Ara h 2 and Ara 6 are the best predictors of severe peanut allergy: a double-blind placebo-controlled study

被引:123
作者
Kukkonen, A. K.
Pelkonen, A. S.
Makinen-Kiljunen, S.
Voutilainen, H.
Makela, M. J.
机构
[1] Univ Helsinki, Skin & Allergy Hosp, Helsinki 00029, Finland
[2] Helsinki Univ Hosp, Helsinki, Finland
关键词
Ara h 2; Ara h 6; Ara h 8; double-blind placebo-controlled food challenge; peanut allergy; FOOD CHALLENGES; SENSITIZATION; DIAGNOSIS; IGE; PREVALENCE; ACCURACY; CHILDREN; ADULTS;
D O I
10.1111/all.12671
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: Component-resolved diagnostics offers a modern tool in peanut allergy, but studies applying consistently double-blind placebo-controlled challenges are lacking. We aimed to optimize diagnostics for moderate-to-severe peanut allergy in a birch-endemic region and to create an oral-peanut challenge with its allergen activity characterized. Methods: We performed double-blind placebo-controlled peanut challenges for a referred sample of 6- to 18-year-olds with peanut sensitization or a high suspicion of peanut allergy, including anaphylaxis. We measured specific IgE (sIgE) to Ara h 1, 2, 3, 6, 8, and 9. Testing of allergen activity of the challenge products was by IgE microarray inhibition. Results: Of the 102 patients, 69 were challenge positive: 25 (36%) had severe, 36 (52%) moderate, and 8 (12%) mild symptoms; 38 (37%) received adrenalin. SIgE to Ara h 6 AUC 0.98 (95% CI, 0.96-1.00) was the best marker of moderate-to-severe allergy. When sIgE to Ara h 2 and Ara h 6 was measured together, all (100%) severe reactions at low doses were successfully diagnosable. SIgE to Ara h 8 had no diagnostic value, AUC 0.42 (95% CI, 0.30-0.52). Both nonroasted and roasted peanut inhibited 100% of IgE binding to Ara h 1, 2, 3, and 6. Nonroasted peanut inhibited 87% of IgE binding to Ara h 8, roasted inhibited 30%. The products lacked Ara h 9 activity. Conclusion: Co-sensitization to Ara h 2 and Ara h 6 was associated with severe reactions distinguishing severe allergy from mild symptoms. SIgE to Ara h 8 added no diagnostic value. Component-resolved diagnostics reduce the need for oral challenges in peanut allergy.
引用
收藏
页码:1239 / 1245
页数:7
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