Abstract
Given the burden of disease and the consequences of a diagnosis of peanut allergy, it is important that peanut allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is peanut sensitization present (eg, a “positive” test) is not always associated with clinical reactivity. This practice parameter addresses the diagnosis of IgE-mediated peanut allergy, both in children and adults, as pertaining to 3 fundamental questions, and based on the systematic reviews and meta-analyses, makes recommendations for the clinician who is evaluating a patient for peanut allergy. These questions relate to when diagnostic tests should be completed, which diagnostic tests to utilize, and the utility (or lack thereof) of diagnostic testing to predict the severity of a future allergic reaction to peanut.
| Original language | English |
|---|---|
| Pages (from-to) | 1302-1334 |
| Number of pages | 33 |
| Journal | Journal of Allergy and Clinical Immunology |
| Volume | 146 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 2020 |
Keywords
- Ara h 2
- GRADE analysis
- Peanut allergy
- cost-effectiveness analysis
- diagnosis
- evidence to recommendation
- likelihood ratio
- meta-analysis
- peanut components
- practice parameter update
- serologic IgE testing
- skin prick testing
- systematic review
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In: Journal of Allergy and Clinical Immunology, Vol. 146, No. 6, 12.2020, p. 1302-1334.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Peanut allergy diagnosis
T2 - A 2020 practice parameter update, systematic review, and GRADE analysis
AU - Greenhawt, Matthew
AU - Shaker, Marcus
AU - Wang, Julie
AU - Oppenheimer, John J.
AU - Sicherer, Scott
AU - Keet, Corinne
AU - Swaggart, Keri
AU - Rank, Matthew
AU - Portnoy, Jay M.
AU - Bernstein, Jonathan
AU - Chu, Derek K.
AU - Dinakar, Chitra
AU - Golden, David
AU - Horner, Carolyn
AU - Lang, David M.
AU - Lang, Eddy S.
AU - Khan, David A.
AU - Lieberman, Jay
AU - Stukus, David
AU - Wallace, Dana
N1 - Funding Information: Disclosure of potential conflict of interest: The Joint Task Force on Practice Parameters (JTFPP) members’ and work group members’ conflict of interest disclosure forms can be found at www.allergyparameters.org . Matthew Greenhawt has received financial support from Aquestive, Aimmune, Merck, Allergenis, Allergy Therapeutics, Sanofi Genzyme, Genentech, GlaxoSmithKline, Merck, Aravax, Prota, Before Brands, the Institute for Clinical and Economic Review, American College of Asthma, Allergy, and Immunology, DBV Technologies, and Intrommune; is supported by the Agency of Healthcare Research and Quality; has served on the advisory board of International Food Protein Induced Enterocolitis Syndrome Association, the Asthma and Allergy Foundation of America, and the National Peanut Board; and is Associate Editor of the Annals of Allergy, Asthma, and Immunology. Marcus Shaker is a member of the Joint Task Force on Allergy Practice Parameters; has a family member who is chief executive officer of Altrix Medical; and serves on the Editorial Board of the Journal of Food Allergy and the Annals of Allergy, Asthma, and Immunology. Julie Wang has received financial support from ALK-Abelló, Regeneron, DBV Technologies, and Aimmune; is an UpToDate author; serves on the Executive Committee of the American Academy of Pediatrics Section on Allergy and Immunology; and serves as Vice Chair of the American Academy of Allergy, Asthma, and Immunology (AAAAI) Anaphylaxis, Dermatitis, Drug Allergy Interest Section. John J. Oppenheimer has received financial support from DBV Technologies, TEVA, GlaxoSmithKline Adjudication/Data Safety Monitoring Board, AstraZeneca, Novartis, and Sanofi; and is Associate Editor of the Annals of Allergy, Asthma, and Immunology and AllergyWatch, an American Board of Internal Medicine (ABIM) Council Member, and American Board of Allergy and Immunology Liaison to the ABIM, UpToDate Reviewer, American College of Chest Physicians Cough Guideline Committee Member, and WebMD Editor. Scott Sicherer has received financial support from Food Allergy Research and Education Clinical Center, John Hopkins University Press, HAL Allergy Group, AAAAI, UpToDate, and National Institutes of Allergy and Infectious Disease; and is a Medical Advisor at International Food Protein Induced Enterocolitis Syndrome Association and member of the Executive Committee at the American Academy of Pediatrics. Corinne Keet received royalties from UpToDate; is an