The fraction of exhaled nitric oxide improves prediction of clinical allergic reaction to peanut challenge in children

Preece, Kahn; Bhatia, Rani; Belcher, Jan; Patchett, Kathryn; McElduff, Patrick; Collison, Adam; Mattes, Joërg

doi:10.1111/cea.12258

Cited by 15 publications

(32 citation statements)

References 47 publications

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“…[11][12][13][14][15][16][17][18][19] GASTROINTESTINAL SYMPTOMS Immediate-onset gastrointestinal symptoms include nausea, abdominal pain and cramps, vomiting and diarrhea. In the lower respiratory tract, symptoms and signs include stridor, hoarse voice, cough, dyspnea and wheezing.…”

Section: Respiratory Symptomsmentioning

confidence: 99%

Evaluation of Food Allergy

Bock¹,

Sampson²

2016

Pediatric Allergy: Principles and Practice

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Section: Respiratory Symptomsmentioning

confidence: 99%

Evaluation of Food Allergy

Bock¹,

Sampson²

2016

Pediatric Allergy: Principles and Practice

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“…Peanut allergen components have been thoroughly investigated, and there is a consistency in results when searching the best predictors for clinical relevance [75,76]. Interestingly, the use of fraction of exhaled nitric oxide (FeNO) was proposed as a safe non-invasive step of a diagnostic algorithm prior to blood collection for measuring specific IgE to Ara h 2, in order to distinguish children with peanut allergy from children tolerant to peanut all of which had a positive skin prick test to peanut with a mean wheal diameter between 3.0 and 8.9 mm [77].…”

Section: Diagnosismentioning

confidence: 99%

Food-Induced Anaphylaxis Year in Review

Tsoumani

Sharma

Papadopoulos

2015

Curr Treat Options Allergy

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This article is part of the Topical Collection on Anaphylaxis Keywords Food anaphylaxis I Food allergy I Anaphylaxis Opinion statement Food allergy is increasing; as a consequence, food-induced anaphylaxis is also becoming a growing problem. Our understanding of the mechanisms of tolerance is still basic and requires much more research before it becomes helpful in guiding our interventions. However, empirical approaches with oral immunotherapy and food introduction manipulation appear promising, although standardization is required before employing them on a large scale. Furthermore, education and public health measures can be helpful for the increasing proportion of the population at risk.

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“…However, there is the associated risk of severe allergic reaction (including anaphylaxis), financial cost to health care (to provide beds and supervision), and finally time involved for patients, their families and health care professionals. To alleviate this, in clinical practice it is routine to conduct open-labelled food challenges [ 2 , 7 ] and to exclude children at extremely low or high risk for clinical allergy from food challenge employing (a set of) non-invasive biomarkers. For instance, the resulting size of SPT wheal to whole peanut antigen or levels of sIgE antibodies to peanut is thought to correlate with an increasing likelihood of reaction [ 8 , 9 ], but not with increasing severity of the reaction at food challenge [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Prospectively measured levels of serum sIgE against the peanut component Ara h2 have been investigated and when used in combination with peanut SPT, found to improve the diagnostic accuracy and reduce the need for oral peanut challenge [ 5 , 7 ]. Two studies published in 2007 [ 10 , 11 ] have investigated the use of Ara h2 purified protein as a SPT reagent, but there has been no further published data reporting on its use.…”

Section: Introductionmentioning

confidence: 99%

“…Fraction of exhaled nitric oxide (FeNO) is a non-invasive marker that has been shown to correlate with allergic airways inflammation and IgE sensitisation [ 12 ]. Additionally, there appears to be enhanced prediction of peanut allergy prior to food challenge when combining measurement of FeNO with current testing (peanut SPT and Ara h2 sIgE) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Reproducibility of serum IgE, Ara h2 skin prick testing and fraction of exhaled nitric oxide for predicting clinical peanut allergy in children

Percival

Bhatia

Preece

et al. 2016

Allergy Asthma Clin Immunol

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BackgroundAra h2 sIgE serum levels improve the diagnostic accuracy for predicting peanut allergy, but the use of Ara h2 purified protein as a skin prick test (SPT), has not been substantially evaluated. The fraction of exhaled nitric oxide (FeNO) shows promise as a novel biomarker of peanut allergy. Reproducibility of these measures has not been determined. The aim was to assess the accuracy and reproducibility (over a time-period of at least 12 months) of SPT to Ara h2 in comparison with four predictors of clinical peanut allergy (Peanut SPT, Ara h2 specific Immunoglobulin E (sIgE), Peanut sIgE and FeNO).MethodsTwenty-seven children were recruited in a follow-up of a prospective cohort of fifty-six children at least 12 months after an open-labelled peanut food challenge. Their repeat assessment involved a questionnaire, SPT to peanut and Ara h2 purified protein, FeNO and sIgE to peanut and Ara h2 measurements.ResultsAra h2 SPT was no worse in accuracy when compared with peanut SPT, FeNO, Ara h2 sIgE and peanut sIgE (AUC 0.908 compared with 0.887, 0.889, 0.935 and 0.804 respectively) for predicting allergic reaction at previous food challenge. SPT for peanut and Ara h2 demonstrated limited reproducibility (ICC = 0.51 and 0.44); while FeNO demonstrated good reproducibility (ICC = 0.73) and sIgE for peanut and Ara h2 were highly reproducible (ICC = 0.81 and 0.85).ConclusionsIn this population, Ara h2 SPT was no worse in accuracy when compared with current testing for the evaluation of clinical peanut allergy, but had—like peanut SPT—poor reproducibility. FeNO, peanut sIgE and Ara h2 sIgE were consistently reproducible despite an interval of at least 12 months between the repeated measurements.Electronic supplementary materialThe online version of this article (doi:10.1186/s13223-016-0143-z) contains supplementary material, which is available to authorized users.

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The fraction of exhaled nitric oxide improves prediction of clinical allergic reaction to peanut challenge in children

Cited by 15 publications

References 47 publications

Evaluation of Food Allergy

Evaluation of Food Allergy

Food-Induced Anaphylaxis Year in Review

Reproducibility of serum IgE, Ara h2 skin prick testing and fraction of exhaled nitric oxide for predicting clinical peanut allergy in children

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