Accurate prediction of peanut allergy in one-third of adults using a validated Ara h 2 cutoff

Hannah M Kansen; Francine C van Erp; André C Knulst; Anna M Ehlers; Sarah A Lyons; Edward F Knol; Yolanda Meijer; Henny G Otten; Cornelis K van der Ent; Thuy-My Le

doi:10.1016/j.jaip.2020.11.024

Accurate prediction of peanut allergy in one-third of adults using a validated Ara h 2 cutoff

Hannah M Kansen, Francine C van Erp, André C Knulst, Anna M Ehlers, Sarah A Lyons, Edward F Knol, Yolanda Meijer, Henny G Otten, Cornelis K van der Ent, Thuy-My Le

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Abstract

BACKGROUND: The diagnostic value of peanut components is extensively studied in children, but to a lesser extent in adults with suspected peanut allergy. The use of peanut components in daily practice may reduce the need for double-blind placebo-controlled food challenges (DBPCFCs); however, validation studies are currently lacking.

OBJECTIVE: To evaluate the diagnostic value of (combined) peanut components and validate a previously found Ara h 2 cutoff level with 100% positive predictive value (PPV) in adults with suspected peanut allergy.

METHODS: Adults who underwent a peanut DBPCFC were included: 84 patients from a previous study (2002-2012) and 70 new patients (2012-2019). Specific IgE (sIgE) to peanut extract, Ara h 1, 2, 3, 6, and 8 was measured using ImmunoCAP. Diagnostic value was assessed with an area under the curve (AUC) analysis.

RESULTS: In total, 95 (62%) patients were peanut allergic. sIgE to Ara h 2 and Ara h 6 were the best predictors with an AUC (95% confidence interval) of 0.85 (0.79-0.91) and 0.85 (0.79-0.92), respectively. The Ara h 2 cutoff level with 100% PPV (≥1.75 kU A/L) was validated in the 70 new patients. Thirty percent of all included patients could be classified correctly as peanut allergic using this validated cutoff level.

CONCLUSION: sIgE to Ara h 2 and Ara h 6 have equally high discriminative ability. Peanut allergy can be predicted accurately in one-third of adults using a validated cutoff level of sIgE to Ara h 2.

Original language	English
Pages (from-to)	1667-1674.e3
Journal	The journal of allergy and clinical immunology. In practice
Volume	9
Issue number	4
Early online date	26 Nov 2020
DOIs	https://doi.org/10.1016/j.jaip.2020.11.024
Publication status	Published - Apr 2021

Keywords

Adults
Ara h 2
Ara h 6
Component-resolved diagnostics
Food challenge
Peanut allergy
Peanut components
Specific IgE

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10.1016/j.jaip.2020.11.024Licence: CC BY

1-s2.0-S2213219820312459-mainFinal published version, 1 MBLicence: CC BY

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Kansen, H. M., van Erp, F. C., Knulst, A. C., Ehlers, A. M., Lyons, S. A., Knol, E. F., Meijer, Y., Otten, H. G., van der Ent, C. K., & Le, T.-M. (2021). Accurate prediction of peanut allergy in one-third of adults using a validated Ara h 2 cutoff. The journal of allergy and clinical immunology. In practice, 9(4), 1667-1674.e3. https://doi.org/10.1016/j.jaip.2020.11.024

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title = "Accurate prediction of peanut allergy in one-third of adults using a validated Ara h 2 cutoff",