Associate Editor for the Journal of Allergy and Clinical Immunology; and is a Board Member for the American Board of Allergy and Immunology. Matthew Rank has received financial support from the American College of Asthma, Allergy, and Immunology (ACAAI), National Institutes of Health, and Levin Family Foundation; has served as Chair of the AAAAI Health Education Delivery and Quality (HEDQ) Interest Section; and is Research Director of the Phoenix Children’s Hospital Breathmobile. Jay M. Portnoy has received financial support from Thermo Fisher Scientific, Kaleo, TEVA, Novartis, Hycor, and Boehringer-Ingelheim. Jonathan Bernstein has received financial support from Sanofi Regeneron, AstraZeneca, Merck, Optinose, Takeda, CSL Behring, Biocryst, Pharming, the National Institutes of Health, Taylor and Francis, and INEOS; is Editor-in-Chief of the Journal of Asthma, INEOS medical immunosurveillance director, Vice Chair and Lectureship Chair of the AAAAI Foundation, chairman of Allergists for Israel (AFI), ACAAI Asthma Chair, Scientific Chair, and Young Investigator Award Chair; and serves on the Board of Directors and Scientific Committee of Interasma. Derek K. Chu is a CAAIF-CSACI-AllerGen Emerging Clinician-Scientist Research Fellow; and is supported by the Canadian Allergy, Asthma and Immunology Foundation (CAAIF), the Canadian Society of Allergy and Clinical Immunology (CSACI), and AllerGen NCE Inc. (the Allergy, Genes and Environment Network). Chitra Dinakar has received financial support from Propeller Health, ACAAI (stipend for Editorial Board of AllergyWatch), and the American Association of Allergists of Indian Origin; serves on the Board of Directors of the AAAAI and on the Medical Advisory Board of Food Equity Initiative; and is Assistant Editor of AllergyWatch. David Golden has received financial support from Aquestive, Sandoz, ALK-Abelló, Genentech, Stallergenes-Greer, and UpToDate. Carolyn Horner has served as Committee Chair for the American Academy of Allergy, Asthma, and Asthma Diagnosis and Treatment Interest Section, Interest Section Coordinating Committee, and In-Training Exam Coordinating Committee. David M. Lang is on the Editorial Board for Allergy and Asthma Proceedings, Topic Editor for DynaMed, Associate Editor for Journal of Asthma, and Delegate to National Quality Forum representing the AAAAI. David A. Khan has received financial support from UpToDate and Aimmune; serves on the Board of Directors of the AAAAI; as ACAAI (Chair of Literature Review, as Co-Chair of Conjoint Board Review, and as Texas Allergy, Asthma, and Immunology Society Chair of Meetings Committee; and is Associate Editor of the Journal of Allergy and Clinical Immunology In Practice. Jay Lieberman has received financial support from the ACAAI, Aquestive, Aimmune, DBV Technologies, Biotest Pharma, and Regeneron; and is Associate Editor of the Annals of Allergy, Asthma, and Immunology, Vice Chair for the ACAAI Food Allergy Committee, and Medical Director for Food Allergy Alliance of the MidSouth. David Stukus has received financial support from Aimmune, Before Brands, Abbott Nutrition, the American Academy of Pediatrics, and ACAAI; and has served as Committee Chair for the AAAAI and ACAAI. Dana Wallace has received financial support from Mylan, Kaleo, Optinose, ALK-Abelló, Bryan, and Sanofi. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: Disclosure of potential conflict of interest: The Joint Task Force on Practice Parameters (JTFPP) members’ and work group members’ conflict of interest disclosure forms can be found at www.allergyparameters.org. Matthew Greenhawt has received financial support from Aquestive, Aimmune, Merck, Allergenis, Allergy Therapeutics, Sanofi Genzyme, Genentech, GlaxoSmithKline, Merck, Aravax, Prota, Before Brands, the Institute for Clinical and Economic Review, American College of Asthma, Allergy, and Immunology, DBV Technologies, and Intrommune; is supported by the Agency of Healthcare Research and Quality; has served on the advisory board of International Food Protein Induced Enterocolitis Syndrome Association, the Asthma and Allergy Foundation of America, and the National Peanut Board; and is Associate Editor of the Annals of Allergy, Asthma, and Immunology. Marcus Shaker is a member of the Joint Task Force on Allergy Practice Parameters; has a family member who is chief executive officer of Altrix Medical; and serves on the Editorial Board of the Journal of Food Allergy and the Annals of Allergy, Asthma, and