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  • The concordance between component tests and clinical history in British adults with suspected pollen-food syndrome to peanut and hazelnut

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Original article
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. 1 Department of Allergy and Immunology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
  2. 2 Department of Immunology, Queen Elizabeth Hospital, Birmingham, UK
  3. 3 Institute 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

https://doi.org/10.1136/jclinpath-2017-204573

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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.