title: Objective eliciting doses of peanut-allergic adults and children can be combined for risk assessment purposes.
abstract: BACKGROUND
  To improve food labelling strategies, information regarding eliciting doses (EDs) and the effect of patient characteristics on these EDs is necessary.
  
  
  OBJECTIVE
  To establish EDs for objective and subjective symptoms and analyse the effect of sensitization levels and other patient characteristics on threshold distribution curves (TDCs).
  
  
  METHODS
  Threshold data from 100 adults and 262 children with a positive food challenge were analysed with interval-censoring survival analysis (ICSA) and fitted to a TDC from which EDs could be extracted. Possible influencing factors were analysed as covariates by ICSA. A hazard ratio (HR) was calculated in case of a significant effect.
  
  
  RESULTS
  TDCs for both objective and subjective symptoms were significantly different between adults and children (P < 0.001). Objective ED05 values, however, were comparable (2.86 mg peanut protein in adults and 6.38 mg in children). Higher levels of sIgE to Ara h 2 and peanut extract were associated with a larger proportion of patient groups reacting to a dose increase with objective symptoms (adults and children) or subjective symptoms (adults, in children a trend). Age had a similar effect in children (HR 1.05 for objective symptoms and 1.09 for subjective symptoms). Gender had no effect on TDCs.
  
  
  CONCLUSIONS
  Subjective and objective TDCs were different between adults and children, but objective ED05 values were comparable, meaning that threshold data from children and adults can be combined for elaboration of reference doses for risk assessment. Higher sIgE levels to Ara h 2 and peanut extract were associated with a larger proportion of both patient groups to react to a certain dose increase.
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: R J B
authors.initials: RJ
authors.lastname: Klemans
authors.affiliation: The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Blom
authors.affiliation: Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: F C
authors.initials: FC
authors.lastname: van Erp
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: L J N
authors.initials: LJ
authors.lastname: Masthoff
authors.affiliation: The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Rubingh
authors.affiliation: Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: C K
authors.initials: CK
authors.lastname: van der Ent
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: C A F M
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.affiliation: The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands.
authors.forename: G F
authors.initials: GF
authors.lastname: Houben
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: S G M A
authors.initials: SG
authors.lastname: Pasmans
authors.affiliation: Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: Meijer
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Knulst
mesh_terms: D000328:Adult; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D052179:Antigens, Plant / Q000008:administration & dosage / Q000276:immunology*; D010367:Arachis / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D021183:Peanut Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology*; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000485:Allergens; D052179:Antigens, Plant
keywords: eliciting dose; food challenge; peanut allergy; risk assessment; threshold distribution curve