Natural history of peanut allergy and predictors of resolution in the first 4 years of life: A population-based assessment - 11/05/15
, Shyamali C. Dharmage, MBBS, MSc, MD, PhD a, c, Jennifer J. Koplin, PhD a, Thanh Dang, PhD a, Kate P. Tilbrook, BSc a, b, Adrian Lowe, PhD a, c, Mimi L.K. Tang, MBBS, PhD, FRACP, FRCPA, FAAAAI a, b, d, Lyle C. Gurrin, PhD a, cfor the
HealthNuts study
Abstract |
Background |
There are no prospectively collected data available on the natural history of peanut allergy in early childhood. Previous studies of predictors of tolerance development have been biased by failure to challenge high-risk children when IgE antibody levels are high, therefore potentially introducing bias to persistent allergy.
Objectives |
We sought to describe the natural history of peanut allergy between 1 and 4 years of age and develop thresholds for skin prick test (SPT) results and specific IgE (sIgE) levels measured at age 1 and 4 years that have 95% positive predictive value (PPV) or negative predictive value for the persistence or resolution of peanut allergy.
Methods |
One-year-old infants with challenge-confirmed peanut allergy (n = 156) from the population-based, longitudinal HealthNuts Study (n = 5276) were followed up at 4 years of age with repeat oral food challenges, SPTs, and sIgE measurements (n = 103). Challenges were undertaken in all peanut-sensitized children at 1 and 4 years of age, irrespective of risk profile.
Results |
Peanut allergy resolved in 22% (95% CI, 14% to 31%) of children by age 4 years. Decreasing wheal size predicted tolerance, and increasing wheal size was associated with persistence. Thresholds for SPT responses and sIgE levels at age 1 year with a 95% PPV for persistent peanut allergy are an SPT-induced response of 13 mm or greater and an sIgE level of 5.0 kU/L or greater. Thresholds for SPT and sIgE results at age 4 years with a 95% PPV for persistent peanut allergy are an SPT response of 8 mm or greater and an sIgE level of 2.1 kU/L or greater. Ara h 2, tree nut, and house dust mite sensitization; coexisting food allergies; eczema; and asthma were not predictive of persistent peanut allergy.
Conclusion |
These thresholds are the first to be generated from a unique data set in which all participants underwent oral food challenges at both diagnosis and follow-up, irrespective of SPT and sIgE results.
Le texte complet de cet article est disponible en PDF.Key words : Peanut allergy, predictive value of tests, natural history, resolution, skin prick test, specific IgE
Abbreviations used : AUC, NPV, OFC, PPV, sIgE, SPT
Plan
| Supported by funding from the National Health and Medical Research Council (NHMRC) of Australia (ID 1006215), the Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, the Victorian Government's Operational Infrastructure Support Program, and the NHMRC Centre for Food and Allergy Research (ID 1041420). K.J.A. is a Viertel senior medical research fellow. R.L.P. is an Australian Postgraduate Award scholar. L.C.G., A.L., J.J.K., and S.C.D. hold NHMRC awards. |
|
| Disclosure of potential conflict of interest: This study was supported by funding from the National Health and Medical Research Council (NHMRC) of Australia (ID 1006215), Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, the Victorian Government's Operational Infrastructure Support Program, and the NHMRC Centre for Food and Allergy Research (ID 1041420). K. J. Allen is a Viertel senior medical research fellow; has received consultancy fees from Nutricia, Aspencare, Nestle, Abbot, and Danone, and a speaker honorarium from Wyeth; and sits on the board of the Ilhan Food Allergy Foundation. S. C. Dharmage, J. J. Koplin, and L. C. Gurrin all hold NHMRC awards. A. Lowe's institution has received funding from the NHMRC. M. L. K. Tang has received payment for delivering lectures from Danone and Nestle Nutrition Institution, as well as compensation for travel and other meeting-related expenses from the Asia Pacific Association of Pediatric Allergy, Respirology and Immunology. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 135 - N° 5
P. 1257 - mai 2015 Retour au numéro
Article précédent
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