Original article
The Utility of Peanut Components in the Diagnosis of IgE-Mediated Peanut Allergy Among Distinct Populations

https://doi.org/10.1016/j.jaip.2012.11.002Get rights and content

Background

Increasing data suggest that analysis of IgE to peanut components can be clinically helpful and possibly more accurate than IgE to whole peanut. Not all studies examining this topic, however, have used prospective samples, multiple components, and peanut challenges.

Objective

We sought to determine the utility of peanut component testing, using a standardized, commercially available test done before oral peanut challenge in various populations of patients with suspected peanut allergy from 2 different countries.

Methods

IgE to whole peanut and the recombinant allergen components Ara h 1, 2, 3, and 8 were analyzed from serum samples drawn before double-blind peanut challenge from 4 distinct cohorts of patients with suspected peanut allergy from 2 nations (United States and Sweden).

Results

Patients (n = 167; median age, 11.7 years; interquartile range, 7.0-15.0 years) had serum analyzed for peanut components and completed an oral food challenge to peanut. Although IgE to peanut was the most sensitive test (0.93), Ara h 2 was the most specific (0.92) and provided the best positive predictive value (0.94) of all the tests. Ara h 2 was also the best overall diagnostic test by receiver operating characteristic analysis (area under the curve, 0.84; P < .05).

Conclusions

In patients with suspected peanut allergy, IgE to peanut is a sensitive test but is not specific. IgE to Ara h 2 is a more specific and more accurate diagnostic test in this sampling of patients with suspected peanut allergy. Given each tests attributes, a stepwise approach to testing may provide clinicians with a way to minimize the need for peanut challenges.

Section snippets

Patient selection

The study was approved by local institutional review board for the following 4 sites: Mount Sinai, Consortium of Food Allergy Research (CoFAR), Sachs Open, and Sachs Double-blind.

At the Mount Sinai site, patients referred for a double-blind oral food challenge (OFC) to peanut from a university-based outpatient pediatric allergy clinic (Mount Sinai, New York, NY) were invited to participate. They were eligible for entry if they had a clinical history for peanut allergy and evidence of peanut

Baseline characteristics

In total, 167 patients had serum analyzed for peanut components and completed an OFC to peanut. The median age of all patients was 11.7 years [interquartile range (IQR), 7.0-15.0 years]. The patients in the CoFAR group were older than the other patients (P < .005) and those in the Mount Sinai cohort were younger than the other patients (P < .005). Most were male (n = 108; 64.7%), and this breakdown was similar in all groups (Table II).

OFC results

Breakdown of results of peanut challenges are presented in

Discussion

We present data from peanut component analysis drawn before oral peanut challenge in patients with suspected peanut allergy from various cohorts in 2 different nations. This work is similar to some prior studies on peanut component testing. However, it is the first to examine peanut component analysis with the use of standardized methods from multiple cohorts of patients with suspected peanut allergy, all of whom underwent oral peanut challenges, which was not the case in many previous studies.

Acknowledgments

We thank all the parents and children who participated in this study. We also thank all members of the Consortium of Food Allergy Research (CoFAR), including the study nurses, data managers, and the principal investigators at each site (Drs Scott Sicherer, Robert Wood, David Fleischer, Stacie Jones, and Wesley Burks). Support for CoFAR was made possible through grants from the National Institute of Allergy and Infectious Diseases (NIAID) (U19AI066738 and U01AI066560).

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      Citation Excerpt :

      In our cohort, Ara h 6 correlated most closely with Ara h 2, not unexpectedly given they are both members of the prolamin protein family, and was the most highly correlated of all variables with challenge severity and ED. Systematic review by Kim et al37 evaluated 3 studies for diagnostic accuracy of Ara h proteins (1, 2, 3, 6, 8, and 9) and reported higher sensitivity and specificity for Ara h 6 (94.9% and 95.1%).16,17,38,39 We found specificity of 98% (sensitivity of 0.56) and PPV of 94% for Ara h 6 at greater than or equal to 1.0 kUA/L.

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    No funding was received for this work.

    Conflicts of interest: S. Glaumann has received research support from the Mjolkdroppen Foundation, Swedish Asthma and Allergy Association's Research Foundation, Centre for Allergy Research at Karolinska Institutet, Hesselman Foundation, Foundation Samariten, and Princess Lovisa's Association for Children's Medical Care. H. A. Sampson is on the Danone Scientific Advisory Board, has received consultancy fees from Allertein Therapeutics and the Food Allergy Initiative, is employed by Mount Sinai Medical School, has received research and travel support from the National Institute of Allergy and Infectious Diseases/National Institutes of Health, receives royalties from Elsevier-Wiley and UpToDate, and is 42.5% share owner in Hers Springs, LLC. C. Nilsson has received research support from the Centre for Allergy Research at Karolinska Institutet, Asthma and Allergy Association, Hesselman Foundation, Mjolkdroppen Foundation, and The Crownprincess Lovisa research foundation. The rest of the authors declare that they have no relevant conflicts.

    Cite this article as: Lieberman JA, Glaumann S, Batelsson S, Borres MP, Sampson HA, Nilsson C. The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations. J Allergy Clin Immunol: In Practice 2013;1:75-82. http://dx.doi.org/10.1016/j.jaip.2012.11.002.

    Current affiliation for J. A. Lieberman is the Division of Allergy & Immunology, Department of Pediatrics, The University of Tennessee, Memphis, Tenn.

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