Medline ® Abstracts for References 31,32
of 'Oral food challenges for diagnosis and management of food allergies'
The natural history of peanut allergy.
Skolnick HS, Conover-Walker MK, Koerner CB, Sampson HA, Burks W, Wood RA
J Allergy Clin Immunol. 2001;107(2):367.
BACKGROUND: It has traditionally been assumed that peanut allergy is rarely outgrown.
OBJECTIVE: The goal of this study was to determine the number of children with peanut allergy who become tolerant of peanut.
METHODS: Patients aged 4 to 20 years with a diagnosis of peanut allergy were evaluated by questionnaire, skin testing, and a quantitative antibody fluorescent-enzyme immunoassay. Patients who had been reaction free in the past year and had a peanut IgE (PN-IgE) level less than 20 kilounits of antibody per liter (kU(A)/L) were offered an open or double-blind, placebo-controlled peanut challenge.
RESULTS: A total of 223 patients were evaluated, and of those, 85 (PN-IgE<0.35-20.4 kU(A)/L [median 1.42 kU(A)/L]) participated in an oral peanut challenge. Forty-eight (21.5%) patients had negative challenge results and were believed to have outgrown their peanut allergy (aged 4-17.5 years [median 6 years]; PN-IgE<0.35-20.4 kU(A)/L [median 0.69 kU(A)/L]). Thirty-seven failed the challenge (aged 4-13 years [median 6.5 years]; RAST<0.35-18.2 kU(A)/L [median 2.06 kU(A)/L]). Forty-one patients with PN-IgE levels less than 20 kU(A)/L declined to undergo challenge, and 97 were not eligible for challenge because their PN-IgE levels were greater than 20 kU(A)/L or they had had a recent reaction. Sixty-seven percent of patients with PN-IgE levels less than 2 kU(A)/L and 61% with levels less than 5 kU(A)/L had negative challenge results. Of those who underwent challenge, PN-IgE levels for those who passed versus those who failed were different at the time of challenge (P = .009), but not at the time of diagnosis (P = .25).
CONCLUSION: This study demonstrates that peanut allergy is outgrown in about 21.5% of patients. Patients with low PN-IgE levels should be offered a peanut challenge in a medical setting to demonstrate whether they can now tolerate peanuts.
Department of Pediatrics, Johns Hopkins University, Baltimore, Md, USA.
Factors resulting in deferral of diagnostic oral food challenges.
Davis N, Egan M, Sicherer SH
J Allergy Clin Immunol Pract. 2015;3(5):811. Epub 2015 Jun 3.
Division of Pediatric Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.