The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy?
Abstract
:1. Introduction
2. Publications that Reported on SPT, sIgE and the Development of Tolerance in Food Allergic Children
3. How Comparable are the Studies: Limitations of and Variations across the Studies
4. What do These Studies Tell Us?
4.1. Peanut Allergy
Author | N | Study design | Diagnosis of food allergy | Age 1 | Follow-up period | Follow-up diagnosis | Resolution | SPT (mm) | sIgE (kUA/L) |
---|---|---|---|---|---|---|---|---|---|
Mudd et al. 2009 [39] | 28 | Retrospective chart review | OFC | 5 years | 2.8 years (range 0.7–10 years) | OFC if clinically indicated (time, exposure and symptom history since last OFC or sIgE) | 46% | Not predictive of tolerance | |
Ho et al. 2008 [10] | 267 | Longitudinal | SPT ≥ 4 mm | <2 years | Reviewed every 1–2 years for up to 8 years. | OFC offered when SPT < 4 mm (<2 years old) or 8 mm (>2 years old) | 18% | Increase SPT ≥ 3 between 1 and 4 years of age is predictor of persistence SPT ≥ 6 before 2 years predictive of persistent allergy | sIgE ≥ 3 before 2 years predictive of persistent allergy |
Nolan et al. 2007 [15] | 54 | Prospective | Clinical history or positive SPT/sIgE with no history of ingestion. Excluded if sIgE >10 kUA/L, reaction in previous 2 years or previous severe reaction | 6.3 years (range 3.7–14.8 years) | NR | OFC (irrespective of SPT however parents could opt-out if SPT ≥ 8 mm | 53% | SPT ≥ 7 mm, 93% PPV | |
Perry et al. 2004 [14] | 173 | Retrospective chart review | Clinical history or SPT/sIgE with no history of ingestion | 4.8 years | NR | OFC (if clinically indicated or when sIgE 25% of previously reported 95% PPV) | 59% | <2, 50% probability of tolerance | |
(range 1–43 years) | |||||||||
Fleischer et al. 2003 [13] | 84 | Retrospective chart review | Clinical history and SPT/sIgE or OFC; or no ingestion but positive SPT/sIgE | >4 years | NR | OFC or DBPCFC if sIgE < 5 | 55% | sIgE < 2 more likely to develop tolerance than sIgE 2–5 kU/L | |
Skolnick et al. 2001 [9] | 223 | Retrospective follow-up | Clinical history and positive SPT, sIgE or OFC; or positive SPT and sIgE but no ingestion | 1.5 years (2 months–15 years) | NR | OFC. sIgE > 20 assumed allergic sIgE > 10 and severe reaction, no OFC (138 not challenged) | 21.5% | sIgE ≥ 5 64% PPV and 61% NPV | |
Hourihane et al. 1998 [40] | 30 | Case-control | Clinical history | 5 years (range 2–10 years) | NR | OFC if clinically indicated (recent non-eventful exposure or negative SPT) | 50% | SPT ≥ 6 100% PPV and 80% NPV | Not predictive of tolerance |
Sampson 1989 [12] | 10 | Retrospective | DBPCFC | 7.9 years (range 3–18 years) | 1–3 years | DBPCFC or accidental ingestion | 20% | Not predictive of tolerance |
4.2. Egg Allergy
Author | N | Study design | Diagnosis of food allergy | Age 1 | Period of follow-up | Follow-up diagnosis | Tolerance | SPT (mm) | sIgE (kUA/L) |
---|---|---|---|---|---|---|---|---|---|
Montesinos et al. 2010 [48] | 42 | Retrospective follow-up | Clinical history and positive SPT/sIgE and OFC | 15.7 months (range 8–27.5 months) | 49 months (range 15–118.6 months) | OFC annually unless reaction in previous 3 months and positive SPT/sIgE | 50% | ≤2 years: 1.37, 96% PPV 0.36, 66% NPV | |
