Background Despite the high risk of anaphylaxis in patients with a macadamia nut allergy (MdA), little is known about the significance of macadamia nut‐specific immunoglobulin E (Md‐sIgE). Thus, this study aimed to investigate the utility of Md‐sIgE for predicting anaphylaxis. Methods Children with suspected MdA who visited our hospital were included. MdA was defined as either failing the 3‐g macadamia nut (Md) oral food challenge (OFC) or confirming obvious immediate symptoms following Md ingestion. Non‐MdA was defined as passing the 3‐g Md OFC. Results A total of 41 children (29 [71%] males) with a median age of 7.7 years were included. The median Md‐sIgE level was 2.23 kUA/L. Among the 21 children diagnosed with MdA, eight and 13 children did (An group) and did not (non‐An group) develop anaphylaxis. Twenty children were included in the non‐MdA group. The Md‐sIgE level was significantly higher in the An group relative to the others (7.97 vs. 1.92 kUA/L, p < .001). Furthermore, the Md‐sIgE level was significantly higher in the An group than in the non‐An group (7.97 vs. 1.92 kUA/L, p = .02). However, there was no significant difference in the Md‐sIgE between the non‐An and non‐MdA groups (1.92 vs. 1.90 kUA/L, p > .99). The area under the curve for predicting anaphylaxis in Md‐sIgE was 0.92 (95% CI: 0.83–1.00), and the optimal cut‐off value was 3.76 kUA/L. Conclusion Md‐sIgE levels were useful in predicting anaphylaxis. Above the cut‐off value, we emphasize paying careful attention to the risk of anaphylaxis.
Background: Approximately 50–90% of children with immediate-type cow’s milk allergy (CMA) acquire tolerance by pre-school age. We aimed to investigate the tolerance acquisition rate of CMA in children aged 6–12 years. Methods: Children with CMA that persisted until 6 years of age were included. Tolerance acquisition was defined as either passing an oral food challenge with 200 mL of unheated cow’s milk (CM) or consuming CM of any quantity without symptoms. Persistent CMA was defined as fulfilling neither of these criteria by 12 years of age. Children undergoing oral immunotherapy were defined as having persistent CMA. Risk factors associated with persistent CMA were assessed using Cox regression analysis. Results: Of the 123 children analyzed, 60 (49%) had previous CM anaphylaxis, 82 (67%) eliminated CM from their diet, and the median CM-specific immunoglobulin E (sIgE) level was 23.3 kU /L at 6 years of age. Twenty-five children (20%) acquired tolerance by 9 years of age, and 46 (37%) by age 12. At baseline, higher CM-sIgE levels (hazard ratio: 2.58 [95% confidence interval: 1.62–4.12], optimal cutoff level: 34.4 kU /L), previous CM anaphylaxis (2.42 [1.24–4.69]), and complete CM elimination (5.18 [2.45–10.99]) were associated with persistent CMA. None of the children with CMA who had all three risk factors (n = 26) acquired tolerance. Conclusion: At least one-third of the children with CMA at 6 years of age acquired tolerance by 12 years of age. Children with CMA who have the risk factors are less likely to acquire tolerance.
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