AUTHOR=Datema Mareen R. , Lyons Sarah A. , Fernández-Rivas Montserrat , Ballmer-Weber Barbara , Knulst André C. , Asero Riccardo , Barreales Laura , Belohlavkova Simona , de Blay Frédéric , Clausen Michael , Dubakiene Ruta , Fernández-Perez Cristina , Fritsche Philipp , Gislason David , Hoffmann-Sommergruber Karin , Jedrzejczak-Czechowicz Monika , Jongejan Laurian , Kowalski Marek L. , Kralimarkova Tanya Z. , Lidholm Jonas , Papadopoulos Nikolaos G. , Popov Todor A. , Prado Nayade del , Purohit Ashok , Reig Isabel , Seneviratne Suranjith L. , Sinaniotis Athanassios , Vassilopoulou Emilia , Versteeg Serge A. , Vieths Stefan , Welsing Paco M. J. , Mills E. N. Clare , Le Thuy-My , Zwinderman Aeilko H. , van Ree Ronald
TITLE=Estimating the Risk of Severe Peanut Allergy Using Clinical Background and IgE Sensitization Profiles
JOURNAL=Frontiers in Allergy
VOLUME=2
YEAR=2021
URL=https://www.frontiersin.org/journals/allergy/articles/10.3389/falgy.2021.670789
DOI=10.3389/falgy.2021.670789
ISSN=2673-6101
ABSTRACT=Background: It is not well-understood why symptom severity varies between patients with peanut allergy (PA).
Objective: To gain insight into the clinical profile of subjects with mild-to-moderate and severe PA, and investigate individual and collective predictive accuracy of clinical background and IgE to peanut extract and components for PA severity.
Methods: Data on demographics, patient history and sensitization at extract and component level of 393 patients with probable PA (symptoms ≤ 2 h + IgE sensitization) from 12 EuroPrevall centers were analyzed. Univariable and penalized multivariable regression analyses were used to evaluate risk factors and biomarkers for severity.
Results: Female sex, age at onset of PA, symptoms elicited by skin contact with peanut, family atopy, atopic dermatitis, house dust mite and latex allergy were independently associated with severe PA; birch pollen allergy with mild-to-moderate PA. The cross-validated AUC of all clinical background determinants combined (0.74) was significantly larger than the AUC of tests for sensitization to extract (0.63) or peanut components (0.54–0.64). Although larger skin prick test wheal size, and higher IgE to peanut extract, Ara h 1 and Ara h 2/6, were associated with severe PA, and higher IgE to Ara h 8 with mild-to-moderate PA, addition of these measurements of sensitization to the clinical background model did not significantly improve the AUC.
Conclusions: Models combining clinical characteristics and IgE sensitization patterns can help establish the risk of severe reactions for peanut allergic patients, but clinical background determinants are most valuable for predicting severity of probable PA in an individual patient.