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Ig E , but not I g G 4, antibodies to A ra h 2 distinguish peanut allergy from asymptomatic peanut sensitization
Author(s) -
Hong X.,
Caruso D.,
Kumar R.,
Liu R.,
Liu X.,
Wang G.,
Pongracic J. A.,
Wang X.
Publication year - 2012
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.12047
Subject(s) - peanut allergy , sensitization , asymptomatic , allergen , immunology , allergy , immunoglobulin e , medicine , anaphylaxis , food allergy , antibody
Background There are no available clinical tests that can accurately predict peanut allergy ( PA ) and/or anaphylaxis. This study is aimed at evaluating whether the component‐resolved diagnostic ( CRD ) I g E and I g G 4 tests can (i) distinguish PA from asymptomatic peanut sensitization ( PS ) and (ii) differentiate anaphylactic from nonanaphylactic PA . Methods This study included 20 nonatopic controls, 58 asymptomatically peanut‐sensitized children, 55 nonanaphylactic, and 53 anaphylactic PA cases from the C hicago F ood A llergy S tudy. IgE and IgG4 to 103 allergens were measured using the Immuno CAP ISAC technology and were compared among each group of children. The random forest test was applied to estimate each allergen's ability to predict PA and/or peanut anaphylaxis. Results Peanut allergy cases (with or without anaphylaxis) had significantly higher I g E reactivity to A ra h 1–3 (peanut allergens) and G ly m 5–6 (soy allergens) than asymptomatically sensitized children ( P < 0.00001). Similar but more modest relationships were found for I g G 4 to Ara h 2 ( P < 0.01). Ig E to A ra h 2 was the major contributor to accurate discrimination between PA and asymptomatic sensitization. With an optimal cutoff point of 0.65 ISU ‐ E , it conferred 99.1% sensitivity, 98.3% specificity, and a 1.2% misclassification rate in the prediction of PA , which represented a higher discriminative accuracy than I g E to whole peanut extract ( P = 0.008). However, none of the I g E and/or I g G 4 tests could significantly differentiate peanut anaphylaxis from nonanaphylactic PA . Conclusions Ig E to A ra h 2 can efficiently differentiate clinical PA from asymptomatic PS , which may represent a major step forward in the diagnosis of PA .