Diagnosis of Peanut Allergy in Preschool Children: The Impact of Skin Testing With a Novel Composition of Peanuts.

Mona I Kidon,Ron S Kenett,Ramit Maoz-Segal,Nancy Agmon-Levin,Ran Hovav,Yael Levy,Irena Offenganden,Shirli Frizinsky,Soad Haj Yahia,Diti Machnes-Maayan

doi:10.3389/fped.2021.739224

Abstract

Peanut allergy is an increasing concern in younger children. Available bedside diagnostic tools, i.e., prick tests with commercial extracts or peanut-containing foods have only limited predictive values. In a cohort of preschoolers with both a history of allergic reactions and sensitization to peanut proteins, we aimed to characterize the impact of skin tests with a novel composition of peanuts LPP-MH. Almost one quarter (27/110) of preschool children, with a history of allergic reactions to peanuts and positive standard IgE-mediated tests for peanut allergy, can tolerate the reintroduction of peanut proteins into their diet after resolving their allergy and, thus, can avoid adverse health outcomes associated with the false diagnosis. In the younger age group, a quarter of peanut allergic children, display a relatively high threshold, potentially enabling an easier and safer oral immunotherapy protocol in this window of opportunity in childhood. The use of the novel diagnostic skin test, LPP-MH, significantly improves the predictive value of outpatient evaluation for the outcomes of peanut challenge as well as the expected threshold at which the PA child will react, thus, making for a better informed decision of how, when, and where to challenge.

Highlights

Peanut allergy continues to be a significant burden to children and families worldwide [1,2,3]
The aim of our study was to explore the value of skin testing with the new lyophilized peanut preparation of immature seeds developed by the Volcani Agricultural Research Center (LPPMH), for the diagnosis of peanut allergy in preschool children at high risk as well as estimating the minimal eliciting threshold for an allergic reaction in these children
We have presented a series of statements, as a formal application of Meaning Equivalence Reusable Learning Objects (MERLO) statements to define a boundary of meaning (BOM) representing a generalizability of findings in this paper

Summary

Introduction

Peanut allergy continues to be a significant burden to children and families worldwide [1,2,3]. 95% confidence levels for both skin tests and peanut-specific IgE have been published [7], and component resolved diagnostics (CRD) have been proposed to improve diagnostic accuracy [8,9,10], medically supervised oral food challenges (OFCs) are still the “gold standard” [6] for diagnosis. A false-positive diagnosis incurs both severe quality of life (QOL) impairment, heightened anxiety from accidental ingestion, and may limit participation in social events, school, and work. This falsely incurred diagnosis increases the risk of developing true lifethreatening allergy secondary to -erm avoidance [15, 16]. Improving the pre challenge diagnostic accuracy is a priority

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