Development of a tool predicting severity of allergic reaction during peanut challenge

R. Sharon Chinthrajah, Natasha Purington, Sandra Andorf, Jaime S. Rosa, Kaori Mukai, Robert Hamilton, Bridget Marie Smith, Ruchi Gupta, Stephen J. Galli, Manisha Desai, Kari C. Nadeau

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Background: Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established. Objective: To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC. Methods: Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC. Results: A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63 hi stimulation with peanut to percentage of CD63 hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P <.001). Conclusion: The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV 1 /FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings. Trial Registration: identifier: NCT02103270.

Original languageEnglish (US)
Pages (from-to)69-76.e2
JournalAnnals of Allergy, Asthma and Immunology
Issue number1
StatePublished - Jul 2018

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine


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