Abstract
BackgroundTo date, diagnosing food allergies in children still presents a diagnostic dilemma, leading to uncertainty concerning the definite diagnosis of peanut allergy, as well as to the need for strict diets and the potential need for adrenalin auto-injectors. This uncertainty in particular is thought to contribute to a lower quality of life. In the diagnostic process double-blind food challenges are considered the gold standard, but they are time-consuming as well as potentially hazardous. Other diagnostic tests have been extensively studied and among these component-resolved diagnostics appeared to present a promising alternative: Ara h2, a peanut storage protein in previous studies showed to have a significant predictive value.MethodsSixty-two out of 72 children, with suspected peanut allergy were analyzed using serum specific IgE and/or skin prick tests and specific IgE to several components of peanut (Ara h 1, 2, 3, 6, 8, 9). Subsequently, double-blind food challenges were performed. The correlation between the various diagnostic tests and the overall outcome of the double-blind food challenges were studied, in particular the severity of the reaction and the eliciting dose.ResultsThe double-blind provocation with peanut was positive in 33 children (53 %). There was no relationship between the eliciting dose and the severity of the reaction. A statistically significant relationship was found between the skin prick test, specific IgE directed to peanut, Ara h 1, Ara h 2 or Ara h 6, and the outcome of the food challenge test, in terms of positive or negative (P < .001). However, we did not find any relationship between sensitisation to peanut extract or the different allergen components and the severity of the reaction or the eliciting dose. There was no correlation between IgE directed to Ara h 3, Ara h 8, Ara h 9 and the clinical outcome of the food challenge.ConclusionsThis study shows that component-resolved diagnostics is not superior to specific IgE to peanut extract or to skin prick testing. At present, it cannot replace double-blind placebo-controlled food challenges for determination of the eliciting dose or the severity of the peanut allergy in our patient group.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0609-7) contains supplementary material, which is available to authorized users.
Highlights
To date, diagnosing food allergies in children still presents a diagnostic dilemma, leading to uncertainty concerning the definite diagnosis of peanut allergy, as well as to the need for strict diets and the potential need for adrenalin auto-injectors
In this study we investigated the predictive value of component-resolved diagnostics for a clinical relevant allergy in a group of consecutive children suspected of a peanut allergy
The cohort predominantly consisted of boys (74 %) and children had a median age of 7.9 years
Summary
Study design (Additional file 1) In 2012 and 2013 consecutive patients attending our outpatient clinic were asked to participate in this prospective cohort study. Children were suspected of having a peanut allergy, because of a history of an allergic reaction in the past or sensitisation to peanut with no or unknown exposure In the latter group the sensitisation was found by previous testing for various reasons. Tests for sensitisation Measurement of peanut-specific IgE (sIgE) was performed in all children using the 3gAllergyTM assay on an IMMULITE® 2000 XPi system (Siemens), according to the manufacturers instructions. Severe food challenge outcome (FCO) was defined as a positive FCO with a severe respiratory and/or cardiovascular reaction of Sampson’s grade 3 or 4. These children were treated with epinephrine intramuscularly. A P-value < .05 was considered statistically significant at the 95 % confidence level
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