Are peanut oral food challenges still useful? An evaluation of children with suspected peanut allergy, sensitization to Ara h 2 and controlled asthma

Iida Ojaniemi, Susanna Salmivesi, Antti Tikkakoski, Jussi Karjalainen, Lauri Lehtimäki, Rüdiger Schultz

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    Abstract

    Background: Sensitization to Ara h 2 has been proposed as a promising biological marker for the severity of peanut allergy and may reduce the need for oral food challenges. This study aimed to evaluate whether peanut oral food challenge is still a useful diagnostic tool for children with suspected peanut allergy and an elevated level of Ara h 2-specific IgE. Additionally, we assessed whether well-controlled asthma is an additional risk for severe reactions. Methods: A retrospective analysis of 107 children with sensitization to Ara h 2-specific IgE (> 0.35 kU/l) undergoing open peanut challenges during 2012–2018 in the Tampere University Hospital Allergy Centre, Finland. Results: Of the 107 challenges, 82 (77%) were positive. Serum levels of Ara h 2 -sIgE were higher in subjects with a positive challenge than in those who remained negative (median 32.9 (IQR 6.7–99.8) vs. 2.1 (IQR 1.0–4.9) kU/l), p < 0.001) but were not significantly different between subjects with and without anaphylaxis. No correlation was observed between the serum level of Ara h 2-sIgE and reaction severity grading. Well-controlled asthma did not affect the challenge outcome. Conclusions: Elevated levels of Ara h 2-specific IgE are associated with a positive outcome in peanut challenges but not a reliable predictor of reaction severity. Additionally, well-controlled asthma is not a risk factor for severe reactions in peanut challenges in children with sensitization to Ara h 2.

    Original languageEnglish
    Article number100
    Number of pages8
    JournalAllergy, Asthma and Clinical Immunology
    Volume18
    Issue number1
    DOIs
    Publication statusPublished - Nov 2022
    Publication typeA1 Journal article-refereed

    Keywords

    • Anaphylaxis
    • Ara h 2
    • Asthma
    • Oral food challenge
    • Peanut allergy

    Publication forum classification

    • Publication forum level 1

    ASJC Scopus subject areas

    • Immunology and Allergy
    • Immunology
    • Pulmonary and Respiratory Medicine

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