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• W2122987339 abstract "Hourihane et al1Hourihane JO Roberts SA Warner JO. Resolution of peanut allergy: case-control study.BMJ. 1998; 316: 1271-1275Crossref PubMed Google Scholar reported that some children lose clinical sensitivity to peanut (including some who “lose” the positive skin test response) and that these children seemed to be less atopic, but the data were controversial.2David T. Resolution of peanut allergy. Patients have not been proved to grow out of peanut allergy.BMJ. 1998; 317 ([letter]): 1317Crossref PubMed Scopus (3) Google Scholar Kelso3Kelso JM. Resolution of peanut allergy.J Allergy Clin Immunol. 2000; 106: 777Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar recently reported a case history in which a child lost the positive skin test response to peanut, which was believed to be a rare occurrence. Given the importance,4Sampson HA Mendelson L Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents.N Engl J Med. 1992; 327: 380-384Crossref PubMed Scopus (1504) Google Scholar we prospectively examined this question. Ninety-six consecutive children with positive skin test responses to peanut (visit 1), regardless of whether they had had a clinical reaction, and who returned more than 1 year later in 1999 for retesting (visit 2) were characterized. Skin tests were performed by the prick method and were measured in 2 directions, at the longest diameter and then at a right angle to that. The average of these 2 measures is reported. Reactions were tested to milk, egg, wheat, soy, peanut, cat, dog, horse, tree, grass, ragweed, Alternaria, Cladosporium, Aspergillus, Dermatophagoides farinae, Dermatophagoides pteronyssinus, and a series of nuts including almond, Brazil nut, cashew, coconut, hazelnut, pecan, pistachio, and walnut (Bencard Ltd, Toronto, Canada). They were also tested with any food identified by history as a problem. Skin tests were positive if they measured at least 3 mm in 1 direction,5Zimmerman B Feanny S Reisman J et al.Allergy in asthma. I. The dose relationship of allergy to severity of childhood asthma.J Allergy Clin Immunol. 1988; 81: 63-70Abstract Full Text PDF PubMed Scopus (121) Google Scholar and peanut testing was always performed in duplicate with 2 different lots. For purposes of this study, a positive reaction to either or both dust mite species, 1 or more of the nuts, 1 or more fish species, and 1 or more shellfish species counted as 1 reaction for each group. At visit 2, if reactions to the peanut test solutions were negative, patients’ responses were tested to peanut butter itself, and then a RAST test was done (CAP-RAST; Pharmacia Upjohn Ltd, Montreal, Canada). If the RAST result was also negative, an open oral challenge was undertaken in the office. Statistical analyses were used to test each variable for a significant difference between those who retained a positive skin test reaction to peanut and those who lost the positive reaction. A t test was used for the skin test responses and age, whereas for categorical binary (yes/no) data, the χ2 Fisher exact test (2 sided) was used. Of the 96 patients, 66 had a history of clinical reaction to peanut, including 1 or more of hives, erythema, angioedema, vomiting, and respiratory symptoms; the rest were found to have positive skin test reactions without ever knowingly having had peanut.6Zimmerman B Forsyth S Gold M. Highly atopic children: formation of IgE antibody to food protein, especially peanut.J Allergy Clin Immunol. 1989; 83: 764-770Abstract Full Text PDF PubMed Scopus (29) Google Scholar At visit 2, it was found that 10 patients had lost the positive skin test response (8 of whom had a prior history of clinical reaction to peanut), had negative responses to RAST testing, and successfully underwent oral challenge without reacting. At visit 1 there was no significant difference in symptoms between the 2 groups (Table I; only respiratory symptoms shown), but the size of the positive skin test to peanut was significantly smaller in those had lost the positive response than in those who had not (Table I; P = .024). Table IPatient data at the first and last visitsGroupAllRetainLosePVisit 1 No. of patients968610 Age (mo)28.528.825.9.65 No. of patients with history of reaction (%)66 (68.75)58 (67.44)8 (80).72 No. of patients with respiratory symptoms (%)13 (19.7)13 (22.4)0.34 Peanut size (mm)9.49.85.8.024 No. of positive skin tests at V12.22.31.3.146Visit 2 No. of patients968610 Time elapsed between V1 and V2 (mo)42.142.835.8.42 No. of positive skin tests at V26.16.70.8<.0001 No. of patients positive to nuts (%)56 (58.3)55 (64)1 (10).0014 No. of patients with asthma (%)65 (67.7)62 (72.1)3 (30).012 No. of patients reacting to a food between V1 and V2 (%)—26 (30.2)0.057V1, Visit 1; V2, visit 2. Open table in a new tab At visit 2, those who lost the positive response had significantly fewer total positive skin test results (0.8 ± 1.5 vs 6.7 ± 3.9, P < .0001), less positivity to nuts (P = .0014), less asthma (P = .012), and no reactions to foods, including peanut, between visit 1 and visit 2 (Table I). Of the 86 patients who retained the positive response to peanut, 26 had a total of 41 further reactions to food (7 peanut) (P = .057) (Table I). The data confirm that some children lose the positive skin test response to peanut and are less atopic than those who retain the positive response. Although they represented only 10% of the patients who had positive peanut skin test results at visit 1, it is important to identify them and perform the oral challenge because peanut can be reintroduced into their diet." @default.
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• W2122987339 title "Peanut allergy: Children who lose the positive skin test response" @default.
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• W2122987339 doi "https://doi.org/10.1067/mai.2001.113526" @default.
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