Edited by: Antonella Muraro
Clinical value of component-resolved diagnostics in peanut-allergic patients
Article first published online: 14 DEC 2012
© 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd
Volume 68, Issue 2, pages 190–194, February 2013
How to Cite
Clinical value of component-resolved diagnostics in peanut-allergic patients. Allergy 2013; 68: 190–194., .
- Issue published online: 16 JAN 2013
- Article first published online: 14 DEC 2012
- Manuscript Accepted: 14 OCT 2012
- Ara h 2;
- diagnostic values;
As replacement for the oral food challenge, decision-points for sensitization test have been established, but suboptimal sensitivity and/or specificity, as well as regional differences, have reduced the clinical usability. IgE toward specific peanut protein components has been reported to be of value, but data on correlation with clinical data are sparse. Our aim was to correlate IgE values with the outcome of peanut challenges.
Data from 175 positive and 30 negative peanut challenges in patients aged 1–26 years were retrospectively correlated with the levels of specific IgE to peanut and peanut components (Ara h 1–3, h 8, and h 9).
The best correlation between IgE and clinical thresholds was found for Ara h 2 (ρs = −0.30, P < 0.01). A cutoff of Ara h 2 > 1.63 kU/l yielded a specificity = 1.00, with a corresponding sensitivity of 0.70. Symptom severity elicited during challenge correlated significantly with the levels of Ara h 2 (ρs = 0.60, P < 0.0001), but large individual variation was found.
The level of IgE toward Ara h 2 can improve diagnostic accuracy by introducing a more clear-cut decision-point with an optimal specificity maintaining a high sensitivity. In our study, this would have reduced the necessary number of challenges to be performed from 205 to 92. Extrapolation between centers is difficult and decision-points need to be addressed in relation to settings and population. Further component-resolved diagnostic cannot replace oral challenge neither in determining thresholds nor in the assessment of severity of symptoms elicited during challenge.