- 作者：Laury J.N. Masthoff ; Lars Mattsson ; Laurian Zuidmeer-Jongejan ; Jonas Lidholm ; Kerstin Andersson ; Jaap H. Akkerdaas ; Serge A. Versteeg ; Cristiano Garino ; Yol ; a Meijer ; Petra Kentie ; Astrid Versluis ; Constance F. den Hartog Jager ; Carla A.F.M. Bruijnzeel-Koomen ; Andr¨¦ C. Knulst ; Ronald van Ree ; Els van Hoffen ; Suzanne G.M.A. Pasmans
- 关键词：Component-resolved diagnosis ; diagnostics ; double-blind ; placebo-controlled food challenge ; hazelnut allergy ; severity ; food allergy
- 刊名：Journal of Allergy and Clinical Immunology
- 出版年：2013
- 出版时间：August, 2013
- 年：2013
- 卷：132
- 期：2
- 页码：393-399
- 全文大小：920 K
Background
Component-resolved diagnosis has been shown to improve the diagnosis of food allergy.Objective
We sought to evaluate whether component-resolved diagnosis might help to identify patients at risk of objective allergic reactions to hazelnut.
Method
A total of 161 hazelnut-sensitized patients were included: 40 children and 15 adults with objective symptoms on double-blind, placebo-controlled food challenges (DBPCFCs) and 24 adults with a convincing objective history were compared with 41 children and 41 adults with no or subjective symptoms on DBPCFCs (grouped together). IgE levels to hazelnut extract and single components were analyzed with ImmunoCAP.
Results
IgE levels to hazelnut extract were significantly higher in children with objective than with no or subjective symptoms. In 13 % of children and 49 % of adults with hazelnut allergy with objective symptoms, only sensitization to rCor a 1.04 was observed and not to other water-soluble allergens. Sensitization to rCor a 8 was rare, which is in contrast to rCor a 1. Sensitization to nCor a 9, rCor a 14, or both was strongly associated with hazelnut allergy with objective symptoms. By using adapted cutoff levels, a diagnostic discrimination between severity groups was obtained. IgE levels to either nCor a 9 of 1 kUA/L or greater or rCor a 14 of 5 kUA/L or greater (children) and IgE levels to either nCor a 9 of 1 kUA/L or greater or rCor a 14 of 1 kUA/L or greater (adults) had a specificity of greater than 90 % and accounted for 83 % of children and 44 % of adults with hazelnut allergy with objective symptoms.
Conclusion
Sensitization to Cor a 9 and Cor a 14 is highly specific for patients with objective symptoms in DBPCFCs as a marker for a more severe hazelnut allergic phenotype.