Food, drug, insect sting allergy, and anaphylaxis
Early clinical predictors of remission of peanut allergy in children

https://doi.org/10.1016/j.jaci.2007.11.024Get rights and content

Background

Understanding predictors of clinical remission would assist in clinical management of peanut allergy.

Objective

We sought to determine the early clinical predictors of peanut allergy remission using a longitudinal cohort of young children with peanut allergy.

Methods

Consecutive patients less than 2 years of age with peanut allergy were identified on the basis of skin prick test (SPT) wheal size of 95% positive predictive value or greater. Baseline SPT responses to peanuts, tree nuts, and sesame and serum peanut-specific IgE antibody levels were documented, and follow-up studies were conducted at 1- to 2-year intervals for up to 8 years. Peanut food challenges were performed when SPT responses decreased to less than the 95% positive predictive value for peanut allergy.

Results

SPT wheal diameters to peanut extract of 6 mm or greater (hazard ratio, 2.16; 95% CI, 1.23-3.786; P = .008) and peanut-specific IgE antibody of 3 kUA/L or greater (hazard ratio, 2.74; 95% CI, 1.13-6.61; P = .025) before the age of 2 years were independent predictors of persistent peanut allergy. Mean SPT wheal diameters of nonremitters increased (r = 0.31, P < .001), whereas those of remitters decreased (r = −0.26, P = .002) between 1 and 4 years of age. Twenty-one percent of young children with peanut allergy became clinically tolerant by age 5 years.

Conclusions

Remission of peanut allergy can be predicted by low levels of IgE antibodies to peanut in the first 2 years of life or decreasing levels of IgE sensitization by the age of 3 years.

Section snippets

Methods

Consecutive children less than 2 years of age referred to the Children's Allergy Centre, Royal Children's Hospital, Melbourne, from 1995 through 2000 and found to have peanut allergy were studied. Peanut allergy was diagnosed if the child had a skin prick test (SPT) diameter of 95% positive predictive value (PPV) or greater for peanut allergy (ie, an SPT response to peanut ≥4 mm).14 Approval for this study was granted by the Royal Children's Hospital Institutional Review Board.

Results

A total of 297 children were given diagnoses of peanut allergy (mean/median age, 14.1/13.5 months; range, 4-23 months; male/female ratio, 1.9:1) during the study period. Of these, 267 who had come back for subsequent evaluation formed this study population, with a median follow-up of 4.7 years (SD, 2 years). They presented (1) with a history of an adverse reaction to peanut (93 [35%] patients), (2) for investigation of an adverse reaction to other common food allergens (109 [41%] patients), or

Discussion

Both the size of the SPT wheal to peanut and the level of serum peanut-specific IgE before 2 years of age were independent predictors of clinical remission to peanut. However, age at diagnosis, mode of presentation, and severity of index reaction were not predictive of remission. SPT response to peanut extract of 6 mm or larger or peanut-specific IgE levels of greater than 3 KUA/L before 2 years of age halved the probability of tolerance development. The long-term prognosis for peanut allergy

References (26)

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Dr Ho was supported by the Ho Hung Chiu Medical Education Scholarship and training grant of the Hospital Authority, Hong Kong SAR, China. Dr Allen is a recipient of an Australian National Health and Medical Research Council Career Development Award and has funding from the Ilhan Food Allergy Foundation and AnaphylaxiStop.

Disclosure of potential conflict of interest: The authors have declared that they have no relevant conflict of interest.

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