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Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants.
J Allergy Clin Immunol 2013; 132(4):874-80JA

Abstract

BACKGROUND

Ninety-five percent positive predictive values (PPVs) provide an invaluable tool for clinicians to avoid unnecessary oral food challenges. However, 95% PPVs specific to infants, the age group most likely to present for diagnosis of food allergy, are limited.

OBJECTIVE

We sought to develop skin prick test (SPT) and allergen-specific IgE (sIgE) thresholds with 95% PPVs for challenge-confirmed food allergy in a large population-based cohort of 1-year-old infants with challenges undertaken irrespective of SPT wheal size or previous history of ingestion.

METHODS

HealthNuts is a population-based, longitudinal food allergy study with baseline recruitment of 1-year-old infants. Infants were recruited from council-run immunization sessions during which they underwent SPTs to 4 allergens: egg, peanut, sesame, and cow's milk/shrimp. Any infant with a detectable SPT response was invited to undergo oral food challenge and sIgE testing.

RESULTS

Five thousand two hundred seventy-six infants participated in the study. Peanut SPT responses of 8 mm or greater (95% CI, 7-9 mm), egg SPT responses of 4 mm or greater (95% CI, 3-5 mm), and sesame SPT responses of 8 mm or greater (95% CI, 5-9 mm) had 95% PPVs for challenge-proved food allergy. Peanut sIgE levels of 34 kUA/L or greater (95% CI, 14-48 kUA/L) and egg sIgE levels of 1.7 kUA/L or greater (95% CI, 1-3 kUA/L) had 95% PPVs for challenge-proved food allergy. Results were robust when stratified on established risk factors for food allergy. Egg SPT responses and sIgE levels were poor predictors of allergy to egg in baked goods.

CONCLUSION

These 95% PPVs, which were generated from a unique dataset, are valuable for the diagnosis of food allergy in young infants and were robust when stratified across a number of different risk factors.

Authors+Show Affiliations

Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23891354

Citation

Peters, Rachel L., et al. "Skin Prick Test Responses and Allergen-specific IgE Levels as Predictors of Peanut, Egg, and Sesame Allergy in Infants." The Journal of Allergy and Clinical Immunology, vol. 132, no. 4, 2013, pp. 874-80.
Peters RL, Allen KJ, Dharmage SC, et al. Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants. J Allergy Clin Immunol. 2013;132(4):874-80.
Peters, R. L., Allen, K. J., Dharmage, S. C., Tang, M. L., Koplin, J. J., Ponsonby, A. L., ... Gurrin, L. C. (2013). Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants. The Journal of Allergy and Clinical Immunology, 132(4), pp. 874-80. doi:10.1016/j.jaci.2013.05.038.
Peters RL, et al. Skin Prick Test Responses and Allergen-specific IgE Levels as Predictors of Peanut, Egg, and Sesame Allergy in Infants. J Allergy Clin Immunol. 2013;132(4):874-80. PubMed PMID: 23891354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants. AU - Peters,Rachel L, AU - Allen,Katrina J, AU - Dharmage,Shyamali C, AU - Tang,Mimi L K, AU - Koplin,Jennifer J, AU - Ponsonby,Anne-Louise, AU - Lowe,Adrian J, AU - Hill,David, AU - Gurrin,Lyle C, AU - ,, Y1 - 2013/07/24/ PY - 2012/12/18/received PY - 2013/05/21/revised PY - 2013/05/31/accepted PY - 2013/7/30/entrez PY - 2013/7/31/pubmed PY - 2013/12/16/medline KW - AUC KW - Allergen-specific IgE KW - Area under the curve KW - Food allergy KW - LR KW - Likelihood ratio KW - NPV KW - Negative predictive value KW - OFC KW - Oral food challenge KW - PPV KW - Positive predictive value KW - ROC KW - Receiver operating characteristic KW - SPT KW - Skin prick test KW - baked egg KW - egg KW - oral food challenge KW - peanut KW - predictive value of tests KW - sIgE KW - serum-specific IgE KW - sesame KW - skin prick test SP - 874 EP - 80 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 132 IS - 4 N2 - BACKGROUND: Ninety-five percent positive predictive values (PPVs) provide an invaluable tool for clinicians to avoid unnecessary oral food challenges. However, 95% PPVs specific to infants, the age group most likely to present for diagnosis of food allergy, are limited. OBJECTIVE: We sought to develop skin prick test (SPT) and allergen-specific IgE (sIgE) thresholds with 95% PPVs for challenge-confirmed food allergy in a large population-based cohort of 1-year-old infants with challenges undertaken irrespective of SPT wheal size or previous history of ingestion. METHODS: HealthNuts is a population-based, longitudinal food allergy study with baseline recruitment of 1-year-old infants. Infants were recruited from council-run immunization sessions during which they underwent SPTs to 4 allergens: egg, peanut, sesame, and cow's milk/shrimp. Any infant with a detectable SPT response was invited to undergo oral food challenge and sIgE testing. RESULTS: Five thousand two hundred seventy-six infants participated in the study. Peanut SPT responses of 8 mm or greater (95% CI, 7-9 mm), egg SPT responses of 4 mm or greater (95% CI, 3-5 mm), and sesame SPT responses of 8 mm or greater (95% CI, 5-9 mm) had 95% PPVs for challenge-proved food allergy. Peanut sIgE levels of 34 kUA/L or greater (95% CI, 14-48 kUA/L) and egg sIgE levels of 1.7 kUA/L or greater (95% CI, 1-3 kUA/L) had 95% PPVs for challenge-proved food allergy. Results were robust when stratified on established risk factors for food allergy. Egg SPT responses and sIgE levels were poor predictors of allergy to egg in baked goods. CONCLUSION: These 95% PPVs, which were generated from a unique dataset, are valuable for the diagnosis of food allergy in young infants and were robust when stratified across a number of different risk factors. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/23891354/Skin_prick_test_responses_and_allergen_specific_IgE_levels_as_predictors_of_peanut_egg_and_sesame_allergy_in_infants_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(13)00920-2 DB - PRIME DP - Unbound Medicine ER -