Prediction of anaphylaxis during peanut food challenge: usefulness of the peanut skin prick test (SPT) and specific IgE level

Authors

  • Brynn Kevin Wainstein,

    1. Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, High Street, Randwick, Sydney, New South Wales, Australia
    2. School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
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  • Jennie Studdert,

    1. Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, High Street, Randwick, Sydney, New South Wales, Australia
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  • Mary Ziegler,

    1. Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, High Street, Randwick, Sydney, New South Wales, Australia
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  • John B. Ziegler

    1. Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, High Street, Randwick, Sydney, New South Wales, Australia
    2. School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
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  • [Correction added after online publication 27-April-2010: References 31–40 has been added and cited throughout the text.]

Dr Brynn Wainstein, Department of Immunology and Infectious Diseases, Level 4, Sydney Children’s Hospital, High Street, Randwick, Sydney, New South Wales 2031, Australia
Tel.: +61 2 9382 1515
Fax: +61 2 9382 1580
E-mail: brynn.wainstein@sesiahs.health.nsw.gov.au

Abstract

Wainstein BK, Studdert J, Ziegler, M, Ziegler JB. Prediction of anaphylaxis during peanut food challenge: usefulness of the peanut skin prick test (SPT) and specific IgE level.
Pediatr Allergy Immunol 2010: 21: 603–611.
© 2010 John Wiley & Sons A/S

Cutoffs (decision points) of the peanut skin prick test (SPT) and specific IgE level for predicting peanut allergy have been proposed. It is not known whether decision points indicating a significant risk of severe reactions on challenge differ from those indicating probable allergy. We aimed at determining the usefulness of allergy tests for predicting the risk of anaphylaxis on challenge following the ingestion of up to 12 g of peanut in peanut-sensitized children. Children attending the Allergy Clinic who had a positive peanut SPT and completed open-label in-hospital peanut challenges were included. The challenge protocol provided for challenges to be continued beyond initial mild reactions. Eighty-nine in-hospital peanut challenges were performed. Thirty-four were excluded as the challenge was not completed, leaving 55 for analysis. Children who completed the challenge and did not react (n = 28) or reacted without anaphylaxis (n = 6) represented the comparison group (n = 34). The study group comprised 21 children whose challenge resulted in anaphylaxis. The mean peanut SPT wheal size and specific IgE level were associated with the severity of reactions on challenge. Among the 21 children, who developed anaphylaxis, in only 3 cases was anaphylaxis the initial reaction. Unexpectedly, a history of anaphylaxis was not predictive of anaphylaxis on challenge. Anaphylaxis developed at cumulative doses of peanut ranging from 0.02 to 11.7 g. Provided that a fixed amount of peanut is ingested, available tests for peanut allergy may assist in predicting the risk of anaphylaxis during challenge in peanut-sensitized children.

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