Prediction of anaphylaxis during peanut food challenge: usefulness of the peanut skin prick test (SPT) and specific IgE level
- 27 April 2010
- journal article
- Published by Wiley in Pediatric Allergy and Immunology
- Vol. 21 (4p1), 603-611
- https://doi.org/10.1111/j.1399-3038.2010.01063.x
Abstract
Cutoffs (decision points) of the peanut skin prick test (SPT) and specific IgE level for predicting peanut allergy have been proposed. It is not known whether decision points indicating a significant risk of severe reactions on challenge differ from those indicating probable allergy. We aimed at determining the usefulness of allergy tests for predicting the risk of anaphylaxis on challenge following the ingestion of up to 12 g of peanut in peanut-sensitized children. Children attending the Allergy Clinic who had a positive peanut SPT and completed open-label in-hospital peanut challenges were included. The challenge protocol provided for challenges to be continued beyond initial mild reactions. Eighty-nine in-hospital peanut challenges were performed. Thirty-four were excluded as the challenge was not completed, leaving 55 for analysis. Children who completed the challenge and did not react (n = 28) or reacted without anaphylaxis (n = 6) represented the comparison group (n = 34). The study group comprised 21 children whose challenge resulted in anaphylaxis. The mean peanut SPT wheal size and specific IgE level were associated with the severity of reactions on challenge. Among the 21 children, who developed anaphylaxis, in only 3 cases was anaphylaxis the initial reaction. Unexpectedly, a history of anaphylaxis was not predictive of anaphylaxis on challenge. Anaphylaxis developed at cumulative doses of peanut ranging from 0.02 to 11.7 g. Provided that a fixed amount of peanut is ingested, available tests for peanut allergy may assist in predicting the risk of anaphylaxis during challenge in peanut-sensitized children.Keywords
This publication has 39 references indexed in Scilit:
- Predictive value of skin prick tests using recombinant allergens for diagnosis of peanut allergyJournal of Allergy and Clinical Immunology, 2006
- Determination of no-observed-adverse-effect levels and eliciting doses in a representative group of peanut-sensitized childrenJournal of Allergy and Clinical Immunology, 2006
- Does severity of low‐dose, double‐blind, placebo‐controlled food challenges reflect severity of allergic reactions to peanut in the community?Clinical and Experimental Allergy, 2005
- A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?Clinical and Experimental Allergy, 2004
- Factors affecting the determination of threshold doses for allergenic foods: How much is too much?Journal of Allergy and Clinical Immunology, 2002
- A voluntary registry for peanut and tree nut allergy: Characteristics of the first 5149 registrants☆Journal of Allergy and Clinical Immunology, 2001
- The natural history of peanut allergy in young children and its association with serum peanut-specific IgEThe Journal of Pediatrics, 2000
- Food allergy to peanuts in France–evaluation of 142 observationsClinical and Experimental Allergy, 1998
- An evaluation of the sensitivity of subjects with peanut allergy to very low doses of peanut protein: A randomized, double-blind, placebo-controlled food challenge studyJournal of Allergy and Clinical Immunology, 1997
- Clinical characteristics of peanut allergyClinical and Experimental Allergy, 1997