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TOPLINE:

In children with peanut allergy, those who had anaphylaxis developed stronger reactions on skin prick tests and had higher peanut-specific immunoglobulin E (IgE) levels and greater basophil activation than those with mild skin-only reactions; lower test responses were linked to developing later tolerance.

METHODOLOGY:

• Researchers in Slovenia conducted a multicenter cross-sectional study including 51 children aged 3 months to 18 years with peanut allergy (25%-45% girls) to identify markers that distinguished mild reactions from severe ones and predict later tolerance.
• They grouped children into those with mild skin-only reactions (n = 24) and those with anaphylactic reactions (n = 27).
• Measurements included wheal diameters on skin prick tests, levels of peanut-specific IgE and component-resolved IgE (Ara h 1, 2, 3, 6, 8, and 9), and basophil activation.
• Researchers followed up children for up to 4 years post-diagnosis and offered supervised open oral peanut challenges to 27 children at lower risk to confirm who developed spontaneous tolerance.

TAKEAWAY:

• Children with anaphylaxis had larger wheal diameters than those with cutaneous reactions (median, 9 mm vs 5 mm; P = .037). They also had higher levels of peanut-specific IgE and IgE responses to Ara h 1, 2, and 6 and stronger basophil activation at 33.3 ng/mL (P < .050 for all).
• Wheal diameters on skin prick tests; peanut-specific IgE levels; levels of IgE response to Ara h 1, 2, 3, and 6; and basophil activation at the highest allergen dose performed moderately well at distinguishing mild from severe reactions, with area under receiver operating characteristic values ranging between 0.75 and 0.80.
• Of 20 children who underwent an oral food challenge, nine tolerated peanut. Tolerance was linked to lower levels of peanut-specific IgE, Ara h 2, and Ara h 6 (P < .050 for all), whereas basophil activation showed a trend toward lower responses (P = .060).
• Children with anaphylaxis were more often sensitized to multiple foods and inhalants, had more reactions outside the home, and were more likely to be prescribed an epinephrine autoinjector after their first reaction (unadjusted P < .050 for all).

IN PRACTICE:

“[The] observations emphasize the importance and high clinical utility of cost-effective skin testing or component-resolved diagnostics in comparison with demanding and complicated cellular tests,” the authors of the study wrote.

SOURCE:

Tadej Petek, MD, with the University Medical Centre Maribor, Maribor, Slovenia, was the corresponding author of this study, which was published online on June 3 in Frontiers in Allergy.

LIMITATIONS:

The small cohort size limited the statistical power of the tests. Oral food challenges were not performed in 60% of children. The findings came from a single, homogeneous Slovenian cohort, which limited generalizability.

DISCLOSURES:

This study received funding from the University Medical Centre Maribor. One author reported being an editorial board member of Frontiers in Allergy at the time of submission. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.