Moving from peanut extract to peanut components: towards validation of component‐resolved IgE tests

Aalberse, Joost A.; Meijer, Y.; Derksen, Ninotska I. L.; Palen-Merkus, Tjitske van der; Knol, Edward F.; Aalberse, Rob C.

doi:10.1111/all.12160

Cited by 37 publications

(38 citation statements)

References 24 publications

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“…Even at the best cutoff value of 0.5 kU/l, whole-peanut sIgE used alone appeared to be of a low diagnostic value, yielding a maximal Youden index below 0.80, with poor specificity and PPV. We conclude that it cannot reasonably be retained as an accurate tool to discriminate peanut allergy from tolerance, consistent with previous reports [12,23,24,25]. At a cutoff of 0.35 kU/l, the Ara h 2 sIgE immunoassay was acceptable, with a Youden index of 0.94 and a PPV of 100%, in line with recent results [17,26,27,28].…”

Section: Discussionsupporting

confidence: 90%

“…Laboratory tests measuring the serum levels of specific immunoglobulin E (sIgE) directed against whole-peanut protein extracts have been used to evaluate peanut sensitization. However, even when combined with skin tests, these assays are not able to accurately diagnose peanut allergy and evaluate the risk of anaphylaxis because of a lack of sensitivity and specificity [11,12]. …”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Value of Antigen-Specific Immunoglobulin E Immunoassays against Ara h 2 and Ara h 8 Peanut Components in Child Food Allergy

Martinet¹,

Couderc²,

Renosi³

et al. 2016

Int Arch Allergy Immunol

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Background: Peanut allergy is one of the most severe food allergies in children. The diagnostic gold standard is the oral food challenge (OFC). However, OFC has inherent risks and is time consuming. The measurement of specific immunoglobulin E (sIgE) to peanut components in blood detects peanut sensitization, but the decision point predicting allergy is still unclear. The aim of this study was to determine the diagnostic value of these tests for the evaluation of child peanut allergy. Methods: In this retrospective study, 81 children were referred for peanut allergy. The diagnosis of peanut allergy was based on the clinical context and a positive OFC. Levels of sIgE against whole peanuts or peanut components (Ara h 2 and Ara h 8) were determined by immunoassay. Results: The Ara h 2 sIgE assay has the best negative predictive value (0.93) and positive predictive value (1) at a cutoff of 0.1 kU/l. Ara h 2 sIgE titers can predict the risk of anaphylaxis (<0.44 kU/l, low risk; >14 kU/l, high risk). The Ara h 8 sIgE assay is not able to discriminate peanut-allergic patients but can be used to evaluate possible cross-reactions to birch pollen with a low risk of anaphylaxis. The best diagnostic strategy is to first determine the Ara h 2 sIgE level and, if negative, evaluate Ara h 8 sIgE. Conclusions: We propose an algorithm for a better use of peanut component sIgE immunoassays that should improve their diagnostic value and avoid unnecessary OFC.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Antigen-Specific Immunoglobulin E Immunoassays against Ara h 2 and Ara h 8 Peanut Components in Child Food Allergy

Martinet¹,

Couderc²,

Renosi³

et al. 2016

Int Arch Allergy Immunol

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“…However, because of crossreactivity between crude allergen extracts from different fungi [9], apparent sensitization to crude Af extract does not always indicate genuine Af-sensitization. Recently, allergen components purified from their native sources or produced as recombinant proteins have been introduced into the battery of tests available for the diagnosis of allergic diseases [10][11][12][13], generally known as component-resolved diagnostics (CRD) [14][15][16], more recently, molecular-based allergy (MA) diagnostics [17]. Such techniques and diagnostics may solve this problem; however, clinical studies in MA diagnostics for fungal allergy have thus far been limited [18].…”

Section: Introductionmentioning

confidence: 99%

Molecular‐based allergy diagnosis of allergic bronchopulmonary aspergillosis in Aspergillus fumigatus‐sensitized Japanese patients

