Can we predict severe allergic reactions in peanut allergic children?
Published Online: September 1, 2011
Several risk factors for severe anaphylactic reactions to food in daily life are known: older age, coexistent atopic disease and, in some studies, degree of sensitization (levels of food specific IgE and outcome of skin prick tests) and a history of severe reactions to small amounts of allergenic food. However, to date, it is not possible to predict the severity of food allergic reactions in the individual patient with accuracy. Some studies show that a history of severe reactions is associated with a lower eliciting dose in double-blind, placebo-controlled food challenges (DBPCFCs).
In a recent article in The Journal of Allergy & Clinical Immunology (JACI), van der Zee et al. used the eliciting dose as a measure for clinical sensitivity. They studied whether risk factors for severe food allergic reactions in daily life could influence the eliciting dose in DBPCFCs in peanut allergic children.
Data from 126 children having a positive DBPCFC with peanut at the University Medical Center Groningen (2001-2009) were analyzed. Age older than 10 years, a specific IgE level above the lowest tertile (≥5.6 kU/L) and the absence of atopic dermatitis were associated with reactions to lower doses. No significant associations with eliciting dose were found for sex, presence of asthma and rhinitis and the severity of food reactions by history.
The authors conclude that using eliciting dose as a measure for clinical sensitivity, greater clinical sensitivity in DBPCFCs to peanut was associated with older age, higher specific IgE and the absence of atopic dermatitis. This finding may explain why adolescents experience severe food allergic reactions in daily life to peanut more often than younger children.
The study underlines the necessity of stringent dietary adherence and provision of self-injectable epinephrine in peanut allergic older children, children with higher peanut specific IgE and children without atopic dermatitis.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.