2–3 years: 1.52, 100% PPV 0.54, 75% NPV | |||||||||
3–4 years: 1.35, 100% PPV 0.36, 75% NPV | |||||||||
4–5 years: 2.59, 100% PPV 0.96, 60% NPV | |||||||||
>5 years: 1.84, 100% PPV 0.65, 100% NPV | |||||||||
Dieguez et al. 2009 [20] | 157 | Retrospective follow-up | Clinical history and positive SPT or sIgE, or OFC | 2.5 years (range 1–16 years) | NR | DBPCFC | 36% | ≥7, 90% PPV, LR + 6.7 | ≥1.5 90% PPV, LR + 5.5 |
≥9, 96% PPV, LR + 12.3 | |||||||||
Kim 2009 [41] | 106 | Retrospective | sIgE > 2 | <2 years | Median 49 months (range 23–132 months) | Home challenge test if sIgE < 1.5 or accidental ingestion without reaction | 58% | Peak sIgE not predictive of outcome | |
Mudd 2009 [39] | 38 | Retrospective chart review | OFC | 5 years | 2.8 years | OFC when clinically indicated | 47% | Not predictive of tolerance | |
Savage et al. 2007 [22] | 881 | Retrospective chart review | Clinical history or sIgE > 2 and no known exposure | 14 months (IQR 10, 23 months) | Median 59 months (range 5–285 months) | OFC if sIgE < 2 kUA/L | 68% | Rate of tolerance inversely related to peak sIgE. sIgE > 50 marker for persistent allergy | |
Perry et al. 2004 [14] | 138 | Retrospective chart review | Clinical history or SPT/sIgE | NR | NR | OFC when clinically indicated or sIgE < 95% PPV | 57% | sIgE < 2 50% probability of tolerance | |
Shek et al. 2004 [33] | 88 | Retrospective | DBPCFC | 6 months–17 years | Up to 10 years | DBPCFC | 32% | sIgE decrease by 50% in 12 months: 0.52 probability of tolerance | |
sIgE decrease by 90% in 12 months: 0.78 probability of tolerance | |||||||||
Boyano-martinez et al. 2002 [49] | 59 | Prospective | OFC (n = 35) or recent reaction and positive sIgE | <2 years | Median 32 months | OFC every 1–3 years depending on previous symptoms | 59% | SPT < 6 increased likelihood (HR) of tolerance by 3.74 (95% CI 1.60–8.74). | sIgE predicted tolerance only in children with cutaneous symptoms |
Crespo et al. 1994 [43] | 40 | OFC | 1 year | 2.5 years | OFC | 38% | sIgE ≥ 1.2 kuA/L 92% PPV | ||
Sampson 1989 [12] | 59 | Retrospective | DBPCFC | 7.9 years (range 3–18 years) | 1–3 years | DBPCFC or accidental ingestion | 24% | Not predictive of tolerance | |
Ford 1982 [47] | 25 | DBPCFC | 17 months (range 6 months–10 years) | 2–2.5 years | OFC | 44% | Decreased in resolved allergy |
4.3. Milk Allergy
Author | N | Study design | Diagnosis | Age 1 | Period of follow-up | Follow-up diagnosis | Tolerance | SPT (mm) | sIgE (kUA/L) |
---|---|---|---|---|---|---|---|---|---|
Yavuz 2013 [53] | 148 | Retrospective | Clinical history, positive SPT/sIgE and either positive OFC or history of anaphylaxis | 1.6 years (IQR 0.9–3.1 years) | 3.5 years (IQR 1.8–5.2 years) | OFC if sIgE low and no recent reaction | 45% | Age-specific 95% PPVs to persistent allergy | |
<1 years: 1.4 | |||||||||
<2 years: 9.3 | |||||||||
<4 years: 9.4 | |||||||||
<6 years:11 | |||||||||
All: 11 | |||||||||
Suh 2011 [36] | 115 | Retrospective | Clinical history and sIgE > 0.35; or sIgE > 5 | <24 months | Mean 47 months (range 24–114 months) | OFC or home introduction | 41% | Higher peak sIgE in first 24 months reduced probability of tolerance. | |
Savilahti 2010 [46] | 83 | Prospective birth cohort (n = 6,209) | Open OFC and SPT ≥ 3 mm or sIgE ≥ 0.7 | 7 months | Up to 8 years | OFC or home introduction | 78% | sIgE higher in those with persistent allergy | |
