TY - JOUR
T1 - Development of a tool predicting severity of allergic reaction during peanut challenge
AU - Chinthrajah, R. Sharon
AU - Purington, Natasha
AU - Andorf, Sandra
AU - Rosa, Jaime S.
AU - Mukai, Kaori
AU - Hamilton, Robert
AU - Smith, Bridget Marie
AU - Gupta, Ruchi
AU - Galli, Stephen J.
AU - Desai, Manisha
AU - Nadeau, Kari C.
N1 - Funding Information:
Funding Sources: This study was supported by grants U19 AI104209 (Drs Chinthrajah, Mukai, Nadeau, and Galli) and T32 AR050942 (Dr Rosa) from the National Institutes of Health , Glen and Wendy Miller Family Foundation (Drs Gupta and Smith), and the Sean N. Parker Center for Allergy and Asthma Research at Stanford University .
Publisher Copyright:
© 2018 American College of Allergy, Asthma & Immunology
PY - 2018/7
Y1 - 2018/7
N2 - Background: Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established. Objective: To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC. Methods: Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC. Results: A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63 hi stimulation with peanut to percentage of CD63 hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P <.001). Conclusion: The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV 1 /FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings. Trial Registration: ClinicalTrials.gov identifier: NCT02103270.
AB - Background: Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established. Objective: To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC. Methods: Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC. Results: A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63 hi stimulation with peanut to percentage of CD63 hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P <.001). Conclusion: The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV 1 /FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings. Trial Registration: ClinicalTrials.gov identifier: NCT02103270.
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U2 - 10.1016/j.anai.2018.04.020
DO - 10.1016/j.anai.2018.04.020
M3 - Article
C2 - 29709643
AN - SCOPUS:85048931241
VL - 121
SP - 69-76.e2
JO - Annals of Allergy, Asthma and Immunology
JF - Annals of Allergy, Asthma and Immunology
SN - 1081-1206
IS - 1
ER -