The Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Allergy. 2015 Oct;70(10):1239-45. doi: 10.1111/all.12671. Epub 2015 Jul 1.
Component-resolved diagnostics offers a modern tool in peanut allergy, but studies applying consistently double-blind placebo-controlled challenges are lacking. We aimed to optimize diagnostics for moderate-to-severe peanut allergy in a birch-endemic region and to create an oral-peanut challenge with its allergen activity characterized.
We performed double-blind placebo-controlled peanut challenges for a referred sample of 6- to 18-year-olds with peanut sensitization or a high suspicion of peanut allergy, including anaphylaxis. We measured specific IgE (sIgE) to Ara h 1, 2, 3, 6, 8, and 9. Testing of allergen activity of the challenge products was by IgE microarray inhibition.
Of the 102 patients, 69 were challenge positive: 25 (36%) had severe, 36 (52%) moderate, and 8 (12%) mild symptoms; 38 (37%) received adrenalin. SIgE to Ara h 6 AUC 0.98 (95%CI, 0.96-1.00) was the best marker of moderate-to-severe allergy. When sIgE to Ara h 2 and Ara h 6 was measured together, all (100%) severe reactions at low doses were successfully diagnosable. SIgE to Ara h 8 had no diagnostic value, AUC 0.42 (95%CI, 0.30-0.52). Both nonroasted and roasted peanut inhibited 100% of IgE binding to Ara h 1, 2, 3, and 6. Nonroasted peanut inhibited 87% of IgE binding to Ara h 8, roasted inhibited 30%. The products lacked Ara h 9 activity.
Co-sensitization to Ara h 2 and Ara h 6 was associated with severe reactions distinguishing severe allergy from mild symptoms. SIgE to Ara h 8 added no diagnostic value. Component-resolved diagnostics reduce the need for oral challenges in peanut allergy.
成分分辨诊断为花生过敏提供了一种现代工具，但缺乏应用一致的双盲安慰剂对照挑战的研究。我们旨在优化桦木流行地区中重度花生过敏的诊断，并创建具有特征性过敏原活性的口服花生挑战。
我们对 6 至 18 岁的花生致敏或高度怀疑花生过敏（包括过敏反应）的患者进行了双盲安慰剂对照的花生挑战。我们测量了 Ara h 1、2、3、6、8 和 9 的特异性 IgE（sIgE）。挑战产品过敏原活性的检测是通过 IgE 微阵列抑制进行的。
在 102 名患者中，有 69 名患者呈阳性反应：25 名（36%）有严重症状，36 名（52%）有中度症状，8 名（12%）有轻度症状；38 名（37%）接受了肾上腺素治疗。Ara h 6 AUC 0.98（95%CI，0.96-1.00）的 sIgE 是中度至重度过敏的最佳标志物。当同时测量 Ara h 2 和 Ara h 6 的 sIgE 时，所有低剂量的严重反应（100%）都可以成功诊断。Ara h 8 的 sIgE 没有诊断价值，AUC 为 0.42（95%CI，0.30-0.52）。非烤制和烤制的花生均能抑制 100%的 Ara h 1、2、3 和 6 的 IgE 结合。非烤制花生抑制 87%的 Ara h 8 的 IgE 结合，烤制花生抑制 30%。这些产品缺乏 Ara h 9 的活性。
Ara h 2 和 Ara h 6 的共同致敏与严重反应有关，可将严重过敏与轻度症状区分开来。Ara h 8 的 sIgE 没有增加诊断价值。成分分辨诊断减少了花生过敏口服挑战的需要。