Santos 2010 [54] | 66 | Retrospective | OFC and SPT or sIgE | NR | Median 7 years | OFC if SPT or sIgE decreased and no recent reaction | 50% | Peak > 10 mm reduced the likelihood of tolerance (HR 0.38, 95% CI 0.14–0.99) | Higher maximum sIgE over time reduced the likelihood of tolerance |
Martorell 2008 [16] | 170 | Prospective | Clinical history or OFC, and SPT or sIgE | 5.4 months (1–12 months) | Up to 4 years of age | OFC if no reaction in previous 3 months | 82% | Age-specific 95% PPVs to persistent allergy | |
12 months: 5.86 | |||||||||
18 months: 9.79 | |||||||||
24 months: 25.7 | |||||||||
36 months: 7.38 | |||||||||
48 months: 5.0 | |||||||||
Skripak 2007 [23] | 807 | Retrospective review | Clinical history plus OFC or elimination diet | 13 months (range 1–209 months) | Median 54 months | OFC if sIgE < 2; or home introduction | 15% | Higher peak sIgE reduced probability of tolerance. | |
Saarinen 2005 [17] | 86 | Prospective birth cohort | Elimination challenge test | 7 months | Up to 8 years | Home challenge test or OFC | 85% | SPT 12 months after diagnosis: ≥7 mm AUC 0.84 | |
Perry 2004 [14] | 166 | Retrospective chart review | Clinical history or SPT/sIgE | NR | NR | OFC if clinically indicated | 45% | <2 50% probability of tolerance | |
Garcia-Ara 2004 [44] | 66 | Prospective | OFC | 4.8 months (range 1–11 months) | Mean 32.9 months (range 9–99 months) | OFC | 68% | Age-specific 95% PPVsto persistent allergy | |
13–18months: 2.7 | |||||||||
19–24months: 9 | |||||||||
26–36months: 24 | |||||||||
Shek 2004 [33] | 49 | Retrospective | DBPCFC | 34 months | Up to 10 years | DBPCFC | 33% | sIgE decrease of 50% in 12 months—0.31 probability of tolerance | |
sIgE decrease of 90% in 12months—0.66 probability of tolerance | |||||||||
Hill 1993 [45] | 69 | Prospective | OFC or SPT | 20 months | Median 24 months | Home introduction or OFC at 5 years of age | 22% | Lower in transient allergy | |
James 1992 [42] | 29 | DBPCFC | 7 years (range 3–14 years) | Median 3 years | DBPCFC | 38% | Not predictive of tolerance | Not predictive of tolerance | |
Sampson 1989 [12] | 21 | Retrospective | DBPCFC | 7.9 years (range 3–18 years) | 1–3 years | DBPCFC or accidental ingestion | 19% | Not predictive of tolerance |
5. Summary and Future Directions
6. Conclusions
Conflicts of Interest
References
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Peters, R.L.; Gurrin, L.C.; Dharmage, S.C.; Koplin, J.J.; Allen, K.J. The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy? Int. J. Environ. Res. Public Health 2013, 10, 5039-5061. https://doi.org/10.3390/ijerph10105039
Peters RL, Gurrin LC, Dharmage SC, Koplin JJ, Allen KJ. The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy? International Journal of Environmental Research and Public Health. 2013; 10(10):5039-5061. https://doi.org/10.3390/ijerph10105039
Chicago/Turabian StylePeters, Rachel L., Lyle C. Gurrin, Shyamali C. Dharmage, Jennifer J. Koplin, and Katrina J. Allen. 2013. "The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy?" International Journal of Environmental Research and Public Health 10, no. 10: 5039-5061. https://doi.org/10.3390/ijerph10105039