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More accurate peanut allergy test could be on the way

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Component-resolved diagnostics facilitate the diagnosis of peanut allergy

Journal of Allergy and Clinical Immunology

Not all peanut-sensitized children experience allergic reactions on exposure. Tests that could discriminate peanut allergy from tolerance without the need to perform oral food challenge would be extremely useful. Within the context of a population-based birth cohort, Nicolaou et al (p 191) determined, on the basis of peanut challenge, the proportion of children with peanut allergy among those considered peanut-sensitized using skin prick tests, sIgE measurements, or both (with whole peanut extract) and investigated whether blood tests with component-resolved diagnostics (microarray with major peanut and cross-reactive components) could differentiate peanut allergy from tolerance. Although approximately 1 in 10 children 8 years of age in the United Kingdom is peanut sensitized, on the basis of the oral food challenge, only 1 in 50 has peanut allergy. Component-resolved diagnostics revealed marked differences in the pattern recognition between subjects with peanut allergy and peanut-tolerant subjects (see Figure). Children with peanut allergy had higher responses to Ara h 1 to 3, whereas peanut-tolerant children had higher responses to grass components and cross-reactive carbohydrate determinants. Ara h 2 offered the best discrimination between the groups. These data confirm that the majority of children considered peanut sensitized on the basis of standard test responses do not have peanut allergy and suggest that measurement of IgE response to Ara h 2 might prove to be a clinically useful tool in predicting peanut allergy.