Development of a tool predicting severity of allergic reaction during peanut challenge

R. Sharon Chinthrajah, Natasha Purington, Sandra Andorf, Jaime S. Rosa, Kaori Mukai, Robert G Hamilton, Bridget Marie Smith, Ruchi Gupta, Stephen J. Galli, Manisha Desai, Kari C. Nadeau

Research output: Contribution to journalArticle

Abstract

Background: Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established. Objective: To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC. Methods: Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC. Results: A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63hi stimulation with peanut to percentage of CD63hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P <.001). Conclusion: The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV1/FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings. Trial Registration: ClinicalTrials.gov identifier: NCT02103270.

Original languageEnglish (US)
Pages (from-to)69-76.e2
JournalAnnals of Allergy, Asthma and Immunology
Volume121
Issue number1
DOIs
StatePublished - Jul 1 2018

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Hypersensitivity
Food
Exercise-Induced Asthma
Vital Capacity
Forced Expiratory Volume
Basophils
Information Storage and Retrieval
Arachis
Immunoglobulin E
Placebos
Demography
Research

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Development of a tool predicting severity of allergic reaction during peanut challenge. / Chinthrajah, R. Sharon; Purington, Natasha; Andorf, Sandra; Rosa, Jaime S.; Mukai, Kaori; Hamilton, Robert G; Smith, Bridget Marie; Gupta, Ruchi; Galli, Stephen J.; Desai, Manisha; Nadeau, Kari C.

In: Annals of Allergy, Asthma and Immunology, Vol. 121, No. 1, 01.07.2018, p. 69-76.e2.

Research output: Contribution to journalArticle

Chinthrajah, RS, Purington, N, Andorf, S, Rosa, JS, Mukai, K, Hamilton, RG, Smith, BM, Gupta, R, Galli, SJ, Desai, M & Nadeau, KC 2018, 'Development of a tool predicting severity of allergic reaction during peanut challenge', Annals of Allergy, Asthma and Immunology, vol. 121, no. 1, pp. 69-76.e2. https://doi.org/10.1016/j.anai.2018.04.020
Chinthrajah, R. Sharon ; Purington, Natasha ; Andorf, Sandra ; Rosa, Jaime S. ; Mukai, Kaori ; Hamilton, Robert G ; Smith, Bridget Marie ; Gupta, Ruchi ; Galli, Stephen J. ; Desai, Manisha ; Nadeau, Kari C. / Development of a tool predicting severity of allergic reaction during peanut challenge. In: Annals of Allergy, Asthma and Immunology. 2018 ; Vol. 121, No. 1. pp. 69-76.e2.
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AU - Andorf, Sandra

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AU - Mukai, Kaori

AU - Hamilton, Robert G

AU - Smith, Bridget Marie

AU - Gupta, Ruchi

AU - Galli, Stephen J.

AU - Desai, Manisha

AU - Nadeau, Kari C.

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N2 - Background: Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established. Objective: To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC. Methods: Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC. Results: A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63hi stimulation with peanut to percentage of CD63hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P <.001). Conclusion: The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV1/FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings. Trial Registration: ClinicalTrials.gov identifier: NCT02103270.

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