期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
卷 146, 期 2, 页码 344-355出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2020.03.035
关键词
Basophil; basophil activation test; diagnosis; food allergy; LEAP study; peanut allergy; severity; threshold; adverse events
资金
- Immune Tolerance Network
- National Institute of Allergy and Infectious Diseases of the National Institutes of Health [UM1AI109565]
- Medical Research Council (MRC) [G090218, MR/M008517/1]
- Asthma UK Centre
- UK Department of Health through the National Institute for Health Research Comprehensive Biomedical Research Centre
- King's College London
- King's College HospitalNHS Foundation Trust
- National Peanut Board, Atlanta, Ga
- Davis Foundation
- MRC [G0902018, MR/M008517/1] Funding Source: UKRI
Background: Oral food challenge (OFC) is the criterion standard to assess peanut allergy (PA), but it involves a risk of allergic reactions of unpredictable severity. Objective: Our aim was to identify biomarkers for risk of severe reactions or low dose threshold during OFC to peanut. Methods: We assessed Learning Early about Peanut Allergy study, Persistance of Oral Tolerance to Peanut study, and Peanut Allergy Sensitization study participants by administering the basophil activation test (BAT) and the skin prick test (SPT) and measuring the levels of peanut-specific IgE, Arachis hypogaea 2 specific IgE, and peanut-specific IgG4, and we analyzed the utility of the different biomarkers in relation to PA status, severity, and threshold dose of allergic reactions to peanut during OFC. Results: When a previously defined optimal cutoff was used, the BAT diagnosed PA with 98% specificity and 75% sensitivity. The BAT identified severe reactions with 97% specificity and 100% sensitivity. The SPT, level of Arachis hypogaea 2 specific IgE, level of peanut-specific IgE, and IgG4/IgE ratio also had 100% sensitivity but slightly lower specificity (92%, 93%, 90%, and 88%, respectively) to predict severity. Participants with lower thresholds of reactivity had higher basophil activation to peanut in vitro. The SPT and the BAT were the best individual predictors of threshold. Multivariate models were superior to individual biomarkers and were used to generate nomograms to calculate the probability of serious adverse events during OFC for individual patients. Conclusions: The BAT diagnosed PA with high specificity and identified severe reactors and low threshold with high specificity and high sensitivity. The BAT was the best biomarker for severity, surpassed only by the SPT in predicting threshold. Nomograms can help estimate the likelihood of severe reactions and reactions to a low dose of allergen in individual patients with PA.
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