The diagnostic value of specific IgE to Ara h 2 to predict peanut allergy in children is comparable to a validated and updated diagnostic prediction model

RJB Klemans, D Otte, M Knol, EF Knol, Y Meijer, FHJ Gmelig-Meyling, CAFM Bruijnzeel-Koomen, AC (André) Knulst, Suzanne Pasmans

Research output: Contribution to journalArticleAcademicpeer-review

104 Citations (Scopus)

Abstract

Background: A diagnostic prediction model for peanut allergy in children was recently published, using 6 predictors: sex, age, history, skin prick test, peanut specific immunoglobulin E (sIgE), and total IgE minus peanut sIgE. Objectives: To validate this model and update it by adding allergic rhinitis, atopic dermatitis, and sIgE to peanut components Ara h 1, 2, 3, and 8 as candidate predictors. To develop a new model based only on sIgE to peanut components. Methods: Validation was performed by testing discrimination (diagnostic value) with an area under the receiver operating characteristic curve and calibration (agreement between predicted and observed frequencies of peanut allergy) with the Hosmer-Lemeshow test and a calibration plot. The performance of the (updated) models was similarly analyzed. Results: Validation of the model in 100 patients showed good discrimination (88%) but poor calibration (P < .001). In the updating process, age, history, and additional candidate predictors did not significantly increase discrimination, being 94%, and leaving only 4 predictors of the original model: sex, skin prick test, peanut sIgE, and total IgE minus sIgE. When building a model with sIgE to peanut components, Ara h 2 was the only predictor, with a discriminative ability of 90%. Cutoff values Conclusions: Discrimination of the validated model was good; however, calibration was poor. The discriminative ability of Ara h 2 was almost comparable to that of the updated model, containing 4 predictors. With both models, the need for peanut challenges could be reduced by at least 50%. (J Allergy Clin Immunol 2013;131:157-63.)
Original languageEnglish
Pages (from-to)157-163
Number of pages7
JournalJournal of Allergy and Clinical Immunology
Volume131
Issue number1
DOIs
Publication statusPublished - 2013

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