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Skin prick testing predicts peanut challenge outcome in previously allergic or sensitized children with low serum peanut‐specific IgE antibody concentration

Skin prick testing predicts peanut challenge outcome in previously allergic or sensitized... Peanut allergy is transient in some children but it is not clear whether quantitating peanut‐specific IgE by Skin Prick Test (SPT) adds additional information to fluorescent‐enzyme immunoassay (FEIA) in discriminating between allergic and tolerant children. To investigate whether SPT with a commercial extract or fresh foods adds additional predictive information for peanut challenge in children with a low FEIA (<10 kUA/L) who were previously sensitized, or allergic to peanuts. Children from a hospital‐based allergy service who were previously sensitized or allergic to peanuts were invited to undergo a peanut challenge unless they had a serum peanut‐specific IgE>10 kUA/L, a previous severe reaction, or a recent reaction to peanuts (within two years). SPT with a commercial extract, raw and roasted saline soaked peanuts was performed immediately prior to open challenge in hospital with increasing quantity of peanuts until total of 26.7 g of peanut was consumed. A positive challenge consisted of an objective IgE mediated reaction occurring during the observation period. 54 children (median age of 6.3 years) were admitted for a challenge. Nineteen challenges were positive, 27 negative, five were indeterminate and three did not proceed after SPT. Commercial and fresh food extracts provided similar diagnostic information. A wheal diameter of ≥7 mm of the commercial extract predicted an allergic outcome with specificity 97%, positive predictive value 93% and sensitivity 83%. There was a tendency for an increase in SPT wheal since initial diagnosis in children who remained allergic to peanuts while it decreased in those with a negative challenge. The outcome of a peanut challenge in peanut sensitized or previously allergic children with a low FEIA can be predicted by SPT. In this cohort, not challenging children with a SPT wheal of ≥7mm would have avoided 15 of 18 positive challenges and denied a challenge to one out of 27 tolerant children. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pediatric Allergy and Immunology Wiley

Skin prick testing predicts peanut challenge outcome in previously allergic or sensitized children with low serum peanut‐specific IgE antibody concentration

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References (26)

Publisher
Wiley
Copyright
Copyright © 2007 Wiley Subscription Services, Inc., A Wiley Company
ISSN
0905-6157
eISSN
1399-3038
DOI
10.1111/j.1399-3038.2007.00519.x
pmid
17433000
Publisher site
See Article on Publisher Site

Abstract

Peanut allergy is transient in some children but it is not clear whether quantitating peanut‐specific IgE by Skin Prick Test (SPT) adds additional information to fluorescent‐enzyme immunoassay (FEIA) in discriminating between allergic and tolerant children. To investigate whether SPT with a commercial extract or fresh foods adds additional predictive information for peanut challenge in children with a low FEIA (<10 kUA/L) who were previously sensitized, or allergic to peanuts. Children from a hospital‐based allergy service who were previously sensitized or allergic to peanuts were invited to undergo a peanut challenge unless they had a serum peanut‐specific IgE>10 kUA/L, a previous severe reaction, or a recent reaction to peanuts (within two years). SPT with a commercial extract, raw and roasted saline soaked peanuts was performed immediately prior to open challenge in hospital with increasing quantity of peanuts until total of 26.7 g of peanut was consumed. A positive challenge consisted of an objective IgE mediated reaction occurring during the observation period. 54 children (median age of 6.3 years) were admitted for a challenge. Nineteen challenges were positive, 27 negative, five were indeterminate and three did not proceed after SPT. Commercial and fresh food extracts provided similar diagnostic information. A wheal diameter of ≥7 mm of the commercial extract predicted an allergic outcome with specificity 97%, positive predictive value 93% and sensitivity 83%. There was a tendency for an increase in SPT wheal since initial diagnosis in children who remained allergic to peanuts while it decreased in those with a negative challenge. The outcome of a peanut challenge in peanut sensitized or previously allergic children with a low FEIA can be predicted by SPT. In this cohort, not challenging children with a SPT wheal of ≥7mm would have avoided 15 of 18 positive challenges and denied a challenge to one out of 27 tolerant children.

Journal

Pediatric Allergy and Immunology – Wiley

Published: May 1, 2007

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