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Ann Allergy Asthma Immunol. 2018 Jul;121(1):69-76.e2. doi: 10.1016/j.anai.2018.04.020. Epub 2018 Apr 27.

Development of a tool predicting severity of allergic reaction during peanut challenge.

Author information

1
Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
2
Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; School of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California.
3
Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California.
4
Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
5
Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Pathology, Stanford University School of Medicine, Stanford, California; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California.
6
Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
7
Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois.
8
Department of Pediatrics and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
9
Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; School of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California; Department of Pathology, Stanford University School of Medicine, Stanford, California.
10
Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California. Electronic address: knadeau@stanford.edu.

Abstract

BACKGROUND:

Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established.

OBJECTIVE:

To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC.

METHODS:

Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC.

RESULTS:

A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63hi stimulation with peanut to percentage of CD63hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P < .001).

CONCLUSION:

The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV1/FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings.

TRIAL REGISTRATION:

ClinicalTrials.gov identifier: NCT02103270.

PMID:
29709643
PMCID:
PMC6026554
DOI:
10.1016/j.anai.2018.04.020
[Indexed for MEDLINE]
Free PMC Article

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