Schots Mirjam, de Mol Amerik C, Vermeer Henricus J, Roosen Yvonne M, Vriesman Aldonse W
1Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
2Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Diagnosis (Berl). 2016 Mar 1;3(1):31-35. doi: 10.1515/dx-2015-0032.
Specific immunoglobulin E to Ara h 2 (sIgE to Ara h 2) is described as an upcoming predicting factor for diagnosing peanut allergy in children. The gold standard for diagnosing peanut allergy is a double blind placebo controlled food challenge, however this is time consuming and potentially harmful. We investigate Ara h 2 as a preliminary less invasive diagnostic tool for diagnosing peanut allergy in a general population of peanut sensitized children.
Children (n=52) with peanut sensitization were retrospectively included. An oral food challenge (OFC) confirmed peanut allergy or tolerance, as primary outcome. Individual candidate predictors were identified by univariate regression analysis and used in a prediction model. Different cut-off values were obtained and receiver operating characteristic curves were plotted.
Multivariate analyses resulted in Ara h 2 as best predictor, with a discriminative ability of 0.87 (95% confidence interval, 0.77-0.97). Sensitivity and specificity of 55% and 95%, respectively, were found for a sIgE to Ara h 2 cut-off value of 4.25 kU/L. The highest positive predictive value of 100% was reached at 5.61 kU/L. No absolute relation was found between the value of Ara h 2 and the severity of the reaction during OFC.
This study developed a prediction model in which sIgE to Ara h 2 was the best predictor for peanut allergy in sensitized children in a general hospital. Therefore depending on the history and the Ara h 2 results, an OFC is not always needed to confirm the diagnosis.
抗花生2号蛋白特异性免疫球蛋白E（sIgE to Ara h 2）被认为是诊断儿童花生过敏的一个新兴预测因子。诊断花生过敏的金标准是双盲安慰剂对照食物激发试验，但该试验耗时且有潜在危害。我们研究将Ara h 2作为一种初步的、侵入性较小的诊断工具，用于在花生致敏儿童的普通人群中诊断花生过敏。
回顾性纳入52名花生致敏儿童。以口服食物激发试验（OFC）确认花生过敏或耐受作为主要结果。通过单变量回归分析确定个体候选预测因子，并将其用于预测模型。获得不同的临界值并绘制受试者工作特征曲线。
多变量分析结果显示Ara h 2是最佳预测因子，判别能力为0.87（95%置信区间，0.77 - 0.97）。当sIgE to Ara h 2临界值为4.25 kU/L时，敏感性和特异性分别为55%和95%。在5.61 kU/L时达到最高阳性预测值100%。未发现Ara h 2的值与OFC期间反应的严重程度之间存在绝对关系。
本研究建立了一个预测模型，其中sIgE to Ara h 2是综合医院中致敏儿童花生过敏的最佳预测因子。因此，根据病史和Ara h 2结果，并非总是需要进行OFC来确诊。
