Distinct parameters of the basophil activation test reflect the severity and threshold of allergic reactions to peanut - 06/01/15
Abstract |
Background |
The management of peanut allergy relies on allergen avoidance and epinephrine autoinjector for rescue treatment in patients at risk of anaphylaxis. Biomarkers of severity and threshold of allergic reactions to peanut could significantly improve the care for patients with peanut allergy.
Objective |
We sought to assess the utility of the basophil activation test (BAT) to predict the severity and threshold of reactivity to peanut during oral food challenges (OFCs).
Methods |
The severity of the allergic reaction and the threshold dose during OFCs to peanut were determined. Skin prick tests, measurements of specific IgE to peanut and its components, and BATs to peanut were performed on the day of the challenge.
Results |
Of the 124 children submitted to OFCs to peanut, 52 (median age, 5 years) reacted with clinical symptoms that ranged from mild oral symptoms to anaphylaxis. Severe reactions occurred in 41% of cases, and 57% reacted to 0.1 g or less of peanut protein. The ratio of the percentage of CD63+ basophils after stimulation with peanut and after stimulation with anti-IgE (CD63 peanut/anti-IgE) was independently associated with severity (P = .001), whereas the basophil allergen threshold sensitivity CD-sens (1/EC50 × 100, where EC50 is half maximal effective concentration) value was independently associated with the threshold (P = .020) of allergic reactions to peanut during OFCs. Patients with CD63 peanut/anti-IgE levels of 1.3 or greater had an increased risk of severe reactions (relative risk, 3.4; 95% CI, 1.8-6.2). Patients with a CD-sens value of 84 or greater had an increased risk of reacting to 0.1 g or less of peanut protein (relative risk, 1.9; 95% CI, 1.3-2.8).
Conclusions |
Basophil reactivity is associated with severity and basophil sensitivity is associated with the threshold of allergic reactions to peanut. CD63 peanut/anti-IgE and CD-sens values can be used to estimate the severity and threshold of allergic reactions during OFCs.
Le texte complet de cet article est disponible en PDF.Key words : Basophil activation test, peanut, peanut allergy, threshold, severity, sensitivity, CD63, CD203c, CD-sens, double-blind, placebo-controlled food challenge
Abbreviations used : CD63 peanut/anti-IgE, CD-sens, DBPCPC, EC50, LEAP, PA, PE, SPT
Plan
| Supported by the Medical Research Council (G0902018), Goldman Sachs Gives, and the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The clinical trials unit is supported by the National Peanut Board, Atlanta, Ga. The Programme for Advanced Medical Education is sponsored by Fundação Calouste Gulbenkian, Fundação Champalimaud, Ministério da Saúde and Fundação para a Ciência e a Tecnologia, Portugal. |
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| Disclosure of potential conflict of interest: This study was funded by the Medical Research Council (G0902018), Goldman Sachs Gives, and the Department of Health through the National Institute for Health Research in partnership with King's College London and King's College Hospital NHS Foundation Trust. A. F. Santos and her institution have received funding from the Medical Research Council (G0902018), the National Peanut Board, the Immune Tolerance Network/National Institute of Allergy and Infectious Diseases (ITN032AD and ITN049AD), the Medical Research Council (MRC Centenary Early Career Award), and the National Institute for Health Research and has received support for travel and other meeting-related purposes from the European Academy of Allergy and Clinical Immunology (EAACI) and the American Academy of Allergy Asthma and Immunology. G. Du Toit is employed by St Thomas' Hospital, a National Health Service (NHS) teaching hospital, which has received funding from the Immune Tolerance Network (ITN032AD and ITN049AD) and received compensation for delivering lectures at the Annual Swineford Conference and for travel and other meeting-related expenses from the EAACI. A. Douiri's institution has received funding from the National Institute for Health Research. S. Radulovic is employed by Kings College London. G. Lack's institution has received funding from the Immune Tolerance Network (ITN032AD and ITN049AD), supported by the National Institute of Allergy and Infectious Diseases, as well as the National Peanut Board and the Department of Health, and he holds stock/stock options in DBV Technologies. The rest of the authors declare that they have no other relevant conflicts of interest. |
Vol 135 - N° 1
P. 179-186 - janvier 2015 Retour au numéro
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