Early clinical predictors of remission of peanut allergy in children.
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.
Ho
Marco H K
MH
Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia.
Wong
Wilfred H S
WH
Heine
Ralf G
RG
Hosking
Clifford S
CS
Hill
David J
DJ
Allen
Katrina J
KJ
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
D007073:Immunoglobulin E