abstract = "BACKGROUND: The diagnostic value of peanut components is extensively studied in children, but to a lesser extent in adults with suspected peanut allergy. The use of peanut components in daily practice may reduce the need for double-blind placebo-controlled food challenges (DBPCFCs); however, validation studies are currently lacking.OBJECTIVE: To evaluate the diagnostic value of (combined) peanut components and validate a previously found Ara h 2 cutoff level with 100% positive predictive value (PPV) in adults with suspected peanut allergy.METHODS: Adults who underwent a peanut DBPCFC were included: 84 patients from a previous study (2002-2012) and 70 new patients (2012-2019). Specific IgE (sIgE) to peanut extract, Ara h 1, 2, 3, 6, and 8 was measured using ImmunoCAP. Diagnostic value was assessed with an area under the curve (AUC) analysis.RESULTS: In total, 95 (62%) patients were peanut allergic. sIgE to Ara h 2 and Ara h 6 were the best predictors with an AUC (95% confidence interval) of 0.85 (0.79-0.91) and 0.85 (0.79-0.92), respectively. The Ara h 2 cutoff level with 100% PPV (≥1.75 kU A/L) was validated in the 70 new patients. Thirty percent of all included patients could be classified correctly as peanut allergic using this validated cutoff level. CONCLUSION: sIgE to Ara h 2 and Ara h 6 have equally high discriminative ability. Peanut allergy can be predicted accurately in one-third of adults using a validated cutoff level of sIgE to Ara h 2.",

keywords = "Adults, Ara h 2, Ara h 6, Component-resolved diagnostics, Food challenge, Peanut allergy, Peanut components, Specific IgE",

author = "Kansen, {Hannah M} and {van Erp}, {Francine C} and Knulst, {Andr{\'e} C} and Ehlers, {Anna M} and Lyons, {Sarah A} and Knol, {Edward F} and Yolanda Meijer and Otten, {Henny G} and {van der Ent}, {Cornelis K} and Thuy-My Le",

note = "Funding Information: We thank L. Bok and A. Kooij (Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands) for performing ImmunoCAP measurements, M. Smits (Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands; TNO, Zeist, the Netherlands) for performing EUROLINE measurements, and P. M. J. Welsing (Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands) for giving statistical advice. We acknowledge R. Klemans (Bergman Clinics, the Netherlands) for providing data from the previous diagnostic study. ImmunoCAP material was provided by Thermo Fisher Scientific (Uppsala, Sweden). The EUROLINE material was provided by EUROIMMUN (L{\"u}beck, Germany). Conflicts of interest: The authors declare that they have no relevant conflicts of interest. Outside submitted work, E. F. Knol reports personal fees from Thermo Fisher Diagnostics. A. M. Ehlers reports that her research position at the UMC Utrecht is partially funded by EUROIMMUN AG, L{\"u}beck, Germany. C. K. van der Ent reports grants from GSK, Nutricia, TEVA, Gilead, Vertex, ProQR, Proteostasis, Galapagos NV, and Eloxx; and has a patent 10006904 with royalties paid. Publisher Copyright: {\textcopyright} 2020 The Authors",

year = "2021",

month = apr,

doi = "10.1016/j.jaip.2020.11.024",

language = "English",

volume = "9",

pages = "1667--1674.e3",

number = "4",

}

TY - JOUR

T1 - Accurate prediction of peanut allergy in one-third of adults using a validated Ara h 2 cutoff

AU - Kansen, Hannah M

AU - van Erp, Francine C

AU - Knulst, André C

AU - Ehlers, Anna M

AU - Lyons, Sarah A

AU - Knol, Edward F

AU - Meijer, Yolanda

AU - Otten, Henny G

AU - van der Ent, Cornelis K

AU - Le, Thuy-My

N1 - Funding Information: We thank L. Bok and A. Kooij (Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands) for performing ImmunoCAP measurements, M. Smits (Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands; TNO, Zeist, the Netherlands) for performing EUROLINE measurements, and P. M. J. Welsing (Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands) for giving statistical advice. We acknowledge R. Klemans (Bergman Clinics, the Netherlands) for providing data from the previous diagnostic study. ImmunoCAP material was provided by Thermo Fisher Scientific (Uppsala, Sweden). The EUROLINE material was provided by EUROIMMUN (Lübeck, Germany). Conflicts of interest: The authors declare that they have no relevant conflicts of interest. Outside submitted work, E. F. Knol reports personal fees from Thermo Fisher Diagnostics. A. M. Ehlers reports that her research position at the UMC Utrecht is partially funded by EUROIMMUN AG, Lübeck, Germany. C. K. van der Ent reports grants from GSK, Nutricia, TEVA, Gilead, Vertex, ProQR, Proteostasis, Galapagos NV, and Eloxx; and has a patent 10006904 with royalties paid. Publisher Copyright: © 2020 The Authors

