The Journal of Allergy and Clinical Immunology
Volume 118, Issue 1 , Pages 250-256, July 2006

Predictive value of skin prick tests using recombinant allergens for diagnosis of peanut allergy

  • Catherine Astier, PhD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • JE2482: Lipidomix, Laboratory of Molecular Medicine and Therapeutics, Nancy
    • ,
  • Martine Morisset, MD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • ,
  • Olivier Roitel, PhD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • ,
  • Fanny Codreanu, MD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • ,
  • Sandrine Jacquenet, PhD

      Affiliations

    • JE2482: Lipidomix, Laboratory of Molecular Medicine and Therapeutics, Nancy
    • ,
  • Patricia Franck, PharmD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • ,
  • Virginie Ogier, PhD

      Affiliations

    • JE2482: Lipidomix, Laboratory of Molecular Medicine and Therapeutics, Nancy
    • ,
  • Nicolas Petit, MD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • ,
  • Barbara Proust, PharmD, PhD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • ,
  • Denise-Anne Moneret-Vautrin, MD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • ,
  • A. Wesley Burks, MD

      Affiliations

    • Department of Pediatrics, Division of Pediatric Allergy and Immunology, Duke University Medical Center, Durham
    • ,
  • Bernard Bihain, MD

      Affiliations

    • JE2482: Lipidomix, Laboratory of Molecular Medicine and Therapeutics, Nancy
    • ,
  • Hugh A. Sampson, MD

      Affiliations

    • Department of Pediatrics, Division of Allergy and Immunology, Mount Sinai Hospital, New York
    • ,
  • Gisèle Kanny, MD, PhD

      Affiliations

    • From EA3999 Allergic Diseases: Diagnosis and Therapeutics Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Central Hospital, Nancy
    • Corresponding Author InformationReprint requests: Gisèle Kanny, MD, PhD, EA 3999 Maladies allergiques: Diagnostic et Thérapeutique, Laboratoire de Médecine et Thérapeutique Moléculaire, 15 rue du Bois de la Champelle, 54500 Vandoeuvre-lès-Nancy, France.

Received 10 February 2006; received in revised form 11 April 2006; accepted 12 April 2006.

Nancy, France, Durham, NC, and New York, NY

Background

Current diagnosis of peanut allergy relies on natural extracts that lack standardization. Recombinant DNA technology allows production of pure biochemically characterized proteins. Their usefulness for peanut allergy diagnosis is not established.

Objective

This study aimed to evaluate the diagnostic value of the 3 major recombinant peanut allergens.

Methods

Recombinant (r) Ara h 1, rAra h 2, and rAra h 3 were produced according to the recommendations of good manufacturing practice for recombinant allergens. Skin prick tests (SPTs) and IgE ELISA assays were performed in 30 patients with peanut allergy and 30 control subjects without food allergy: 15 nonatopic and 15 sensitized to birch pollen. Disease severity was graded by clinical scoring.

Results

All patients with peanut allergy showed positive SPT results to rAra h 2; 40% reacted with rAra h 1 and 27% with rAra h 3. No control subjects reacted with any of the recombinant allergens. Monosensitization to rAra h 2 was observed in 53% of patients. Neither SPT size nor levels of specific IgE were correlated with the disease severity. However, patients with monosensitization to rAra h 2 had a significantly lower severity score than polysensitized subjects and a lower level of specific IgE against peanut extract and rAra h 2.

Conclusion

Skin prick tests to individual recombinant peanut allergens appear to be a safe and effective diagnostic tool. Cosensitization to rAra h 2 and rArah 1 and/or rAra h 3 is predictive of more severe reactions.

Clinical implications

Recombinant peanut allergens can be used by SPTs for diagnosis and evaluation of allergy severity.

Key words: Food allergy, peanut, diagnosis, recombinant allergens

Abbreviations used: AU, Arbitrary unit, CPE, Commercial peanut extract, DBPCFC, Double-blind placebo-controlled food challenge, FA, Food allergy, LAL, Limulus Amoebocyte Lysate, sIgE, Specific IgE, SPT, Skin prick test

 

 Supported in part by a grant from Allerbio and funding from the Ministry of Higher Education, Lorraine Region, and the Urban Community of Nancy.Disclosure of potential conflict of interest: A. W. Burks owns stock in Seer Pharmaceuticals, Inc. and has received grant support from the National Institutes of Health, Gerber Foundation, and Food Allergy and Anaphylaxis Network. H. A. Sampson has consultant arrangements with Seer Pharmaceuticals, Inc., owns stock in Seer Pharmaceuticals, Inc., has a patent licensing agreement for Ara h 3, and has received grant support from the National Institutes of Health. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(06)01053-0

doi:10.1016/j.jaci.2006.04.053

The Journal of Allergy and Clinical Immunology
Volume 118, Issue 1 , Pages 250-256, July 2006

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