Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Division of internal medicine and dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Allergy. 2022 May;77(5):1559-1569. doi: 10.1111/all.15166. Epub 2021 Nov 16.
Component-resolved diagnostics (CRD) help predict hazelnut allergy (HA) in children, but are of unknown diagnostic value in adults. This study aimed to evaluate the diagnostic accuracy of IgE to hazelnut extract and components in adults.
A Dutch population of consecutively presenting adults suspected of HA, who underwent a double-blind placebo-controlled food challenge, were included. Serum IgE to hazelnut extract and Cor a 1, 8, 9, and 14 was measured on ImmunoCAP. Diagnostic accuracy was assessed by area under the curve (AUC) analysis.
Of 89 patients undergoing challenge, 46 had challenge-confirmed HA: 17 based on objective and 29 based on subjective symptoms. At commonly applied cutoffs 0.1 and 0.35 kU /L, high sensitivity was observed for IgE to hazelnut extract and Cor a 1 (range 85-91%), and high specificity for IgE to Cor a 8, 9 and 14 (range 77-95%). However, the AUCs for hazelnut extract and components were too low for accurate prediction of HA (range 0.50-0.56). Combining hazelnut extract and component IgE measurements did not significantly improve accuracy. Higher IgE levels to Cor a 9 and 14 were tentatively associated with HA with objective symptoms, but the corresponding AUCs still only reached 0.68 and 0.63, respectively.
Although hazelnut allergic adults are generally sensitized to hazelnut extract and Cor a 1, and hazelnut tolerant adults are usually not sensitized to Cor a 8, 9, or 14, challenge testing is still needed to accurately discriminate between presence and absence of HA in adults from a birch-endemic country.
成分分辨诊断（CRD）有助于预测儿童榛子过敏（HA），但在成人中的诊断价值未知。本研究旨在评估成人榛子提取物和成分 IgE 的诊断准确性。
纳入了荷兰连续就诊的疑似 HA 成人患者，这些患者进行了双盲安慰剂对照食物挑战。在 ImmunoCAP 上测量榛子提取物和 Cor a 1、8、9 和 14 的血清 IgE。通过曲线下面积（AUC）分析评估诊断准确性。
在接受挑战的 89 例患者中，有 46 例经挑战证实为 HA：17 例基于客观症状，29 例基于主观症状。在常用的 0.1 和 0.35 kU/L 截断值下，榛子提取物和 Cor a 1 的 IgE 具有高灵敏度（范围 85-91%），而 Cor a 8、9 和 14 的 IgE 具有高特异性（范围 77-95%）。然而，榛子提取物和成分的 AUC 对于准确预测 HA 过低（范围 0.50-0.56）。组合榛子提取物和成分 IgE 测量并未显著提高准确性。Cor a 9 和 14 的 IgE 水平较高与有客观症状的 HA 有初步关联，但相应的 AUC 仍分别仅达到 0.68 和 0.63。
尽管榛子过敏的成年人均普遍对榛子提取物和 Cor a 1 致敏，而榛子耐受的成年人均通常不对 Cor a 8、9 或 14 致敏，但在桦木流行的国家，仍需要进行挑战测试以准确区分成人 HA 的存在与不存在。
