Abstract
The usefulness of peanut specific IgE levels for diagnosing peanut allergy has not been studied in primary and secondary care where most cases of suspected peanut allergy are being evaluated. We aimed to determine the relationship between peanut-specific IgE levels and clinical peanut allergy in peanut-sensitized children and how this was influenced by eczema, asthma and clinical setting (primary or secondary care). We enrolled 280 children (0–18 years) who tested positive for peanut-specific IgE (> 0.35 kU/L) requested by primary and secondary physicians. We used predefined criteria to classify participants into three groups: peanut allergy, no peanut allergy, or possible peanut allergy, based on responses to a validated questionnaire, a detailed food history, and results of oral food challenges.Fifty-two participants (18.6%) were classified as peanut allergy, 190 (67.9%) as no peanut allergy, and 38 (13.6%) as possible peanut allergy. The association between peanut-specific IgE levels and peanut allergy was significant but weak (OR 1.46 for a 10.0 kU/L increase in peanut-specific IgE, 95% CI 1.28-1.67). Eczema was the strongest risk factor for peanut allergy (aOR 3.33, 95% CI 1.07-10.35), adjusted for demographic and clinical characteristics. Asthma was not significantly related to peanut allergy (aOR 1.93, 95% CI 0.90-4.13). Peanut allergy was less likely in primary than in secondary care participants (OR 0.46, 95% CI 0.25-0.86), at all levels of peanut-specific IgE.The relationship between peanut-specific IgE and peanut allergy in children is weak, is strongly dependent on eczema, and is weaker in primary compared to secondary care. This limits the usefulness of peanut-specific IgE levels in the diagnosis of peanut allergy in children.
Highlights
The double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for diagnosing peanut allergy [1], its use in daily practice is limited because it is time consuming, expensive, and not available in all hospitals
As peanut-specific IgE levels have only been studied in general population samples or in tertiary care food allergy centres, it’s unclear how useful they are in predicting clinical peanut allergy in children seen in primary and secondary care, where most cases of suspected peanut allergy are evaluated
This study shows that the relationship between peanutspecific IgE and peanut allergy is significantly and strongly influenced by the presence of eczema, and differs between children in primary and secondary care
Summary
The double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for diagnosing peanut allergy [1], its use in daily practice is limited because it is time consuming, expensive, and not available in all hospitals. There are no universally agreed criteria for a suggestive clinical history Are both objective symptoms, such as urticaria or vomiting, High levels of peanut-specific IgE are taken to indicate clinical allergy to peanut [6]. The cut-off levels of peanut-specific IgE above which >95% of children are clinically allergic to peanut vary from 15 to 57 kU/l in different studies [6,7,8,9]. This is likely to result van Veen et al Clinical and Translational Allergy 2013, 3:34 http://www.ctajournal.com/content/3/1/34 from differences in study populations and food challenge protocols. As peanut-specific IgE levels have only been studied in general population samples or in tertiary care food allergy centres, it’s unclear how useful they are in predicting clinical peanut allergy in children seen in primary and secondary care, where most cases of suspected peanut allergy are evaluated
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