Diagnostic accuracy of Ara h 2 for detecting peanut allergy in children.
| Title: | Diagnostic accuracy of Ara h 2 for detecting peanut allergy in children. |
|---|---|
| Authors: | Kansen HM; Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.; Department of Dermatology/Allergology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.; van Erp FC; Department of Dermatology/Allergology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.; Meijer Y; Department of Pediatric Allergology, Amsterdam University Medical Center, Amsterdam, The Netherlands.; Gorissen DMW; Department of Pediatrics, Deventer Hospital, Deventer, The Netherlands.; Stadermann M; Department of Allergology, Utrecht, The Netherlands.; van Velzen MF; Department of Pediatrics, Meander Medical Center, Amersfoort, The Netherlands.; Keusters WR; Julius Center for Health Sciences and Primary Care, University Medical Center, University of Utrecht, The Netherlands.; Frederix GWJ; Julius Center for Health Sciences and Primary Care, University Medical Center, University of Utrecht, The Netherlands.; Knulst AC; Department of Dermatology/Allergology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.; van der CK; Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.; Le TM; Department of Dermatology/Allergology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands. |
| Source: | Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology [Clin Exp Allergy] 2021 Aug; Vol. 51 (8), pp. 1069-1079. Date of Electronic Publication: 2021 Jul 29. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 8906443 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2222 (Electronic) Linking ISSN: 09547894 NLM ISO Abbreviation: Clin Exp Allergy Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford : Blackwell Scientific Publications, c1989- |
| MeSH Terms: | 2S Albumins, Plant/*immunology ; Antigens, Plant/*immunology ; Immunoglobulin E/*blood ; Peanut Hypersensitivity/*diagnosis; Peanut Hypersensitivity/blood ; Peanut Hypersensitivity/immunology ; Adolescent ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; Male ; Prospective Studies ; Reference Values |
| Abstract: | Background: Specific IgE to Ara h 2 is a diagnostic test for peanut allergy which may reduce the need for double-blind placebo-controlled food challenges (DBPCFC); however, guidance for using Ara h 2 in place of DBPCFCs has not been validated.; Objective: To prospectively evaluate 1) diagnostic accuracy of previously published Ara h 2 cut-off levels to diagnose peanut allergy in children and 2) costs.; Methods: A consecutive series of 150 children age 3.5 to 18 years was evaluated in secondary and tertiary settings in the Netherlands. sIgE to Ara h 2 was the index test, and oral peanut ingestion was the reference test. Oral peanut ingestion was home or supervised introduction for Ara h 2 ≤ 0.1, DBPCFC for 0.1-5.0 and open food challenge for ≥5.0. Costs were calculated using financial healthcare data.; Results: A conclusive reference test was performed in 113 children (75%). Sixty-four children (57%) had peanut allergy, as confirmed by a DBPCFC (27/47) or an open challenge (37/50). Forty-nine children (43%) were considered peanut-tolerant after peanut introduction (19/19), a DBPCFC (20/47) or an open challenge (10/50). Area under the curve for Ara h 2 was 0.94 (95% CI 0.90-0.98). The diagnostic flow chart correctly classified 26/26 (100%; 84-100) of children with Ara h 2 ≤ 0.1 as peanut-tolerant and 34/35 (97%; 83-100) of children with Ara h 2 ≥ 5.0 as peanut-allergic. At a cut-off of ≤0.1 and ≥5.0, a sensitivity of respectively 100% (93-100) and 53% (38-67) was observed and a specificity of 53% (38-67) and 98% (87-100). Mean annual costs of the flow chart were estimated as €320-€636 per patient lower than following national allergy guidelines.; Conclusions: In this diagnostic accuracy study, which did not take into account pretest probability, we have validated previously published Ara h 2 cut-off levels which are associated with peanut tolerance and allergy.; (© 2021 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.) |
| References: | J Allergy Clin Immunol. 2019 Mar;143(3):1243-1246. (PMID: 30445059); Allergy. 2011 Jul;66(7):948-54. (PMID: 21255039); J Allergy Clin Immunol. 2013 Jan;131(1):157-63. (PMID: 23026497); N Engl J Med. 2016 May 5;374(18):1733-43. (PMID: 26943128); J Allergy Clin Immunol Pract. 2015 Nov-Dec;3(6):968-9. (PMID: 25939537); J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):131-2.e1. (PMID: 25577637); Pediatr Allergy Immunol. 2010 Mar;21(2 Pt 2):e439-45. (PMID: 19694978); Allergy. 2014 Aug;69(8):992-1007. (PMID: 24816523); Clin Exp Allergy. 2018 Jan;48(1):60-65. (PMID: 28906044); Pediatr Allergy Immunol. 2018 Aug;29(5):527-537. (PMID: 29660855); Clin Transl Allergy. 2015 Feb 25;5:8. (PMID: 25774288); Clin Exp Allergy. 2019 Aug;49(8):1107-1115. (PMID: 31108010); Allergy. 2015 Apr;70(4):391-407. (PMID: 25620497); J Allergy Clin Immunol. 2017 Jan;139(1):358-360.e8. (PMID: 27516216); Allergy. 2013 Feb;68(2):190-4. (PMID: 23240588); Clin Transl Allergy. 2014 Nov 30;4(1):43. (PMID: 25493173); Ann Allergy Asthma Immunol. 2019 Apr;122(4):373-380.e1. (PMID: 30703439); J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):68-75. (PMID: 25577621); Ann Allergy Asthma Immunol. 2016 May;116(5):420-4. (PMID: 27017564); Int Arch Allergy Immunol. 2019;178(4):370-376. (PMID: 30677773); Allergy. 2014 Aug;69(8):1008-25. (PMID: 24909706); Pediatr Allergy Immunol. 2013 Nov;24(7):665-70. (PMID: 24112427); Int Arch Allergy Immunol. 2012;159(2):209-12. (PMID: 22677622); Clin Exp Allergy. 2021 Aug;51(8):1069-1079. (PMID: 34288182); Clin Exp Allergy. 2014 Mar;44(3):371-80. (PMID: 24345088) |
| Contributed Indexing: | Keywords: anxiety; component-resolved diagnostics; costs; food challenge; peanut allergy |
| Substance Nomenclature: | 0 (2S Albumins, Plant); 0 (Antigens, Plant); 0 (Ara h 2 allergen, Arachis hypogaea); 37341-29-0 (Immunoglobulin E) |
| Entry Date(s): | Date Created: 20210721 Date Completed: 20220228 Latest Revision: 20220228 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC8456915 |
| DOI: | 10.1111/cea.13987 |
| PMID: | 34288182 |
| Database: | MEDLINE |
Journal Article