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

• Published in: Annals of allergy, asthma, & immunology Vol. 121; no. 1; pp. 69 - 76.e2
• Main Authors: Chinthrajah, R. Sharon, Purington, Natasha, Andorf, Sandra, Rosa, Jaime S., Mukai, Kaori, Hamilton, Robert, Smith, Bridget Marie, Gupta, Ruchi, Galli, Stephen J., Desai, Manisha, Nadeau, Kari C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2018
• Subjects: Adolescent; Algorithms; Arachis - immunology; Asthma, Exercise-Induced - diagnosis; Asthma, Exercise-Induced - immunology; Asthma, Exercise-Induced - pathology; Basophils - immunology; Basophils - pathology; Biomarkers - analysis; Child; Child, Preschool; Double-Blind Method; Female; Forced Expiratory Volume - immunology; Humans; Immunoglobulin E - blood; Male; Peanut Hypersensitivity - diagnosis; Peanut Hypersensitivity - immunology; Peanut Hypersensitivity - pathology; Predictive Value of Tests; Severity of Illness Index; Tetraspanin 30 - genetics; Tetraspanin 30 - immunology; Vital Capacity - immunology
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2018.04.020

Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established.
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.
Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 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 multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC.
A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63hi stimulation with peanut to percentage of CD63hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P < .001).
The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory 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 OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings.
ClinicalTrials.gov identifier: NCT02103270.