Development of a tool predicting severity of allergic reaction during peanut challenge

Publication date: Available online 27 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): R. Sharon Chinthrajah, Natasha Purington, Sandra Andorf, Jaime S. Rosa, Kaori Mukai, Robert Hamilton, Bridget Marie Smith, Ruchi Gupta, Stephen J. Galli, Manisha Desai, Kari C. Nadeau
BackgroundReliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFC) have not been established.ObjectiveWe sought to develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC.MethodsMedical history and allergy tests were obtained for 120 peanut-allergic participants who underwent double-blind, placebo-controlled food challenges (DBPCFCs). Reactions were assigned a CSS between 1 to 6 based on cumulative tolerated dose and a "severity clinical indicator." Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multi-step analysis to derive a flexible decision rule to understand risk during peanut of OFC.Results18.3% participants had a severe reaction (CSS >4). The decision rule identified the following three variables (in order of importance) as predictors of reaction severity: ratio of %CD63hi stimulation with peanut to %CD63hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and forced expiratory volume in 1 sec/forced vital capacity (FEV1/FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (p<0.001).ConclusionThe CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Lab-values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV1/FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFC. Further testing of this decision rule is needed in a larger external data source before it can be considered outside of research settings.



https://ift.tt/2wLKeme