Allergology Department, Hôpital A. Trousseau, Sorbonne Université, AP-HP, Paris, France.
Allergology Department, Hôpital A. Trousseau, Sorbonne Université, AP-HP, Paris, France; Epidemiology of Allergic and Respiratory Diseases, IPLESP, INSERM and Sorbonne Université, Paris, France.
J Allergy Clin Immunol Pract. 2021 Jan;9(1):275-282.e1. doi: 10.1016/j.jaip.2020.09.043. Epub 2020 Oct 7.
Safe and cost-effective biological surrogate markers to evaluate the severity and threshold dose of peanut allergy (PA) reactions during an oral food challenge (OFC) are lacking.
To evaluate biological markers associated with the severity and threshold dose of an allergic reaction during an OFC in a population of children with PA.
Demographic and biological parameters of children with peanut OFC and basophil activation test (BAT) results were collected. Patients were stratified into 2 severity groups (mild-to-moderate and severe) and 2 cumulative threshold dose groups: low (LCTG) ≤100 mg crushed peanut and high >100 mg.
Among the 68 children included, there was a 96% concordance between the OFC and BAT result for the diagnosis of PA. Of the 56 children with a positive OFC and BAT to peanut (median age: 8.8 years), the severity of an allergic reaction and the cumulative threshold dose were not correlated (P = .24). Higher Ara h 2-specific IgE and FcεRI-positive control values were both associated with severe reactions to peanut. Combining these 2 markers led to a 92% sensitivity (84%-97%) and an 82% specificity (71%-89%) for severe reactions in all subjects. For children in the LCTG, a 4-variable composite marker, including age, normalized basophil sensitivity (EC), and FcεRI- and fMLP-positive control values, resulted in a 97% sensitivity (89%-99%) and 61% specificity (49%-71%).
Distinct composite markers including BAT allergen-specific and non-allergen-specific parameters appear to be associated with severity and cumulative threshold dose in children with PA.
在口服食物挑战（OFC）期间，缺乏安全且具有成本效益的生物替代标志物来评估花生过敏（PA）反应的严重程度和阈值剂量。
评估与 PA 儿童 OFC 期间过敏反应严重程度和阈值剂量相关的生物标志物。
收集花生口服食物挑战和嗜碱性粒细胞激活试验（BAT）结果的儿童的人口统计学和生物学参数。患者分为 2 个严重程度组（轻度至中度和重度）和 2 个累积阈值剂量组：低（LCTG）≤100mg 压碎花生和高>100mg。
在 68 名入组的儿童中，OFC 和 BAT 结果在 PA 诊断方面有 96%的一致性。在 56 名阳性 OFC 和 BAT 对花生的儿童中（中位年龄：8.8 岁），过敏反应的严重程度和累积阈值剂量无相关性（P=0.24）。更高的 Ara h 2 特异性 IgE 和 FcεRI 阳性对照值均与花生严重反应相关。将这 2 个标志物结合起来，可使所有受试者严重反应的敏感性达到 92%（84%-97%），特异性为 82%（71%-89%）。对于 LCTG 中的儿童，包括年龄、归一化嗜碱性粒细胞敏感性（EC）、FcεRI 和 fMLP 阳性对照值在内的 4 变量复合标志物，敏感性为 97%（89%-99%），特异性为 61%（49%-71%）。
包括 BAT 过敏原特异性和非过敏原特异性参数的独特复合标志物似乎与 PA 儿童的严重程度和累积阈值剂量相关。
