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J Allergy Clin Immunol. 2008 Mar;121(3):731-6. doi: 10.1016/j.jaci.2007.11.024. Epub 2008 Jan 30.

Early clinical predictors of remission of peanut allergy in children.

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  • 1Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia.

Abstract

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.

Comment in

PMID:
18234313
[PubMed - indexed for MEDLINE]
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