Early clinical predictors of remission of peanut allergy in children

被引:108
作者
Ho, Marco H. K. [1 ]
Wong, Wilfred H. S. [2 ]
Heine, Ralf G. [1 ,3 ,4 ]
Hosking, Clifford S. [5 ]
Hill, David J. [3 ]
Allen, Katrina J. [1 ,3 ,4 ,5 ]
机构
[1] Royal Childrens Hosp, Dept Allergy & Immunol, Parkville, Vic 3052, Australia
[2] Univ Hong Kong, Dept Pediat & Adolescent Med, Hong Kong, Hong Kong, Peoples R China
[3] Murdoch Childrens Res, Melbourne, Vic, Australia
[4] Univ Melbourne, Dept Pediat, Parkville, Vic 3052, Australia
[5] John Hunter Childrens Hosp, Newcastle, NSW, Australia
基金
英国医学研究理事会;
关键词
peanut allergy; tree nut; sesame; clinical predictors; skin prick test; peanut-specific IgE;
D O I
10.1016/j.jaci.2007.11.024
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: Understanding predictors of clinical remission would assist in clinical management of peanut allergy. Objective: We sought to determine the early clinical predictors of peanut allergy remission using a longitudinal cohort of young children with peanut allergy. Methods: Consecutive patients less than 2 years of age with peanut allergy were identified on the basis of skin prick test (SPT) wheal size of 95% positive predictive value or greater. Baseline SPT responses to peanuts, tree nuts, and sesame and serum peanut-specific IgE antibody levels were documented, and follow-up studies were conducted at 1- to 2-year intervals for up to 8 years. Peanut food challenges were performed when SPT responses decreased to less than the 95% positive predictive value for peanut allergy. Results: SPT wheal diameters to peanut extract of 6 rum or greater (hazard ratio, 2.16; 95% CI, 1.23-3.786; P = .008) and peanut-specific IgE antibody of 3 kUA/L or greater (hazard ratio, 2.74; 95% CI, 1.13-6.61; P = .025) before the age of 2 years were independent predictors of persistent peanut allergy. Mean SPT wheal diameters of nonremitters increased (r = 0.31, P < .001), whereas those of remitters decreased (r = -0.26, P = .002) between 1 and 4 years of age. Twenty-one percent of young children with peanut allergy became clinically tolerant by age 5 years. Conclusions: Remission of peanut allergy can be predicted by low levels of IgE antibodies to peanut in the first 2 years of life or decreasing levels of IgE sensitization by the age of 3 years.
引用
收藏
页码:731 / 736
页数:6
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