NDLI: Skin prick testing and peanut-specific IgE can predict peanut challenge outcomes in preschoolchildren with peanut sensitization.

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Skin prick testing and peanut-specific IgE can predict peanut challenge outcomes in preschoolchildren with peanut sensitization.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Johannsen, H. Nolan, R. Pascoe, E. M. Cuthbert, P. Noble, V. Corderoy, T. Franzmann, A. Loh, R. Prescott, S. L.
Description	Country affiliation: Australia Author Affiliation: Johannsen H ( School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.)
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 preschoolchildren with peanut sensitization. METHODS: Forty-nine preschoolchildren (<5 years of age) with peanut sensitization (SPT ≥ 2 mm or peanut-specific IgE ≥ 0.35 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 >7 mm 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 >2.0 kU/L showed a sensitivity of 79% and an NPV of 80%. Predicting challenge outcome from a combination of SPT and FEIA (SPT >7 and/or FEIA >2 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 SPT<7 mm and FEIA<2 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.
File Format	HTM / HTML
ISSN	09547894
Issue Number	7
Volume Number	41
e-ISSN	13652222
Journal	Clinical & Experimental Allergy
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2011-07-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Immunology Antibody Specificity Arachis Hypogaea Immunology Immunoglobulin E Blood Peanut Hypersensitivity Diagnosis Child, Preschool Humans Immune Tolerance Immunoenzyme Techniques Methods Infant Epidemiology Predictive Value Of Tests Skin Tests Treatment Outcome Evaluation Studies Journal Article
Content Type	Text
Resource Type	Article
Subject	Immunology and Allergy Immunology

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