Is Ara h 2 indeed the best predictor for peanut allergy in Dutch children?
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Mirjam Schots
Abstract
Background: Specific immunoglobulin E to Ara h 2 (sIgE to Ara h 2) is described as an upcoming predicting factor for diagnosing peanut allergy in children. The gold standard for diagnosing peanut allergy is a double blind placebo controlled food challenge, however this is time consuming and potentially harmful. We investigate Ara h 2 as a preliminary less invasive diagnostic tool for diagnosing peanut allergy in a general population of peanut sensitized children.
Methods: Children (n=52) with peanut sensitization were retrospectively included. An oral food challenge (OFC) confirmed peanut allergy or tolerance, as primary outcome. Individual candidate predictors were identified by univariate regression analysis and used in a prediction model. Different cut-off values were obtained and receiver operating characteristic curves were plotted.
Results: Multivariate analyses resulted in Ara h 2 as best predictor, with a discriminative ability of 0.87 (95% confidence interval, 0.77–0.97). Sensitivity and specificity of 55% and 95%, respectively, were found for a sIgE to Ara h 2 cut-off value of 4.25 kU/L. The highest positive predictive value of 100% was reached at 5.61 kU/L. No absolute relation was found between the value of Ara h 2 and the severity of the reaction during OFC.
Conclusion: This study developed a prediction model in which sIgE to Ara h 2 was the best predictor for peanut allergy in sensitized children in a general hospital. Therefore depending on the history and the Ara h 2 results, an OFC is not always needed to confirm the diagnosis.
Acknowledgments
The authors would like to thank Mr. M. Verdaas and Mrs. G. Leenheer-Van Leerdam for performing the laboratory measurements and Mr. J. Kalter for assistance with statistical analyses.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. MS acquired data by chart review, carried out the analyses, drafted the manuscript; YM and WV assisted with study design, coordinated and supervised data collection; AM assisted with the study design and interpretation of data, provided expert statistical input for data analyses; EV assisted with the study concept and design. All authors contributed to review and revision of the article and have given final approval of the version to be published.
Research funding: This study was partially funded by an internal Albert Schweitzer Hospital Grant, Dordrecht, The Netherlands.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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Articles in the same Issue
- Frontmatter
- Guidelines and Recommendations
- Methodologies for evaluating strategies to reduce diagnostic error: report from the research summit at the 7th International Diagnostic Error in Medicine Conference
- Mini Review
- Evaluation of DSM-5 and IWG-2 criteria for the diagnosis of Alzheimer’s disease and dementia with Lewy bodies
- Opinion Paper
- The Choosing Wisely campaign – don’t throw the baby out with the bathwater
- Original Articles
- Online public reactions to frequency of diagnostic errors in US outpatient care
- Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity
- Is Ara h 2 indeed the best predictor for peanut allergy in Dutch children?
- Factors associated with a delayed diagnosis of pulmonary embolism
