Chua Gilbert T, Chong Patrick Cy, Au Elaine Yl, Cheong K N, Wong Wilfred Hs, Chan Eric Yt, Ho Marco Hk, Lau Y L, Duque Jaime S Rosa
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Division of Clinical Immunology, Department of Pathology & Clinical Biochemistry, Queen Mary Hospital, Hong Kong, China.
Asian Pac J Allergy Immunol. 2021 Dec;39(4):241-248. doi: 10.12932/AP-110319-0519.
Peanut allergy is common in Chinese children, yet the most predictive diagnostic cut-offs for skin prick test (SPT) and blood testing in this population are unclear.
We aimed to determine the optimal cut-off values for whole-peanut SPT, specific IgE (sIgE) and component-resolved diagnostics (CRD) for Chinese children based on outcomes of open oral food challenges (OFC) to peanut.
We recruited ethnic-Chinese patients 1-18 years old who were suspected of having peanut allergy based on a history of reactions after exposure or sensitization although peanut naïve. Considering the AUC value of 0.8, 80% power and 5% level of significance with two tails, 26 patients were needed. Sensitivities, specificities, positive and negative predictive values, and receiver operating characteristic curves (ROCs) and their area-under-curves (AUCs) for SPT, peanut sIgE, and CRD were compared.
Thirty-one subjects participated. Only SPT reached statistical significance (AUC 0.91, p = 0.0001), but not the other tests. Seven retrospective data were added to optimize the power. SPT remained to be the best predictor, followed by Ara h 2 sIgE (AUC 0.72, p = 0.02). An SPT wheal size of 3 mm and Ara h 2 sIgE of 0.14 kU(A)/L yielded the highest Youden's index. The specificity of SPT and Ara h 2 sIgE reached 94% at 6 mm and 0.74 kU(A)/L, respectively. Comparisons of ROCs revealed that SPT was significantly better than Ara h 2 sIgE (p = 0.03) and whole-peanut sIgE (AUC 0.61, p = 0.26).
In Chinese children, SPT appeared to be the best predictor for peanut allergy, followed by Ara h 2 sIgE.
花生过敏在中国儿童中很常见，但该人群中皮肤点刺试验（SPT）和血液检测最具预测性的诊断临界值尚不清楚。
我们旨在根据花生开放口服食物激发试验（OFC）的结果，确定中国儿童全花生SPT、特异性IgE（sIgE）和组分分辨诊断（CRD）的最佳临界值。
我们招募了1至18岁的华裔患者，这些患者虽未接触过花生，但根据接触或致敏后的反应史怀疑患有花生过敏。考虑到曲线下面积（AUC）值为0.8、检验效能为80%以及双侧显著性水平为5%，需要26名患者。比较了SPT、花生sIgE和CRD的敏感性、特异性、阳性和阴性预测值，以及受试者工作特征曲线（ROC）及其曲线下面积（AUC）。
31名受试者参与。只有SPT达到统计学显著性（AUC 0.91，p = 0.0001），其他检测未达到。添加了7份回顾性数据以优化检验效能。SPT仍然是最佳预测指标，其次是Ara h 2 sIgE（AUC 0.72，p = 0.02）。SPT风团大小为3 mm和Ara h 2 sIgE为0.14 kU(A)/L时约登指数最高。SPT和Ara h 2 sIgE的特异性分别在风团大小为6 mm和浓度为0.74 kU(A)/L时达到94%。ROC比较显示，SPT显著优于Ara h 2 sIgE（p = 0.03）和全花生sIgE（AUC 0.61，p = 0.26）。
在中国儿童中，SPT似乎是花生过敏的最佳预测指标，其次是Ara h 2 sIgE。
