在以普通人群为基础的出生队列中，我们在8岁时通过皮肤点刺试验和特异性IgE检测确定了对花生的敏感性。在这些敏感儿童中，我们通过食物挑战试验来确定对花生的过敏或耐受。我们对一部分人(n = 45)用开放式食物挑战的方法;另外一些人接受了双盲安慰剂对照的食物挑战试验(n = 34)。我们使用含有12种组分的微阵列(主要的花生成分和潜在的交叉反应成分，包括草变应原)，比较了花生过敏儿童和花生耐受儿童的致敏特性。
933名儿童中，110名(11.8%)对花生敏感。19人没有接受挑战(17人没有同意)。12人有确证的接触反应病史,且IgE≥15Ku/ L和/或皮肤测试≥8毫米被认为过敏，而未进行挑战试验。对剩余的79名儿童进行了挑战试验,7人有大于等于2项的客观体征而被指定为花生过敏。我们估计临床花生过敏的患病率为22.4% (95% CI, 14.8%到32.3%)。通过组份诊断，我们发现花生过敏儿童组(n = 29;含12例牛奶过敏)和花生耐受组儿童(n = 52)之间在组份识别模式上存在显著差异。花生成分Ara h2是临床过敏最重要的预测因子。
Allergy or tolerance in children sensitized to peanut: Prevalence and differentiation using component-resolved diagnostics
Not all peanut-sensitized children develop allergic reactions on exposure.
To establish by oral food challenge the proportion of children with clinical peanut allergy among those considered peanut-sensitized by using skin prick tests and/or IgE measurement, and to investigate whether component-resolved diagnostics using microarray could differentiate peanut allergy from tolerance.
Within a population-based birth cohort, we ascertained peanut sensitization by skin tests and IgE measurement at age 8 years. Among sensitized children, we determined peanut allergy versus tolerance by oral food challenges. We used open challenge among children consuming peanuts (n = 45); others underwent double-blind placebo-controlled challenge (n = 34). We compared sensitization profiles between children with peanut allergy and peanut-tolerant children by using a microarray with 12 pure components (major peanut and potentially cross-reactive components, including grass allergens).
Of 933 children, 110 (11.8%) were peanut-sensitized. Nineteen were not challenged (17 no consent). Twelve with a convincing history of reactions on exposure, IgE ≥15 kUa/L and/or skin test ≥8mm were considered allergic without challenge. Of the remaining 79 children who underwent challenge, 7 had ≥2 objective signs and were designated as having peanut allergy. We estimated the prevalence of clinical peanut allergy among sensitized subjects as 22.4% (95% CI, 14.8% to 32.3%). By using component-resolved diagnostics, we detected marked differences in the pattern of component recognition between children with peanut allergy (n = 29; group enriched with 12 children with allergy) and peanut-tolerant children (n = 52). The peanut component Ara h 2 was the most important predictor of clinical allergy.
The majority of children considered peanut-sensitized on the basis of standard tests do not have peanut allergy. Component-resolved diagnostics may facilitate the diagnosis of peanut allergy.
lNicolaosNicolaouMD, MPhilaMaryamPoorafsharPhDbClareMurrayMDaAngelaSimpsonMDaHenricWinellMScbGinaKerryRNaAnnikaHärlinMScbAshleyWoodcockMD, FMedSciaStaffanAhlstedtPhDcAdnanCustovicMD, PhD, FRCPa