Peanut Allergen Threshold Study (PATS): Novel single-dose oral food challenge study to validate eliciting doses in children with peanut allergy

Jonathan O.B. Hourihane, Katrina J. Allen, Wayne G. Shreffler, Gillian Dunngalvin, Julie A. Nordlee, Giovanni A. Zurzolo, Audrey Dunngalvin, Lyle C. Gurrin, Joseph L. Baumert, Steve L. Taylor

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background Eliciting doses (EDs) of allergenic foods can be defined by the distribution of threshold doses for subjects within a specific population. The ED05 is the dose that elicits a reaction in 5% of allergic subjects. The predicted ED05 for peanut is 1.5 mg of peanut protein (6 mg of whole peanut). Objective We sought to validate the predicted peanut ED05 (1.5 mg) with a novel single-dose challenge. Methods Consecutive eligible children with peanut allergy in 3 centers were prospectively invited to participate, irrespective of previous reaction severity. Predetermined criteria for objective reactions were used to identify ED05 single-dose reactors. Results Five hundred eighteen children (mean age, 6.8 years) were eligible. No significant demographic or clinical differences were identified between 381 (74%) participants and 137 (26%) nonparticipants or between subjects recruited at each center. Three hundred seventy-eight children (206 male) completed the study. Almost half the group reported ignoring precautionary allergen labeling. Two hundred forty-five (65%) children experienced no reaction to the single dose of peanut. Sixty-seven (18%) children reported a subjective reaction without objective findings. Fifty-eight (15%) children experienced signs of a mild and transient nature that did not meet the predetermined criteria. Only 8 (2.1%; 95% CI, 0.6%-3.4%) subjects met the predetermined criteria for an objective and likely related event. No child experienced more than a mild reaction, 4 of the 8 received oral antihistamines only, and none received epinephrine. Food allergy–related quality of life improved from baseline to 1 month after challenge regardless of outcome (η2 = 0.2, P < .0001). Peanut skin prick test responses and peanut- and Ara h 2–specific IgE levels were not associated with objective reactivity to peanut ED05. Conclusion A single administration of 1.5 mg of peanut protein elicited objective reactions in fewer than the predicted 5% of patients with peanut allergy. The novel single-dose oral food challenge appears clinically safe and patient acceptable, regardless of the outcome. It identifies the most highly dose-sensitive population with food allergy not otherwise identifiable by using routinely available peanut skin prick test responses or specific IgE levels, but this single-dose approach has not yet been validated for risk assessment of individual patients.

Original languageEnglish (US)
Pages (from-to)1583-1590
Number of pages8
JournalJournal of Allergy and Clinical Immunology
Volume139
Issue number5
DOIs
StatePublished - May 2017

Fingerprint

Peanut Hypersensitivity
Allergens
Food
Skin Tests
Immunoglobulin E
Arachis
Food Quality
Food Hypersensitivity
Histamine Antagonists
Vulnerable Populations
Epinephrine
Proteins

Keywords

  • Eliciting dose
  • Peanut Allergen Threshold Study
  • Voluntary Incidental Trace Allergen Labelling
  • food allergy related quality of life questionnaire
  • oral food challenges
  • peanut thresholds
  • single dose

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Peanut Allergen Threshold Study (PATS) : Novel single-dose oral food challenge study to validate eliciting doses in children with peanut allergy. / Hourihane, Jonathan O.B.; Allen, Katrina J.; Shreffler, Wayne G.; Dunngalvin, Gillian; Nordlee, Julie A.; Zurzolo, Giovanni A.; Dunngalvin, Audrey; Gurrin, Lyle C.; Baumert, Joseph L.; Taylor, Steve L.

In: Journal of Allergy and Clinical Immunology, Vol. 139, No. 5, 05.2017, p. 1583-1590.

