title: Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants.
abstract: BACKGROUND
  Ninety-five percent positive predictive values (PPVs) provide an invaluable tool for clinicians to avoid unnecessary oral food challenges. However, 95% PPVs specific to infants, the age group most likely to present for diagnosis of food allergy, are limited.
  
  
  OBJECTIVE
  We sought to develop skin prick test (SPT) and allergen-specific IgE (sIgE) thresholds with 95% PPVs for challenge-confirmed food allergy in a large population-based cohort of 1-year-old infants with challenges undertaken irrespective of SPT wheal size or previous history of ingestion.
  
  
  METHODS
  HealthNuts is a population-based, longitudinal food allergy study with baseline recruitment of 1-year-old infants. Infants were recruited from council-run immunization sessions during which they underwent SPTs to 4 allergens: egg, peanut, sesame, and cow's milk/shrimp. Any infant with a detectable SPT response was invited to undergo oral food challenge and sIgE testing.
  
  
  RESULTS
  Five thousand two hundred seventy-six infants participated in the study. Peanut SPT responses of 8 mm or greater (95% CI, 7-9 mm), egg SPT responses of 4 mm or greater (95% CI, 3-5 mm), and sesame SPT responses of 8 mm or greater (95% CI, 5-9 mm) had 95% PPVs for challenge-proved food allergy. Peanut sIgE levels of 34 kUA/L or greater (95% CI, 14-48 kUA/L) and egg sIgE levels of 1.7 kUA/L or greater (95% CI, 1-3 kUA/L) had 95% PPVs for challenge-proved food allergy. Results were robust when stratified on established risk factors for food allergy. Egg SPT responses and sIgE levels were poor predictors of allergy to egg in baked goods.
  
  
  CONCLUSIONS
  These 95% PPVs, which were generated from a unique dataset, are valuable for the diagnosis of food allergy in young infants and were robust when stratified across a number of different risk factors.
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Peters
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Allen
authors.forename: Shyamali C
authors.initials: SC
authors.lastname: Dharmage
authors.forename: Mimi L K
authors.initials: ML
authors.lastname: Tang
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Koplin
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Ponsonby
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Lowe
authors.forename: David
authors.initials: D
authors.lastname: Hill
authors.forename: Lyle C
authors.initials: LC
authors.lastname: Gurrin
mesh_terms: D000485:Allergens / Q000276:immunology*; D000918:Antibody Specificity; D010367:Arachis / Q000276:immunology; D021181:Egg Hypersensitivity; D004531:Eggs / Q000009:adverse effects; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D031685:Sesamum / Q000276:immunology; D012882:Skin Tests / Q000379:methods / Q000592:standards*
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: AUC; Allergen-specific IgE; Area under the curve; Food allergy; LR; Likelihood ratio; NPV; Negative predictive value; OFC; Oral food challenge; PPV; Positive predictive value; ROC; Receiver operating characteristic; SPT; Skin prick test; baked egg; egg; oral food challenge; peanut; predictive value of tests; sIgE; serum-specific IgE; sesame; skin prick test