Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants - 27/09/13
, Shyamali C. Dharmage, MBBS, MSc, MD, PhD a, d, Mimi L.K. Tang, MBBS, FRACP, FRCPA, PhD a, b, c, Jennifer J. Koplin, PhD a, b, Anne-Louise Ponsonby, BMedSci, MBBS, PhD a, b, d, Adrian J. Lowe, PhD a, d, David Hill, MBBD, FRACP a, Lyle C. Gurrin, PhD a, dfor the
HealthNuts study
Abstract |
Background |
Ninety-five percent positive predictive values (PPVs) provide an invaluable tool for clinicians to avoid unnecessary oral food challenges. However, 95% PPVs specific to infants, the age group most likely to present for diagnosis of food allergy, are limited.
Objective |
We sought to develop skin prick test (SPT) and allergen-specific IgE (sIgE) thresholds with 95% PPVs for challenge-confirmed food allergy in a large population-based cohort of 1-year-old infants with challenges undertaken irrespective of SPT wheal size or previous history of ingestion.
Methods |
HealthNuts is a population-based, longitudinal food allergy study with baseline recruitment of 1-year-old infants. Infants were recruited from council-run immunization sessions during which they underwent SPTs to 4 allergens: egg, peanut, sesame, and cow’s milk/shrimp. Any infant with a detectable SPT response was invited to undergo oral food challenge and sIgE testing.
Results |
Five thousand two hundred seventy-six infants participated in the study. Peanut SPT responses of 8 mm or greater (95% CI, 7-9 mm), egg SPT responses of 4 mm or greater (95% CI, 3-5 mm), and sesame SPT responses of 8 mm or greater (95% CI, 5-9 mm) had 95% PPVs for challenge-proved food allergy. Peanut sIgE levels of 34 kUA/L or greater (95% CI, 14-48 kUA/L) and egg sIgE levels of 1.7 kUA/L or greater (95% CI, 1-3 kUA/L) had 95% PPVs for challenge-proved food allergy. Results were robust when stratified on established risk factors for food allergy. Egg SPT responses and sIgE levels were poor predictors of allergy to egg in baked goods.
Conclusion |
These 95% PPVs, which were generated from a unique dataset, are valuable for the diagnosis of food allergy in young infants and were robust when stratified across a number of different risk factors.
Le texte complet de cet article est disponible en PDF.Key words : Food allergy, skin prick test, serum-specific IgE, oral food challenge, predictive value of tests, egg, baked egg, peanut, sesame
Abbreviations used : AUC, LR, NPV, OFC, PPV, ROC, sIgE, SPT
Plan
| Supported by funding from the National Health and Medical Research Council (NHMRC) of Australia, the Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, and the Victorian Government’s Operational Infrastructure Support Program. K.J.A. is a Viertel senior medical research fellow. R.L.P. is an Australian Postgraduate Award scholar. L.C.G., J.J.K., A.J.L., A.-L.P., and S.C.D. hold NHMRC awards. |
|
| Disclosure of potential conflict of interest: K. J. Allen is a board member for Ilhan Food Allergy Foundation and has received payment for lectures, including service on speakers, bureaus for Pfizer, Nutricia, Annual Women's Update, and Abbott. M. L. K. Tang has received grants from the National Health and Medical Research Council (NHMRC) and is an allergist, immunologist, and immunopathologist who performs skin prick testing and serum allergen-specific IgE testing in work. A.-L. Ponsonby has received grants from, has grants/grants pending with, and is employed by the NHMRC. A. J. Lowe has received grants from NHMRC for project grant funding. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 132 - N° 4
P. 874-880 - octobre 2013 Retour au numéro
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