Development of a tool predicting severity of allergic reaction during peanut challenge

Ann Allergy Asthma Immunol. 2018 Jul;121(1):69-76.e2. doi: 10.1016/j.anai.2018.04.020. Epub 2018 Apr 27.


Background: Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established.

Objective: To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC.

Methods: Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC.

Results: A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63hi stimulation with peanut to percentage of CD63hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P < .001).

Conclusion: The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV1/FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings.

Trial registration: identifier: NCT02103270.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Algorithms
  • Arachis / immunology*
  • Asthma, Exercise-Induced / diagnosis*
  • Asthma, Exercise-Induced / immunology
  • Asthma, Exercise-Induced / pathology
  • Basophils / immunology
  • Basophils / pathology
  • Biomarkers / analysis
  • Child
  • Child, Preschool
  • Double-Blind Method
  • Female
  • Forced Expiratory Volume / immunology
  • Humans
  • Immunoglobulin E / blood
  • Male
  • Peanut Hypersensitivity / diagnosis*
  • Peanut Hypersensitivity / immunology
  • Peanut Hypersensitivity / pathology
  • Predictive Value of Tests
  • Severity of Illness Index
  • Tetraspanin 30 / genetics
  • Tetraspanin 30 / immunology*
  • Vital Capacity / immunology


  • Biomarkers
  • CD63 protein, human
  • Tetraspanin 30
  • Immunoglobulin E

Associated data