Early clinical predictors of remission of peanut allergy in children

Background

Understanding predictors of clinical remission would assist in clinical management of peanut allergy.

Objective

We sought to determine the early clinical predictors of peanut allergy remission using a longitudinal cohort of young children with peanut allergy.

Methods

Consecutive patients less than 2 years of age with peanut allergy were identified on the basis of skin prick test (SPT) wheal size of 95% positive predictive value or greater. Baseline SPT responses to peanuts, tree nuts, and sesame and serum peanut-specific IgE antibody levels were documented, and follow-up studies were conducted at 1- to 2-year intervals for up to 8 years. Peanut food challenges were performed when SPT responses decreased to less than the 95% positive predictive value for peanut allergy.

Results

SPT wheal diameters to peanut extract of 6 mm or greater (hazard ratio, 2.16; 95% CI, 1.23-3.786; P = .008) and peanut-specific IgE antibody of 3 kUA/L or greater (hazard ratio, 2.74; 95% CI, 1.13-6.61; P = .025) before the age of 2 years were independent predictors of persistent peanut allergy. Mean SPT wheal diameters of nonremitters increased (r = 0.31, P < .001), whereas those of remitters decreased (r = −0.26, P = .002) between 1 and 4 years of age. Twenty-one percent of young children with peanut allergy became clinically tolerant by age 5 years.

Conclusions

Remission of peanut allergy can be predicted by low levels of IgE antibodies to peanut in the first 2 years of life or decreasing levels of IgE sensitization by the age of 3 years.

Key words: Peanut allergy, tree nut, sesame, clinical predictors, skin prick test, peanut-specific IgE

Abbreviations used: FEIA, Fluorescent enzyme immunoassay, PPV, Positive predictive value, SPT, Skin prick test