PMID- 34896310
OWN - NLM
STAT- MEDLINE
DCOM- 20220316
LR  - 20220316
IS  - 1534-4436 (Electronic)
IS  - 1081-1206 (Linking)
VI  - 128
IP  - 3
DP  - 2022 Mar
TI  - Optimizing tools for evaluating challenge outcomes in children with cashew nut 
      allergy.
PG  - 270-278
LID - S1081-1206(21)01302-8 [pii]
LID - 10.1016/j.anai.2021.12.006 [doi]
AB  - BACKGROUND: The incidence of cashew nut anaphylaxis is increasing and there is a 
      need for accurate diagnostic tests. Age-specific cutoffs in children are lacking. 
      Changes in serum tryptase levels are not well documented in pediatric food 
      allergy, except in anaphylaxis. OBJECTIVE: To evaluate the ability of various 
      tests to diagnose cashew nut allergy and to predict reaction severity. We also 
      investigated changes in tryptase and their correlation to reaction severity. 
      METHODS: We performed an open cashew nut challenge on 106 children (aged 1-16 
      years), who were sensitized to cashew nut with either previous allergic reaction 
      to cashew nut or no known exposure. We analyzed the accuracy of Ana o 3 
      immunoglobulin E (IgE), cashew nut IgE, skin prick test, basophil activation test 
      (BAT), and combinations thereof to diagnose cashew nut allergy and to predict 
      reaction severity. Tryptase level was measured at the baseline and during an 
      allergic reaction. RESULTS: A total of 72 children had positive challenge 
      outcomes. Ana o 3 IgE seemed to be the best single test to diagnose cashew 
      allergy, with a 0.97 kU/L cutoff exhibiting 94.1% specificity and 61.1% 
      sensitivity. Though BAT values of at least 22.8% best predicted reaction 
      severity, with 91.7% specificity and 60.7% sensitivity, the cutoffs were 
      age-specific. Tryptase levels increased substantially 1 to 2 hours after the 
      first allergic symptoms compared with baseline. CONCLUSION: Ana o 3 IgE seems to 
      be the best diagnostic test in pediatric cashew nut allergy, and test 
      combinations do not seem to improve the diagnostics. Cutoffs are age-specific. 
      BAT is promising in predicting reaction severity. Tryptase levels should be 
      measured 1 to 2 hours after initiation of an allergic reaction.
CI  - Copyright (c) 2021 American College of Allergy, Asthma & Immunology. Published by 
      Elsevier Inc. All rights reserved.
FAU - Rontynen, Petteri
AU  - Rontynen P
AD  - Skin and Allergy Hospital, University of Helsinki and Helsinki University 
      Hospital, Helsinki, Finland. Electronic address: petteri.rontynen@hus.fi.
FAU - Kukkonen, Kaarina
AU  - Kukkonen K
AD  - Children's Hospital and Pediatric Research Center, University of Helsinki and 
      Helsinki University Hospital, Helsinki, Finland.
FAU - Savinko, Terhi
AU  - Savinko T
AD  - Skin and Allergy Hospital, University of Helsinki and Helsinki University 
      Hospital, Helsinki, Finland.
FAU - Makela, Mika J
AU  - Makela MJ
AD  - Skin and Allergy Hospital, University of Helsinki and Helsinki University 
      Hospital, Helsinki, Finland.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20211208
PL  - United States
TA  - Ann Allergy Asthma Immunol
JT  - Annals of allergy, asthma & immunology : official publication of the American 
      College of Allergy, Asthma, & Immunology
JID - 9503580
RN  - 0 (Allergens)
RN  - 37341-29-0 (Immunoglobulin E)
SB  - IM
MH  - Adolescent
MH  - Allergens
MH  - *Anacardium
MH  - Child
MH  - Child, Preschool
MH  - Humans
MH  - Immunoglobulin E
MH  - Infant
MH  - *Nut Hypersensitivity/diagnosis
MH  - Skin Tests
EDAT- 2021/12/14 06:00
MHDA- 2022/03/17 06:00
CRDT- 2021/12/13 12:18
PHST- 2021/06/03 00:00 [received]
PHST- 2021/11/02 00:00 [revised]
PHST- 2021/12/01 00:00 [accepted]
PHST- 2021/12/14 06:00 [pubmed]
PHST- 2022/03/17 06:00 [medline]
PHST- 2021/12/13 12:18 [entrez]
AID - S1081-1206(21)01302-8 [pii]
AID - 10.1016/j.anai.2021.12.006 [doi]
PST - ppublish
SO  - Ann Allergy Asthma Immunol. 2022 Mar;128(3):270-278. doi: 
      10.1016/j.anai.2021.12.006. Epub 2021 Dec 8.