Tanimoto

Fukutomi

Yasueda

et al. 2015

Clin Experimental Allergy

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SummaryBackgroundDistinguishing between patients with allergic bronchopulmonary aspergillosis (ABPA) and Aspergillus fumigatus (Af)‐sensitized asthmatic patients without ABPA is sometimes difficult owing to the IgE‐cross‐reactivity between Af and other fungal allergens.ObjectiveTo establish the usefulness of molecular‐based allergy diagnostics using allergen components from Af in distinguishing ABPA from Af‐sensitized asthma without ABPA.MethodsSera from Japanese patients with ABPA (n = 53) and Af‐sensitized asthma without ABPA (n = 253) were studied. The levels of IgE and IgG antibodies to allergen components from Af and IgE antibodies to different fugal allergen extracts were measured by ImmunoCAP. Comorbid atopic dermatitis (AD) was taken into consideration in the sensitization profile analysis.ResultsPatients with ABPA possessed significantly higher levels of IgE antibodies to Asp f 1, and Asp f 2 than asthmatic patients without ABPA. The areas under the receiver operating characteristic curves for the levels of IgE to Asp f 1 and Asp f 2 as diagnostic markers of ABPA were 0.75 and 0.78, respectively. The presence of IgE positivity to Asp f 1 and/or Asp f 2 resulted in increased sensitivity while losing little specificity. Comorbid AD was associated with higher levels of IgE to Asp f 6 (manganese superoxide dismutase from Af, a ubiquitous pan‐allergen in fungi) and low but positive levels of IgE to other Af‐components, which hampered the serological discrimination of ABPA.Conclusions and Clinical RelevanceThe levels of IgE to Asp f 1 and/or Asp f 2 can effectively differentiate ABPA from Af‐sensitized asthma, suggesting that the amounts of IgE specific for these molecules are markers for genuine Af‐sensitization in ABPA. However, comorbid AD must be taken into consideration in the interpretation of high IgE to Asp f 6. Establishing of IgE‐sensitization profiles using panel of Af‐allergen components provides valuable information for distinguishing genuine vs. cross‐reactive sensitization in Af‐sensitized patients.

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“…The evaluation of components, however, should be interpreted with caution, as it is likely that the panel of hazelnut components is still not complete and therefore could affect the results [23], e.g. we did not determine sIgE to oleosins [24].…”

Section: Discussionmentioning

confidence: 99%

Cor a 14: Missing Link in the Molecular Diagnosis of Hazelnut Allergy?

Faber

Graag

Heijden

et al. 2014

Int Arch Allergy Immunol

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Background: Hazelnut allergy shows distinct clinical patterns that can be predicted through component-resolved diagnosis. However, identification of sensitization profiles remains incomplete. Methods: Sera of 75 patients allergic to hazelnuts, 14 infants with atopic dermatitis (AD) sensitized to hazelnuts, 15 hazelnut-tolerant individuals with specific IgE (sIgE) to hazelnuts and 15 healthy control individuals were tested for sIgE reactivity to rCor a 1.04, rCor a 8, nCor a 9, nCor a 11, rCor a 14, rBet v 1, rBet v 2 and cross-reactive carbohydrate determinants (CCDs). Results: Sensitization to Cor a 14 was observed in 18 out of 20 preschool children, 8 out of 10 school-aged children and 2 out of 7 adults with generalized reactions and in 3 out of 14 infants with AD. Only 2 out of 38 patients with an oral allergy syndrome (OAS) were sensitized to Cor a 14. No sensitization to Cor a 14 was observed in the group of hazelnut-tolerant and healthy control individuals. Sensitization to Cor a 1.04 was seen in 36 out of 38 OAS patients and in 14 out of 37 patients with generalized reactions. However, only 3 patients with generalized reactions were monosensitized to Cor a 1.04. Sensitization to Cor a 9 was observed in 26 out of 37 patients with generalized reactions and in 4 out of 14 infants with AD. Sensitization to Cor a 11, Cor a 8, rBet v 2 and CCDs was rare. Conclusions: Sensitization to Cor a 14 can have early onset and shows age-related variations. Together with Cor a 9, Cor a 14 enables us to correctly identify almost 90% of children with generalized reactions to hazelnut.

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Moving from peanut extract to peanut components: towards validation of component‐resolved IgE tests

Cited by 37 publications

References 24 publications

Diagnostic Value of Antigen-Specific Immunoglobulin E Immunoassays against Ara h 2 and Ara h 8 Peanut Components in Child Food Allergy

Diagnostic Value of Antigen-Specific Immunoglobulin E Immunoassays against Ara h 2 and Ara h 8 Peanut Components in Child Food Allergy

Molecular‐based allergy diagnosis of allergic bronchopulmonary aspergillosis in Aspergillus fumigatus‐sensitized Japanese patients

Cor a 14: Missing Link in the Molecular Diagnosis of Hazelnut Allergy?

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