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Predicting reactivity threshold in children with anaphylaxis to peanut

机译：预测过敏性儿童对花生儿童的反应性阈值

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Summary Background Peanut allergy necessitates dietary restrictions, preferably individualized by determining reactivity threshold through an oral food challenge ( OFC ). However, risk of systemic reactions often precludes OFC in children with severe peanut allergy. Objective We aimed to determine whether clinical and/or immunological characteristics were associated with reactivity threshold in children with anaphylaxis to peanut and secondarily, to investigate whether these characteristics were associated with severity of the allergic reaction during OFC . Methods A double‐blinded placebo‐controlled food challenge ( DBPCFC ) with peanut was performed in 96 5‐ to 15‐year‐old children with a history of severe allergic reactions to peanut and/or sensitization to peanut (skin prick test [ SPT ] ≥3 mm or specific immunoglobulin E [s‐IgE] ≥0.35 kUA /L). Investigations preceding the DBPCFC included a structured interview, SPT , lung function measurements, serological immunology assessment (IgE, IgG and IgG 4 ), basophil activation test ( BAT ) and conjunctival allergen provocation test ( CAPT ). International standards were used to define anaphylaxis and grade the allergic reaction during OFC . Results During DBPCFC , all 96 children (median age 9.3, range 5.1‐15.2) reacted with anaphylaxis (moderate objective symptoms from at least two organ systems). Basophil activation ( CD 63 + basophils ≥15%), peanut SPT and the ratio of peanut s‐IgE/total IgE were significantly associated with reactivity threshold and lowest observed adverse events level ( LOAEL ) (all P .04). Basophil activation best predicted very low threshold level (3 mg of peanut protein), with an optimal cut‐off of 75.8% giving a 93.5% negative predictive value. None of the characteristics were significantly associated with the severity of allergic reaction. Conclusion and Clinical Relevance In children with anaphylaxis to peanut, basophil activation, peanut SPT and the ratio of peanut s‐IgE/total IgE were associated with reactivity threshold and LOAEL , but not with allergy reaction severity.
机译：发明内容背景花生过敏需要饮食限制，优选通过通过口腔食物挑战（OFC）确定反应性阈值来个体化。然而，系统性反应的风险通常禁止对具有严重花生过敏的儿童。目的我们旨在确定临床和/或免疫特征是否与过敏性儿童的临床和/或免疫学特征有关，并且其次，研究这些特性是否与OFC期间过敏反应的严重程度有关。方法对花生进行双盲安慰剂对照食物挑战（DBPCFC）在96名5岁儿童中进行了对花生和/或对花生敏感的严重过敏反应史（皮肤刺测试[SPT] ≥3mm或特异性免疫球蛋白E [S-IgE]≥0.35kua / l）。在DBPCFC之前的研究包括结构化面试，SPT，肺功能测量，血清学免疫学评估（IgE，IgG和IgG 4），嗜碱性激活试验（BAT）和结膜过敏原挑衅试验（上尉）。国际标准用于定义过敏反应和级别的过敏反应。结果在DBPCFC期间，所有96名儿童（中位数9.3，范围5.1-15.2）与过敏反应（来自至少两个器官系统的中等客观症状）反应。嗜碱性粒子激活（CD 63 +嗜碱性粒细胞≥15％），花生SPT和花生S-IgE /总IgE的比例与反应性阈值和最低观察到的不良事件水平（LOAEL）（所有P <.04）显着相关。嗜碱性激活最佳预测非常低的阈值水平（＆ 3mg花生蛋白），最佳截止值为75.8％，给出了93.5％的负面预测值。没有任何特性与过敏反应的严重程度显着相关。结论及临床相关性在对花生，嗜碱性粒细胞激活，花生SPT和花生S-IgE /总IgE的比例与反应性阈值和泳池相关，但不具有过敏反应严重程度。

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