Peanut allergy diagnosis: Moving from basic to more elegant testing

Abstract

Peanut allergy (PNA) is an IgE-mediated immune disorder, which merits particular attention due to its impact on the health and quality of life of millions of patients worldwide.Peanut allergy is particularly widespread in the younger population and affects almost ¼ of children with food allergy (FA). 1 Although PNA tends to develop in early life, it resolves in only 20% of children. 2 The overall prevalence of PNA is estimated as 0.4% in Europe and 0.6% in the United States. 3,4 The frequency of PNA by self-report is higher in the United States (1.2% to 8% of children) 5,6 than in Europe (from 0.5% to 2.5%). 3,7 Studies based on oral food challenge (OFC) have estimated the prevalence of PNA in Europe as 0.2%-1. 6%, 8,9 in Australia to be 3% at 12 months of age and 1.9% at 4 years. 10 On the basis of stringent criteria (peanut IgE > 14 kUA/L and prescribed epinephrine autoinjector), its prevalence among US school children was found to be 2%. 11Overall, the prevalence of PNA appears to be increasing, especially in developed countries. A large telephone-based survey found rates of PNA in US children rising from 0.6% in 1997 to 1.2% in 2002 and 2.1% in 2007. 2,5,6 Similar trends have been reported from the UK 8 ; however, studies from Canada 12 and a newer one from the UK suggest the prevalence has stabilized. 13 Peanut allergy also represents the most common cause of anaphylactic reactions in children, with its incidence increasing between five and sevenfold over the past 10 years. 14,15 It accounts for the majority of severe food-related allergic reactions and has the highest lifetime risk for both anaphylaxis and anaphylaxis mortalities. 16 Exposure to even trace amounts of peanut can induce a serious reaction, including anaphylactic shock.These facts result in significant effects on quality of life of patients and their families. In addition, the widespread distribution of peanuts (PN) in food products not only complicates their avoidance but also increases the risk of allergic reactions through accidental consumption. 2,16 Hence, an accurate diagnosis of PNA is vital. However, while the diagnosis is often obvious just based on the clinical history, in many cases it is far less clear given the imperfect nature of food allergy Abstract Peanut allergy (PNA) is an IgE-mediated immune disorder, which merits particular attention due to its impact on the health and quality of life of millions of patients worldwide. PNA tends to develop in early life and resolves in only 20% of peanutallergic children. It accounts for the majority of severe food-related allergic reactions.An accurate diagnosis of PNA is vital. In this review, we present the approach to the diagnosis of peanut allergy, starting from the history and proceeding to measures of overall sensitization and then to component-resolved diagnostics and oral food challenges as indicated. Additional testing in development includes basophil activation testing and determination of epitopes for peanut-allergic responses. Based on the literature, stepwise approaches and...

Biomarkers of diagnosis and resolution of food allergy

“…In terms of specific food allergies in children, one of the allergenic foods that has had greater focus in terms of diagnostic studies over the last decade has been peanut 35…”

“…In terms of specific food allergies in children, one of the allergenic foods that has had greater focus in terms of diagnostic studies over the last decade has been peanut 35 but recent data have emerged on other foods, including hazelnut, cashew and sesame. The focus on peanut may have been influenced by the increasing prevalence of peanut allergy in the last decade with approximately 0.4%‐3% of children in developed countries being affected as well as it being one of the most common causes of anaphylactic reactions in children 35 …”

IgE-Mediated Peanut Allergy: Current and Novel Predictive Biomarkers for Clinical Phenotypes Using Multi-Omics Approaches

“…Taken individually, each omics-approach has assets and drawbacks (reviewed by ( 127 , 128 ) but together they might unfold their full potential. Unbiased machine-learning, integrated data analysis of heterogeneous datasets as well as network-based approaches will be required to establish algorithms for providing insights in disease pathophysiology and for inferring biomarkers or biomarker signatures being predictive for reaction phenotypes ( 33 , 127 , 129 , 130 ). Finally, those insights shall advance the stratification of individuals prior to selection for oral immunotherapy or early food introduction for prevention, both pioneer areas research in PA ( 131 , 132 ).…”

Cyclophilin – A novel cross‐reactive determinant in peanut

“…Component‐resolved diagnostics (CRD) is an important tool in the investigation of suspected peanut allergy. Primary sensitization to peanut, generally characterized by sensitization to the storage proteins Ara h 1, Ara h 2, Ara h 3 and/or Ara h 6, is associated with severe allergic symptoms to peanut 1,2 . On the other hand, cross‐reactive pollen sensitization may confound the interpretation of IgE tests to peanut.…”