Published Online: June 27, 2013
Previous studies have shown that peanut allergy can be expected to resolve spontaneously in 20% to 25% of cases. However, it remains unclear how long clinicians and patients should wait for this to happen.
In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Bégin et al, report on data from 202 participants who were followed longitudinally for 12 years after an early diagnosis of peanut allergy (median 12 months). Resolution was confirmed by double blind placebo controlled food challenge offered to subjects with specific IgE lower than 15 ku/L.
During the study period, 51 subjects (25%) were found to resolve their peanut allergy. Most resolutions (80%) occurred before age 8 with mean annual rates of 6.6, 2.2, and 0.6 per 100 patients per year between ages 3 to 6, 6 to 10, and 10 to 15, respectively. As expected in infants, initial specific IgE levels were generally low at diagnosis, but they increased rapidly in persisters while they remained low in remitters. In addition to having low initial peanut specific IgE at diagnosis (<0.7 ku/L), strict avoidance of traces was also independently associated with increased chances of spontaneous resolution.
These data can help individualize a patient’s risk of persistent disease which may eventually weight in the balance when considering new emerging therapies for food allergy. They also support current recommendations for strict trace avoidance.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.