Ara h 2–specific IgE is superior to whole peanut extract–based serology or skin prick test for diagnosis of peanut allergy in infancy

Corinne Keet, Mihaela Plesa, Daria Szelag, Wayne Shreffler, Robert Wood, Joan Dunlop, Roger Peng, Jennifer Dantzer, Robert G. Hamilton, Alkis Togias, Michael Pistiner

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Screening of high-risk infants for peanut allergy (PA) before introduction is now recommended in the United States, but the optimal approach is not clear. Objective: We sought to compare the diagnostic test characteristics of peanut skin prick test (SPT), peanut-specific IgE (sIgE), and sIgE to peanut components in a screening population of infants before known peanut exposure. Methods: Infants aged 4 to 11 months with (1) no history of peanut ingestion, testing, or reaction and (2) (a) moderate-severe eczema, (b) history of food allergy, and/or (c) first-degree relative with a history of PA received peanut SPT, peanut-sIgE and component-IgE testing, and, depending on SPT wheal size, oral food challenge or observed feeding. Receiver-operator characteristic areas under the curve (AUCs) were compared, and diagnostic sensitivity and specificity were calculated. Results: A total of 321 subjects completed the enrollment visit (median age, 7.2 months; 58% males), and 37 (11%) were found to have PA. Overall, Ara h 2-sIgE at a cutoff point of 0.1 kUa/L discriminated between allergic and nonallergic best (AUC, 0.96; sensitivity, 94%; specificity, 98%), compared with peanut-sIgE at 0.1 kUa/L (AUC, 0.89; sensitivity, 100%; specificity, 78%) or 0.35 kUa/L (AUC, 0.91; sensitivity, 97%; specificity, 86%), or SPT at wheal size 3 mm (AUC, 0.90; sensitivity, 92%; specificity, 88%) or 8 mm (AUC, 0.87; sensitivity, 73%; specificity, 99%). Ara h 1-sIgE and Ara h 3-sIgE did not add to prediction of PA when included in a model with Ara h 2-sIgE, and Ara h 8-sIgE discriminated poorly (AUC, 0.51). Conclusions: Measurement of only Ara h 2-sIgE should be considered if screening of high-risk infants is performed before peanut introduction.

Original languageEnglish (US)
Pages (from-to)977-983.e2
JournalJournal of Allergy and Clinical Immunology
Volume147
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Ara h-2
  • Peanut allergy
  • diagnostic test
  • peanut components
  • screening
  • skin prick test

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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