Allergy or tolerance in children sensitized to peanut: Prevalence and differentiation using component-resolved diagnostics

Nicolaos Nicolaou, Maryam Poorafshar, Clare Murray, Angela Simpson, Henric Winell, Gina Kerry, Annika Härlin, Ashley Woodcock, Staffan Ahlstedt, Adnan Custovic

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312 Citations (Scopus)

Abstract

Background: Not all peanut-sensitized children develop allergic reactions on exposure. Objective: To establish by oral food challenge the proportion of children with clinical peanut allergy among those considered peanut-sensitized by using skin prick tests and/or IgE measurement, and to investigate whether component-resolved diagnostics using microarray could differentiate peanut allergy from tolerance. Methods: Within a population-based birth cohort, we ascertained peanut sensitization by skin tests and IgE measurement at age 8 years. Among sensitized children, we determined peanut allergy versus tolerance by oral food challenges. We used open challenge among children consuming peanuts (n = 45); others underwent double-blind placebo-controlled challenge (n = 34). We compared sensitization profiles between children with peanut allergy and peanut-tolerant children by using a microarray with 12 pure components (major peanut and potentially cross-reactive components, including grass allergens). Results: Of 933 children, 110 (11.8%) were peanut-sensitized. Nineteen were not challenged (17 no consent). Twelve with a convincing history of reactions on exposure, IgE ≥15 kUa/L and/or skin test ≥8mm were considered allergic without challenge. Of the remaining 79 children who underwent challenge, 7 had ≥2 objective signs and were designated as having peanut allergy. We estimated the prevalence of clinical peanut allergy among sensitized subjects as 22.4% (95% CI, 14.8% to 32.3%). By using component-resolved diagnostics, we detected marked differences in the pattern of component recognition between children with peanut allergy (n = 29; group enriched with 12 children with allergy) and peanut-tolerant children (n = 52). The peanut component Ara h 2 was the most important predictor of clinical allergy. Conclusion: The majority of children considered peanut-sensitized on the basis of standard tests do not have peanut allergy. Component-resolved diagnostics may facilitate the diagnosis of peanut allergy.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Volume125
Issue number1-3
DOIs
Publication statusPublished - Jan 2010

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    Nicolaou, N., Poorafshar, M., Murray, C., Simpson, A., Winell, H., Kerry, G., Härlin, A., Woodcock, A., Ahlstedt, S., & Custovic, A. (2010). Allergy or tolerance in children sensitized to peanut: Prevalence and differentiation using component-resolved diagnostics. Journal of Allergy and Clinical Immunology, 125(1-3). https://doi.org/10.1016/j.jaci.2009.10.008