Research output: Contribution to journalArticle

Hourihane, Jonathan O.B. ; Allen, Katrina J. ; Shreffler, Wayne G. ; Dunngalvin, Gillian ; Nordlee, Julie A. ; Zurzolo, Giovanni A. ; Dunngalvin, Audrey ; Gurrin, Lyle C. ; Baumert, Joseph L. ; Taylor, Steve L. / Peanut Allergen Threshold Study (PATS) : Novel single-dose oral food challenge study to validate eliciting doses in children with peanut allergy. In: Journal of Allergy and Clinical Immunology. 2017 ; Vol. 139, No. 5. pp. 1583-1590.
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title = "Peanut Allergen Threshold Study (PATS): Novel single-dose oral food challenge study to validate eliciting doses in children with peanut allergy",
abstract = "Background Eliciting doses (EDs) of allergenic foods can be defined by the distribution of threshold doses for subjects within a specific population. The ED05 is the dose that elicits a reaction in 5{\%} of allergic subjects. The predicted ED05 for peanut is 1.5 mg of peanut protein (6 mg of whole peanut). Objective We sought to validate the predicted peanut ED05 (1.5 mg) with a novel single-dose challenge. Methods Consecutive eligible children with peanut allergy in 3 centers were prospectively invited to participate, irrespective of previous reaction severity. Predetermined criteria for objective reactions were used to identify ED05 single-dose reactors. Results Five hundred eighteen children (mean age, 6.8 years) were eligible. No significant demographic or clinical differences were identified between 381 (74{\%}) participants and 137 (26{\%}) nonparticipants or between subjects recruited at each center. Three hundred seventy-eight children (206 male) completed the study. Almost half the group reported ignoring precautionary allergen labeling. Two hundred forty-five (65{\%}) children experienced no reaction to the single dose of peanut. Sixty-seven (18{\%}) children reported a subjective reaction without objective findings. Fifty-eight (15{\%}) children experienced signs of a mild and transient nature that did not meet the predetermined criteria. Only 8 (2.1{\%}; 95{\%} CI, 0.6{\%}-3.4{\%}) subjects met the predetermined criteria for an objective and likely related event. No child experienced more than a mild reaction, 4 of the 8 received oral antihistamines only, and none received epinephrine. Food allergy–related quality of life improved from baseline to 1 month after challenge regardless of outcome (η2 = 0.2, P < .0001). Peanut skin prick test responses and peanut- and Ara h 2–specific IgE levels were not associated with objective reactivity to peanut ED05. Conclusion A single administration of 1.5 mg of peanut protein elicited objective reactions in fewer than the predicted 5{\%} of patients with peanut allergy. The novel single-dose oral food challenge appears clinically safe and patient acceptable, regardless of the outcome. It identifies the most highly dose-sensitive population with food allergy not otherwise identifiable by using routinely available peanut skin prick test responses or specific IgE levels, but this single-dose approach has not yet been validated for risk assessment of individual patients.",
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AU - Allen, Katrina J.

AU - Shreffler, Wayne G.

AU - Dunngalvin, Gillian

AU - Nordlee, Julie A.

AU - Zurzolo, Giovanni A.

AU - Dunngalvin, Audrey

AU - Gurrin, Lyle C.

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AU - Taylor, Steve L.

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N2 - Background Eliciting doses (EDs) of allergenic foods can be defined by the distribution of threshold doses for subjects within a specific population. The ED05 is the dose that elicits a reaction in 5% of allergic subjects. The predicted ED05 for peanut is 1.5 mg of peanut protein (6 mg of whole peanut). Objective We sought to validate the predicted peanut ED05 (1.5 mg) with a novel single-dose challenge. Methods Consecutive eligible children with peanut allergy in 3 centers were prospectively invited to participate, irrespective of previous reaction severity. Predetermined criteria for objective reactions were used to identify ED05 single-dose reactors. Results Five hundred eighteen children (mean age, 6.8 years) were eligible. No significant demographic or clinical differences were identified between 381 (74%) participants and 137 (26%) nonparticipants or between subjects recruited at each center. Three hundred seventy-eight children (206 male) completed the study. Almost half the group reported ignoring precautionary allergen labeling. Two hundred forty-five (65%) children experienced no reaction to the single dose of peanut. Sixty-seven (18%) children reported a subjective reaction without objective findings. Fifty-eight (15%) children experienced signs of a mild and transient nature that did not meet the predetermined criteria. Only 8 (2.1%; 95% CI, 0.6%-3.4%) subjects met the predetermined criteria for an objective and likely related event. No child experienced more than a mild reaction, 4 of the 8 received oral antihistamines only, and none received epinephrine. Food allergy–related quality of life improved from baseline to 1 month after challenge regardless of outcome (η2 = 0.2, P < .0001). Peanut skin prick test responses and peanut- and Ara h 2–specific IgE levels were not associated with objective reactivity to peanut ED05. Conclusion A single administration of 1.5 mg of peanut protein elicited objective reactions in fewer than the predicted 5% of patients with peanut allergy. The novel single-dose oral food challenge appears clinically safe and patient acceptable, regardless of the outcome. It identifies the most highly dose-sensitive population with food allergy not otherwise identifiable by using routinely available peanut skin prick test responses or specific IgE levels, but this single-dose approach has not yet been validated for risk assessment of individual patients.

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