Περίληψη:
Background: Component-resolved diagnosis (CRD) has revealed significant associations between IgE against individual allergens and severity of hazelnut allergy. Less attention has been given to combining them with clinical factors in predicting severity. Aim: To analyze associations between severity and sensitization patterns, patient characteristics and clinical history, and to develop models to improve predictive accuracy. Methods: Patients reporting hazelnut allergy (n = 423) from 12 European cities were tested for IgE against individual hazelnut allergens. Symptoms (reported and during Double-blind placebo-controlled food challenge [DBPCFC]) were categorized in mild, moderate, and severe. Multiple regression models to predict severity were generated from clinical factors and sensitization patterns (CRD- and extract-based). Odds ratios (ORs) and areas under receiver-operating characteristic (ROC) curves (AUCs) were used to evaluate their predictive value. Results: Cor a 9 and 14 were positively (OR 10.5 and 10.1, respectively), and Cor a 1 negatively (OR 0.14) associated with severe symptoms during DBPCFC, with AUCs of 0.70-073. Combining Cor a 1 and 9 improved this to 0.76. A model using a combination of atopic dermatitis (risk), pollen allergy (protection), IgE against Cor a 14 (risk) and walnut (risk) increased the AUC to 0.91. At 92% sensitivity, the specificity was 76.3%, and the positive and negative predictive values 62.2% and 95.7%, respectively. For reported symptoms, associations and generated models proved to be almost identical but weaker. Conclusion: A model combining CRD with clinical background and extract-based serology is superior to CRD alone in assessing the risk of severe reactions to hazelnut, particular in ruling out severe reactions. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
Συγγραφείς:
Datema, M.R.
van Ree, R.
Asero, R.
Barreales, L.
Belohlavkova, S.
de Blay, F.
Clausen, M.
Dubakiene, R.
Fernández-Perez, C.
Fritsche, P.
Gislason, D.
Hoffmann-Sommergruber, K.
Jedrzejczak-Czechowicz, M.
Jongejan, L.
Knulst, A.C.
Kowalski, M.
Kralimarkova, T.Z.
Le, T.-M.
Lidholm, J.
Papadopoulos, N.G.
Popov, T.A.
del Prado, N.
Purohit, A.
Reig, I.
Seneviratne, S.L.
Sinaniotis, A.
Versteeg, S.A.
Vieths, S.
Zwinderman, A.H.
Mills, E.N.C.
Fernández-Rivas, M.
Ballmer-Weber, B.
Λέξεις-κλειδιά:
food allergen; immunoglobulin E antibody; placebo; allergen; immunoglobulin E; plant antigen, adult; allergy test; Article; atopic dermatitis; component resolved diagnosis; controlled study; diagnostic accuracy; diagnostic test accuracy study; disease association; disease severity; double blind procedure; Europe; female; food intake; hazelnut; house dust allergy; human; latex allergy; major clinical study; male; medical history; multicenter study; multiple regression; nut allergy; odds ratio; pollen allergy; predictive value; prick test; priority journal; prospective study; receiver operating characteristic; risk factor; sensitivity and specificity; sensitization; symptom; walnut; young adult; area under the curve; blood; hazelnut; immunology; multivariate analysis; nut allergy; randomized controlled trial, Allergens; Antigens, Plant; Area Under Curve; Corylus; Double-Blind Method; Humans; Immunoglobulin E; Multivariate Analysis; Nut Hypersensitivity; ROC Curve; Sensitivity and Specificity