PY - 2021/4

Y1 - 2021/4

N2 - BACKGROUND: The diagnostic value of peanut components is extensively studied in children, but to a lesser extent in adults with suspected peanut allergy. The use of peanut components in daily practice may reduce the need for double-blind placebo-controlled food challenges (DBPCFCs); however, validation studies are currently lacking.OBJECTIVE: To evaluate the diagnostic value of (combined) peanut components and validate a previously found Ara h 2 cutoff level with 100% positive predictive value (PPV) in adults with suspected peanut allergy.METHODS: Adults who underwent a peanut DBPCFC were included: 84 patients from a previous study (2002-2012) and 70 new patients (2012-2019). Specific IgE (sIgE) to peanut extract, Ara h 1, 2, 3, 6, and 8 was measured using ImmunoCAP. Diagnostic value was assessed with an area under the curve (AUC) analysis.RESULTS: In total, 95 (62%) patients were peanut allergic. sIgE to Ara h 2 and Ara h 6 were the best predictors with an AUC (95% confidence interval) of 0.85 (0.79-0.91) and 0.85 (0.79-0.92), respectively. The Ara h 2 cutoff level with 100% PPV (≥1.75 kU A/L) was validated in the 70 new patients. Thirty percent of all included patients could be classified correctly as peanut allergic using this validated cutoff level. CONCLUSION: sIgE to Ara h 2 and Ara h 6 have equally high discriminative ability. Peanut allergy can be predicted accurately in one-third of adults using a validated cutoff level of sIgE to Ara h 2.

AB - BACKGROUND: The diagnostic value of peanut components is extensively studied in children, but to a lesser extent in adults with suspected peanut allergy. The use of peanut components in daily practice may reduce the need for double-blind placebo-controlled food challenges (DBPCFCs); however, validation studies are currently lacking.OBJECTIVE: To evaluate the diagnostic value of (combined) peanut components and validate a previously found Ara h 2 cutoff level with 100% positive predictive value (PPV) in adults with suspected peanut allergy.METHODS: Adults who underwent a peanut DBPCFC were included: 84 patients from a previous study (2002-2012) and 70 new patients (2012-2019). Specific IgE (sIgE) to peanut extract, Ara h 1, 2, 3, 6, and 8 was measured using ImmunoCAP. Diagnostic value was assessed with an area under the curve (AUC) analysis.RESULTS: In total, 95 (62%) patients were peanut allergic. sIgE to Ara h 2 and Ara h 6 were the best predictors with an AUC (95% confidence interval) of 0.85 (0.79-0.91) and 0.85 (0.79-0.92), respectively. The Ara h 2 cutoff level with 100% PPV (≥1.75 kU A/L) was validated in the 70 new patients. Thirty percent of all included patients could be classified correctly as peanut allergic using this validated cutoff level. CONCLUSION: sIgE to Ara h 2 and Ara h 6 have equally high discriminative ability. Peanut allergy can be predicted accurately in one-third of adults using a validated cutoff level of sIgE to Ara h 2.

KW - Adults

KW - Ara h 2

KW - Ara h 6

KW - Component-resolved diagnostics

KW - Food challenge

KW - Peanut allergy

KW - Peanut components

KW - Specific IgE

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U2 - 10.1016/j.jaip.2020.11.024

DO - 10.1016/j.jaip.2020.11.024

M3 - Article

C2 - 33248282

VL - 9

SP - 1667-1674.e3

JO - The journal of allergy and clinical immunology. In practice

JF - The journal of allergy and clinical immunology. In practice

IS - 4

ER -

Accurate prediction of peanut allergy in one-third of adults using a validated Ara h 2 cutoff

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