Diagnosing peanut allergy with skin prick and specific IgE testing

Roberts, Graham and Lack, Gideon (2005) Diagnosing peanut allergy with skin prick and specific IgE testing. Journal of Allergy and Clinical Immunology, 115 (6), 1291-1296. (doi:10.1016/j.jaci.2005.02.038).

Abstract

Background
Food allergy is common in childhood. It has been suggested that the magnitude of a skin prick test or specific IgE result can improve diagnostic usefulness, but this has been addressed in only a few tertiary challenge-based studies. Objective
To determine the predictive value of a wheal ? 8 mm or serum specific IgE ? 15 kUA/L for clinical allergy and investigate whether results are generalizable. Methods
All subjects, up to 16 years of age, who had been investigated with a peanut or tree nut food challenge were eligible for the study. Subjects were referred from either a tertiary allergy clinic or a community birth cohort. All subjects with a history suggestive of food allergy were offered a challenge unless there were features of anaphylaxis. Details of challenges were prospectively recorded. Results were modeled by using logistic regression. Results
There was a total of 161 peanut challenges. Recent skin prick (longest wheal diameter) and specific IgE data were available for 135 and 136 challenges, respectively. The results suggest that a skin prick result ? 8 mm and a specific IgE ? 15 kUA/L have predictive values of 95% (95% CI, 76.2% to 99.9%) and 92.0% (74.0% to 99.0%), respectively, for a positive challenge. Age, the type of nut, and referral pattern of the subject did not appear to alter this relationship. Conclusion
These data suggest that a skin prick result ? 8 mm or a specific IgE ? 15 kUA/L have a high predictive value for clinical allergy to peanut and that these cutoff figures appear generalizable to different populations of children undergoing an assessment for peanut allergy.

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