| Title: |
Diagnostic accuracy of Ara h 2 for detecting peanut allergy in children |
| Authors: |
Kansen, Hannah M.; van Erp, Francine C.; Meijer,Yolanda; Gorissen,Dianne M.W.; Stadermann,Marike; van Velzen, Maartje F.; Keusters, Willem R.; Frederix, Geert W.J.; Knulst, André C.; van der, Cornelis K.; Le, Thuy My; Longziekten onderzoek 1; Unit Opleiding Dermatologie; Longziekten patientenzorg; HEE; Child Health; JC onderzoeksprogramma Methodology; MS Dermatologie/Allergologie; Infection & Immunity; Speerpunt Child Health |
| Publication Year: |
2021 |
| Subject Terms: |
anxiety; component-resolved diagnostics; costs; food challenge; peanut allergy; Journal Article |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
text/plain |
| Language: |
English |
| ISSN: |
0954-7894 |
| Relation: |
https://dspace.library.uu.nl/handle/1874/443362 |
| Availability: |
https://dspace.library.uu.nl/handle/1874/443362 |
| Rights: |
info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.646E1DBF |
| Database: |
BASE |