with resolved peanut allergy to those with persistent allergy.
- To identify clinical and immunological differences between these groups.
Main Methods:
- A case-control study matched for age and sex.
- Involved 30 children (15 resolved, 15 persistent peanut allergy) undergoing open peanut food challenges.
- Measured reactions to peanut challenge and serum specific IgE levels.
Main Results:
- Children with resolved peanut allergy were less likely to have allergies to other foods (2/15 vs 9/15).
- Skin prick tests showed smaller reactions in resolvers (<6 mm weal) compared to persisters (P<0.0001).
- Serum total and peanut-specific IgE levels did not significantly differ between groups.
Conclusions:
- Clinicians should consider food challenges for preschool children with suspected peanut allergy, as some may have developed tolerance.
- Preschoolers whose peanut allergy is disproven by challenge exhibit less comorbidity with other food allergies.
- Skin prick test weal size predicts peanut reactivity but not reaction severity.
Objectives:
To determine whether there are any differences between children who remain mildly or moderately allergic to peanut and children with similar histories but a negative reaction on challenge with peanut.
Design:
Case-controls matched for age and sex.
Setting:
Children's day wards in two teaching hospitals.
Intervention:
Open food challenge with peanut.
Subjects:
15 children with resolved peanut allergy (resolvers) and 15 with persistent allergy (persisters).
Main Outcome Measure:
Reaction on challenge with peanut, serum total and peanut specific IgE concentrations.
Results:
The groups had a similar median age at first reaction to peanut (11 months, range 5-38) and similar symptoms. Allergy to other foods was less common in resolvers (2/15) than persisters (9/15) (P=0.02). On skin prick testing with peanut all 13 resolvers tested but only 3/14 persisters had a weal of <6 mm (P<0.0001). Total and peanut specific IgE concentrations did not differ much between the groups.
Conclusion:
Appropriately trained clinicians must be prepared to challenge preschool children with peanut as some will be tolerant despite a history of reactions to peanut and a positive skin prick test with peanut. Preschool children whose apparent peanut allergy is refuted by food challenge show allergy to other foods less often than those in whom peanut allergy persists. The size of weal on skin prick testing to peanut predicts reactivity but not severity on peanut challenge.