title: Early clinical predictors of remission of peanut allergy in children.
abstract: BACKGROUND
  Understanding predictors of clinical remission would assist in clinical management of peanut allergy.
  
  
  OBJECTIVE
  We sought to determine the early clinical predictors of peanut allergy remission using a longitudinal cohort of young children with peanut allergy.
  
  
  METHODS
  Consecutive patients less than 2 years of age with peanut allergy were identified on the basis of skin prick test (SPT) wheal size of 95% positive predictive value or greater. Baseline SPT responses to peanuts, tree nuts, and sesame and serum peanut-specific IgE antibody levels were documented, and follow-up studies were conducted at 1- to 2-year intervals for up to 8 years. Peanut food challenges were performed when SPT responses decreased to less than the 95% positive predictive value for peanut allergy.
  
  
  RESULTS
  SPT wheal diameters to peanut extract of 6 mm or greater (hazard ratio, 2.16; 95% CI, 1.23-3.786; P = .008) and peanut-specific IgE antibody of 3 kUA/L or greater (hazard ratio, 2.74; 95% CI, 1.13-6.61; P = .025) before the age of 2 years were independent predictors of persistent peanut allergy. Mean SPT wheal diameters of nonremitters increased (r = 0.31, P < .001), whereas those of remitters decreased (r = -0.26, P = .002) between 1 and 4 years of age. Twenty-one percent of young children with peanut allergy became clinically tolerant by age 5 years.
  
  
  CONCLUSIONS
  Remission of peanut allergy can be predicted by low levels of IgE antibodies to peanut in the first 2 years of life or decreasing levels of IgE sensitization by the age of 3 years.
authors.affiliation: Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Marco H K
authors.initials: MH
authors.lastname: Ho
authors.forename: Wilfred H S
authors.initials: WH
authors.lastname: Wong
authors.forename: Ralf G
authors.initials: RG
authors.lastname: Heine
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Hosking
authors.forename: David J
authors.initials: DJ
authors.lastname: Hill
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Allen
mesh_terms: D002675:Child, Preschool; D004485:Eczema / Q000453:epidemiology; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D021183:Peanut Hypersensitivity / Q000097:blood* / Q000276:immunology*; D012075:Remission, Spontaneous; D012129:Respiratory Function Tests; D012882:Skin Tests
chemical_list: D007073:Immunoglobulin E