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

被引:335
作者
Nicolaou, Nicolaos [1 ]
Poorafshar, Maryam [2 ]
Murray, Clare [1 ]
Simpson, Angela [1 ]
Winell, Henric [2 ]
Kerry, Gina [1 ]
Haerlin, Annika [2 ]
Woodcock, Ashley [1 ]
Ahlstedt, Staffan [3 ]
Custovic, Adnan [1 ]
机构
[1] Univ Manchester, Univ Hosp S Manchester NHS Fdn Trust, Sch Translat Med, NIHR Translat Res Facil Resp Med, Manchester M23 9LT, Lancs, England
[2] Phadia AB, Uppsala, Sweden
[3] Karolinska Inst, Natl Inst Environm Med, Ctr Allergy Res, Stockholm, Sweden
基金
英国医学研究理事会;
关键词
Peanut allergy; oral food challenge; component-resolved diagnostics; Ara h 2; microarray; birth cohort; FOOD CHALLENGES; RECOMBINANT ALLERGENS; SKIN PRICK; IGE; IDENTIFICATION; ASSOCIATION; DERMATITIS; REACTIVITY; HISTORY;
D O I
10.1016/j.jaci.2009.10.008
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
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. Q Allergy Clin Immunol 2010;125:191-7.)
引用
收藏
页码:191 / 197
页数:7
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