PT  - JOURNAL ARTICLE
AU  - Sarah C Beck
AU  - Aarnoud P Huissoon
AU  - Donna Collins
AU  - Alex G Richter
AU  - Mamidipudi T Krishna
TI  - The concordance between component tests and clinical history in British adults with suspected pollen-food syndrome to peanut and hazelnut
AID  - 10.1136/jclinpath-2017-204573
DP  - 2017 Aug 04
TA  - Journal of Clinical Pathology
PG  - jclinpath-2017-204573
4099  - http://jcp.bmj.com/content/early/2017/08/05/jclinpath-2017-204573.short
4100  - http://jcp.bmj.com/content/early/2017/08/05/jclinpath-2017-204573.full
AB  - 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.