Skin prick testing and peanut specific IgE can predict challenge outcome in preschool children with peanut senzitisation

Johannsen, H., Nolan, R., Pascoe, E. M., Cuthbert, P., Noble, V., Corderoy, T., Franzmann, A., Loh, R. and Prescott, S. L. (2011) Skin prick testing and peanut specific IgE can predict challenge outcome in preschool children with peanut senzitisation. Clinical & Experimental Allergy, 41 7: 994-1000. doi:10.1111/j.1365-2222.2011.03717.x


Author Johannsen, H.
Nolan, R.
Pascoe, E. M.
Cuthbert, P.
Noble, V.
Corderoy, T.
Franzmann, A.
Loh, R.
Prescott, S. L.
Title Skin prick testing and peanut specific IgE can predict challenge outcome in preschool children with peanut senzitisation
Journal name Clinical & Experimental Allergy   Check publisher's open access policy
ISSN 0954-7894
1365-2222
Publication date 2011-07-01
Sub-type Article (original research)
DOI 10.1111/j.1365-2222.2011.03717.x
Volume 41
Issue 7
Start page 994
End page 1000
Total pages 7
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell
Language eng
Formatted abstract
Background The rise in peanut allergy is a source of considerable burden in the community. A growing number of preschoolchildren have been identified as peanut sensitized in the course of investigation of other allergic conditions. Although many have never knowingly ingested peanuts and their clinical reactivity is not known, it has been common practice to place these children on avoidance diets for many years.
Objective To determine the utility of skin prick tests (SPT) and fluorescent-enzyme
immunoassays (FEIA) for identifying either peanut allergy or tolerance in preschool children with peanut sensitization.
Methods Forty-nine preschoolchildren (o5 years of age) with peanut sensitization (SPT X2mm or peanut-specific IgEX0.35 kU/L) but unknown clinical reactivity had graded open peanut challenges reaching a total of 11 g. A positive challenge was defined as an objective IgE-mediated reaction during challenge or the 2-h observation.
Results Forty-nine percent (24/49) of children had positive challenges. An SPT of 47mm on the day of challenge predicted a positive challenge with a sensitivity of 83% and a negative predictive value (NPV) of 84%. An FEIA of 42.0 kU/L showed a sensitivity of 79% and an NPV of 80%. Predicting challenge outcome from a combination of SPT and FEIA (SPT 47 and/or FEIA 42 is positive) increased sensitivity to 96% and NPV to 95%.
Conclusion and Clinical Relevance At least half of preschoolchildren with peanut sensitization and no antecedent history of peanut ingestion can tolerate peanuts. A SPTo7mm and FEIAo2 kU/L identify children most likely to tolerate peanut, with only a 5% likelihood of failing an oral challenge. This study assists clinicians considering challenges in very young peanut-sensitized children.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Wed, 27 Jun 2012, 01:50:42 EST by Elaine Pascoe on behalf of Medicine - Princess Alexandra Hospital