Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands; Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, the Netherlands.
Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands.
J Allergy Clin Immunol Pract. 2021 Apr;9(4):1667-1674.e3. doi: 10.1016/j.jaip.2020.11.024. Epub 2020 Nov 26.
The diagnostic value of peanut components is extensively studied in children, but to a lesser extent in adults with suspected peanut allergy. The use of peanut components in daily practice may reduce the need for double-blind placebo-controlled food challenges (DBPCFCs); however, validation studies are currently lacking.
To evaluate the diagnostic value of (combined) peanut components and validate a previously found Ara h 2 cutoff level with 100% positive predictive value (PPV) in adults with suspected peanut allergy.
Adults who underwent a peanut DBPCFC were included: 84 patients from a previous study (2002-2012) and 70 new patients (2012-2019). Specific IgE (sIgE) to peanut extract, Ara h 1, 2, 3, 6, and 8 was measured using ImmunoCAP. Diagnostic value was assessed with an area under the curve (AUC) analysis.
In total, 95 (62%) patients were peanut allergic. sIgE to Ara h 2 and Ara h 6 were the best predictors with an AUC (95% confidence interval) of 0.85 (0.79-0.91) and 0.85 (0.79-0.92), respectively. The Ara h 2 cutoff level with 100% PPV (≥1.75 kU/L) was validated in the 70 new patients. Thirty percent of all included patients could be classified correctly as peanut allergic using this validated cutoff level.
sIgE to Ara h 2 and Ara h 6 have equally high discriminative ability. Peanut allergy can be predicted accurately in one-third of adults using a validated cutoff level of sIgE to Ara h 2.
在儿童中广泛研究了花生成分的诊断价值，但在疑似花生过敏的成年人中研究较少。在日常实践中使用花生成分可能会减少对双盲安慰剂对照食物挑战（DBPCFC）的需求；然而，目前缺乏验证研究。
评估（组合）花生成分的诊断价值，并验证之前在疑似花生过敏的成年人中发现的 Ara h 2 截断值，其具有 100%的阳性预测值（PPV）。
纳入接受花生 DBPCFC 的成年人：来自先前研究（2002-2012 年）的 84 名患者和 70 名新患者（2012-2019 年）。使用 ImmunoCAP 测量花生提取物、Ara h 1、2、3、6 和 8 的特异性 IgE（sIgE）。使用曲线下面积（AUC）分析评估诊断价值。
共有 95 名（62%）患者对花生过敏。sIgE 对 Ara h 2 和 Ara h 6 是最佳预测因子，AUC（95%置信区间）分别为 0.85（0.79-0.91）和 0.85（0.79-0.92）。在 70 名新患者中验证了 Ara h 2 截断值为 100%PPV（≥1.75 kU/L）。使用此经过验证的截断值，可正确分类三分之一的所有纳入患者为花生过敏。
sIgE 对 Ara h 2 和 Ara h 6 具有相同的区分能力。使用经过验证的 Ara h 2 sIgE 截断值，可准确预测三分之一的成年人是否患有花生过敏。
