Accuracy of component-resolved diagnostics in peanut allergy: Systematic literature review and meta-analysis

Caroline Nilsson, Malin Berthold, Barbara Mascialino, Michelle E. Orme, Sigrid Sjölander, Robert G. Hamilton

Research output: Contribution to journalArticlepeer-review


Background: Peanut allergy diagnosis relies on clinical reactivity to peanut supported by detection of specific IgE (sIgE) antibodies. Extract-based sIgE tests have low specificity, so component-resolved diagnostics may complement whole-extract testing. Methods: We systematically collected peanut allergen component data in seven databases and studied the diagnostic accuracy of peanut storage proteins (Arah1, 2, 3) and cross-reactive peanut proteins (Arah8 PR-10 and Arah9 lipid transfer protein) through meta-analyses. The systematic literature review included studies employing peanut components and oral food challenge (OFC) as reference standard in patients suspected of peanut allergy. Data for component sIgE at pre-defined detection thresholds were extracted and combined in random-effects bivariate meta-analyses. Risk of bias was assessed as recommended by Cochrane, with two additional quality items of importance for this review. Results: Nineteen eligible studies presented data suitable for meta-analysis. In cross-sectional pediatric studies, the pooled sensitivity of Arah2-sIgE at 0.35 kUA/L cutoff was 83.3% [95% CI 75.6, 88.9] and specificity in diagnosing objective peanut allergy was 83.6% [95% CI 77.4, 88.4]. Compared with 0.1 and 1.0 kUA/L, this threshold provided the best diagnostic accuracy. At 0.35 kUA/L, Arah1 and Arah3 had comparable specificity (86.0% and 88.0%, respectively) but significantly lower sensitivity compared with Arah2 (37.0% and 39.1%, respectively; P <.05). Conclusion: sIgE to Arah2 can enhance the certainty of diagnosis and reduce the number of OFC necessary to rule out clinical peanut allergy in unclear cases.

Original languageEnglish (US)
Pages (from-to)303-314
Number of pages12
JournalPediatric Allergy and Immunology
Issue number3
StatePublished - Apr 1 2020


  • Arah1
  • Arah2
  • Arah3
  • Arah8
  • allergen
  • component-resolved diagnostics
  • peanut
  • storage protein

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Immunology


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