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Objective eliciting doses of peanut-allergic adults and children can be combined for risk assessment purposes

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Author: Klemans, R.J.B. · Blom, W.M. · Erp, F.C. van · Masthoff, L.J.N. · Rubingh, C.M. · Ent, C.K. van der · Bruijnzeel-Koomen, C.A.F.M. · Houben, G.F. · Pasmans, S.G.M.A. · Meijer, Y. · Knulst, A.C.
Source:Clinical and Experimental Allergy, 7, 45, 1237-1244
Identifier: 526250
doi: doi:10.1111/cea.12558
Keywords: Health · Eliciting dose · Food challenge · Peanut allergy · Risk assessment · Threshold distribution curve · Peanut extract · Adult · Allergic asthma · Allergic rhinitis · Asthma · Atopic dermatitis · Childhood disease · Female · Human · Male · Peanut · Peanut allergy · Risk assessment · Sensitization · Survival · Biomedical Innovation · Healthy Living · Life · RAPID - Risk Analysis for Products in Development · ELSS - Earth, Life and Social Sciences


Background: To improve food labelling strategies, information regarding eliciting doses (EDs) and the effect of patient characteristics on these EDs is necessary. Objective: To establish EDs for objective and subjective symptoms and analyse the effect of sensitization levels and other patient characteristics on threshold distribution curves (TDCs). Methods: Threshold data from 100 adults and 262 children with a positive food challenge were analysed with interval-censoring survival analysis (ICSA) and fitted to a TDC from which EDs could be extracted. Possible influencing factors were analysed as covariates by ICSA. A hazard ratio (HR) was calculated in case of a significant effect. Results: TDCs for both objective and subjective symptoms were significantly different between adults and children (P < 0.001). Objective ED<inf>05</inf> values, however, were comparable (2.86 mg peanut protein in adults and 6.38 mg in children). Higher levels of sIgE to Ara h 2 and peanut extract were associated with a larger proportion of patient groups reacting to a dose increase with objective symptoms (adults and children) or subjective symptoms (adults, in children a trend). Age had a similar effect in children (HR 1.05 for objective symptoms and 1.09 for subjective symptoms). Gender had no effect on TDCs. Conclusion and Clinical Relevance: Subjective and objective TDCs were different between adults and children, but objective ED<inf>05</inf> values were comparable, meaning that threshold data from children and adults can be combined for elaboration of reference doses for risk assessment. Higher sIgE levels to Ara h 2 and peanut extract were associated with a larger proportion of both patient groups to react to a certain dose increase. © 2015 John Wiley & Sons Ltd.