Gender, prick test size and rAra h 2 sIgE level may predict the eliciting dose in patients with peanut allergy: Evidence from the Mirabel survey

Abstract

Background: Peanut allergy management is based on active avoidance and access to emergency treatment including self-injectable adrenaline. Knowing the dose at which a patient is likely to react is crucial for risk assessment and could significantly improve management by integrating a personalized approach.Objective: To develop a threshold dose distribution curve model from routinely collected data. Methods:The MIRABEL survey is an observational study of 785 patients with peanut allergy/sensitization conducted in France, Belgium and Luxemburg. The current analysis included the 238 participants for whom medical and oral food challenge data were available. Several statistical models (Kaplan-Meier, Cox model, Weibull and Lognormal with predictive factors, basic Weibull and Lognormal) were compared to select the best model and predictive factor combination associated with the threshold doses. Inferences were made with a Bayesian approach.

Integrating oral immunotherapy into clinical practice

“…In 2 recent studies with peanut OFC data, the median threshold dose was reported as 67 mg (interquartile range, 16-244 mg; n 5 204 OFCs) and 75 mg (range, 0.1-500 mg; n 5 347 OFCs) of peanut protein. 56,57 Limited data have shown that the amount triggering an accidental reaction from products and undeclared ingredients can range from 0.4 to 170 mg of peanut protein (n 5 6 samples). 58 Estimates of an average amount of allergen in 1 to 2 bites of a typical food have helped define lower limits for maintenance dosing.…”

Developments allergy in 2019 through the eyes of Clinical and Experimental Allergy, Part II clinical allergy

“…Elegbede and colleagues have generated threshold curves for peanut using data from the Mirabel survey. 42 In 204 children and young adults with a positive food challenge, 1% where found to react with objective symptoms was 0.26 [0.03; 2.24] mg of peanut protein (ED01). The threshold was significantly lower in girls, with larger skin prick and Ara h 2 results.…”

“…A quantitative risk assessment can only be undertaken if the population threshold for reaction is known. Elegbede and colleagues have generated threshold curves for peanut using data from the Mirabel survey 42 . In 204 children and young adults with a positive food challenge, 1% where found to react with objective symptoms was 0.26 [0.03; 2.24] mg of peanut protein (ED01).…”

The end of as required inhaled short‐acting bronchodilator for asthma?

“…Elegbede et al have explored the threshold at which individuals with peanut allergy react. Given that management is dominated by avoidance, a knowledge of the dose at which individuals react is important .…”