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The concordance between component tests and clinical history in British adults with suspected pollen-food syndrome to peanut and hazelnut
  1. Sarah C Beck1,
  2. Aarnoud P Huissoon1,
  3. Donna Collins1,
  4. Alex G Richter2,3,
  5. Mamidipudi T Krishna1,3
  1. 1Department of Allergy and Immunology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
  2. 2Department of Immunology, Queen Elizabeth Hospital, Birmingham, UK
  3. 3Institute of Immunology and Immunotherapy, University of Birmingham, UK
  1. Correspondence to Sarah C Beck, Department of Allergy and Immunology, Birmingham Heartlands Hospital, Bordesley Green East Birmingham B9 5SS, England; sarah.beck{at}heartofengland.nhs.uk

Abstract

Background Mild oropharyngeal symptoms to peanut/hazelnut occur in ~30% of patients with pollen-food syndrome (PFS). Component tests are considered a useful adjunct to the diagnosis and may help differentiate PFS from those at a risk of anaphylaxis due to storage protein/lipid transfer protein (LTP) sensitisation.

Aims To assess concordance between component tests and clinical history in suspected PFS to peanut/hazelnut in a specialist clinic.

Methods Adult patients were classified into PFS (group 1, n=69) and PFS with mild systemic symptoms (group 2, n=45) based on clinical history. Specific IgE (sIgE) of ≥0.35 kUA/L was considered positive as per manufacturers’ recommendation. Kappa (κ) inter-rater agreement was calculated for concordance between clinical classification and test profiles.

Results Group 1 hazelnut: 85% monosensitised to Cor a1, 12% to storage protein/s or LTP and 3% negative to all components. Group 1 peanut: 41% monosensitised to Ara h8, 44% to storage protein/s or ±LTP and 15% negative to all components. Group 2 hazelnut: 67% monosensitised to Cor a1, 16% sensitised to storage protein/s and 17% negative to all components. Group 2 peanut: 19% monosensitised to Ara h8, 62% sensitised to storage protein/s and/or LTP and 19% negative to all components.

SIgE to Ara h8 and Cor a1 were greater in group 1 versus group 2: (median (IQR) kUA/L; hazelnut: 12.1 (7.8-25.2) vs 2.4 (0.36-6.3), p<0.001; peanut: 2.4 (0.10-21.1) vs 0.3 (0-3), p<0.01)).

Conclusion Concordance between component tests and clinical history for adults with PFS was good for hazelnut (κ=0.63) but poor for peanut (κ=−0.12). Food challenges are warranted in discordant cases for an accurate diagnosis.

  • component tests
  • peanut allergy
  • hazelnut allergy
  • anaphylaxis
  • pollen food syndrome
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Footnotes

  • Handling editor Stephen RA Jolles.

  • Contributors All authors contributed to the planning, conduct and completion of the analysis and report.

  • Competing interests MTK and SB have received an honorarium from Thermo Fisher for a lecture. The department has received educational grants from Thermo Fisher. Other authors have no competing interest to decline.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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