Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Allergy. 2024 Jul;79(7):1868-1880. doi: 10.1111/all.16111. Epub 2024 May 8.
There are no studies of longitudinal immunoglobulin measurements in a population-based cohort alongside challenge-confirmed peanut allergy outcomes. Little is known about biomarkers for identifying naturally resolving peanut allergy during childhood.
To measure longitudinal trends in whole peanut and component Ara h 2 sIgE and sIgG in the first 10 years of life, in a population cohort of children with challenge-confirmed peanut allergy, and to determine whether peanut-specific immunoglobulin levels or trends are associated with peanut allergy persistence or resolution by 10 years of age.
One-year-old infants with challenge-confirmed peanut allergy (n = 156) from the HealthNuts study (n = 5276) were prospectively followed at ages 4, 6, and 10 years with questionnaires, skin prick tests, oral food challenges, and plasma total-IgE, sIgE and sIgG to peanut and Ara h 2.
Peanut allergy resolved in 33.9% (95% CI = 25.3%, 43.3%) of children by 10 years old with most resolving (97.4%, 95% CI = 86.5%, 99.9%) by 6 years old. Decreasing Ara h 2 sIgE (p = .01) and increasing peanut sIgG (p < .001), Ara h 2 sIgG (p = .01), peanut sIgG/sIgE (p < .001) and Ara h 2 sIgG/sIgE (p < .001) from 1 to 10 years of age were associated with peanut allergy resolution. Peanut sIgE measured at 1 year old had the greatest prognostic value (AUC = 0.75 [95% CI = 0.66, 0.82]); however, no single threshold produced both high sensitivity and specificity.
One third of infant peanut allergy resolved by 10 years of age. Decreasing sIgE and sIgG to peanut and Ara h 2 over time were associated with natural resolution of peanut allergy. However, biomarker levels at diagnosis were not strongly associated with the natural history of peanut allergy.
在以挑战确认的花生过敏结局为基础的人群队列中，尚无关于免疫球蛋白纵向测量的研究。对于在儿童时期自然缓解的花生过敏的生物标志物知之甚少。
在一个以挑战确认的花生过敏的人群队列中，测量生命的前 10 年中全花生和成分 Ara h 2 sIgE 和 sIgG 的纵向趋势，并确定花生特异性免疫球蛋白水平或趋势是否与 10 岁时的花生过敏持续或缓解有关。
健康坚果研究（HealthNuts study）（n=5276）中的 1 岁婴儿在接受挑战后确诊患有花生过敏（n=156），他们在 4、6 和 10 岁时接受问卷调查、皮肤点刺试验、口服食物挑战以及血浆总 IgE、sIgE 和 sIgG 检测，以检测花生和 Ara h 2。
在 10 岁时，有 33.9%（95%CI=25.3%，43.3%）的儿童的花生过敏得到缓解，其中 97.4%（95%CI=86.5%，99.9%）在 6 岁前得到缓解。Ara h 2 sIgE 下降（p=0.01）和花生 sIgG 增加（p<0.001）、Ara h 2 sIgG（p=0.01）、花生 sIgG/sIgE（p<0.001）和 Ara h 2 sIgG/sIgE（p<0.001）从 1 岁到 10 岁与花生过敏缓解相关。1 岁时测量的花生 sIgE 具有最大的预测价值（AUC=0.75 [95%CI=0.66，0.82]）；然而，没有单一的阈值可以同时产生高敏感性和特异性。
三分之一的婴儿花生过敏在 10 岁时得到缓解。随着时间的推移，sIgE 和 sIgG 对花生和 Ara h 2 的下降与花生过敏的自然缓解有关。然而，诊断时的生物标志物水平与花生过敏的自然史并没有很强的关联。