Immunology. Julie Wang has received financial support from ALK-Abelló, Regeneron, DBV Technologies, and Aimmune; is an UpToDate author; serves on the Executive Committee of the American Academy of Pediatrics Section on Allergy and Immunology; and serves as Vice Chair of the American Academy of Allergy, Asthma, and Immunology (AAAAI) Anaphylaxis, Dermatitis, Drug Allergy Interest Section. John J. Oppenheimer has received financial support from DBV Technologies, TEVA, GlaxoSmithKline Adjudication/Data Safety Monitoring Board, AstraZeneca, Novartis, and Sanofi; and is Associate Editor of the Annals of Allergy, Asthma, and Immunology and AllergyWatch, an American Board of Internal Medicine (ABIM) Council Member, and American Board of Allergy and Immunology Liaison to the ABIM, UpToDate Reviewer, American College of Chest Physicians Cough Guideline Committee Member, and WebMD Editor. Scott Sicherer has received financial support from Food Allergy Research and Education Clinical Center, John Hopkins University Press, HAL Allergy Group, AAAAI, UpToDate, and National Institutes of Allergy and Infectious Disease; and is a Medical Advisor at International Food Protein Induced Enterocolitis Syndrome Association and member of the Executive Committee at the American Academy of Pediatrics. Corinne Keet received royalties from UpToDate; is an Associate Editor for the Journal of Allergy and Clinical Immunology; and is a Board Member for the American Board of Allergy and Immunology. Matthew Rank has received financial support from the American College of Asthma, Allergy, and Immunology (ACAAI), National Institutes of Health, and Levin Family Foundation; has served as Chair of the AAAAI Health Education Delivery and Quality (HEDQ) Interest Section; and is Research Director of the Phoenix Children's Hospital Breathmobile. Jay M. Portnoy has received financial support from Thermo Fisher Scientific, Kaleo, TEVA, Novartis, Hycor, and Boehringer-Ingelheim. Jonathan Bernstein has received financial support from Sanofi Regeneron, AstraZeneca, Merck, Optinose, Takeda, CSL Behring, Biocryst, Pharming, the National Institutes of Health, Taylor and Francis, and INEOS; is Editor-in-Chief of the Journal of Asthma, INEOS medical immunosurveillance director, Vice Chair and Lectureship Chair of the AAAAI Foundation, chairman of Allergists for Israel (AFI), ACAAI Asthma Chair, Scientific Chair, and Young Investigator Award Chair; and serves on the Board of Directors and Scientific Committee of Interasma. Derek K. Chu is a CAAIF-CSACI-AllerGen Emerging Clinician-Scientist Research Fellow; and is supported by the Canadian Allergy, Asthma and Immunology Foundation (CAAIF), the Canadian Society of Allergy and Clinical Immunology (CSACI), and AllerGen NCE Inc. (the Allergy, Genes and Environment Network). Chitra Dinakar has received financial support from Propeller Health, ACAAI (stipend for Editorial Board of AllergyWatch), and the American Association of Allergists of Indian Origin; serves on the Board of Directors of the AAAAI and on the Medical Advisory Board of Food Equity Initiative; and is Assistant Editor of AllergyWatch. David Golden has received financial support from Aquestive, Sandoz, ALK-Abelló, Genentech, Stallergenes-Greer, and UpToDate. Carolyn Horner has served as Committee Chair for the American Academy of Allergy, Asthma, and Asthma Diagnosis and Treatment Interest Section, Interest Section Coordinating Committee, and In-Training Exam Coordinating Committee. David M. Lang is on the Editorial Board for Allergy and Asthma Proceedings, Topic Editor for DynaMed, Associate Editor for Journal of Asthma, and Delegate to National Quality Forum representing the AAAAI. David A. Khan has received financial support from UpToDate and Aimmune; serves on the Board of Directors of the AAAAI; as ACAAI (Chair of Literature Review, as Co-Chair of Conjoint Board Review, and as Texas Allergy, Asthma, and Immunology Society Chair of Meetings Committee; and is Associate Editor of the Journal of Allergy and Clinical Immunology In Practice. Jay Lieberman has received financial support from the ACAAI, Aquestive, Aimmune, DBV Technologies, Biotest Pharma, and Regeneron; and is Associate Editor of the Annals of Allergy, Asthma, and Immunology, Vice Chair for the ACAAI Food Allergy Committee, and Medical Director for Food Allergy Alliance of the MidSouth. David Stukus has received financial support from Aimmune, Before Brands, Abbott Nutrition, the American Academy of Pediatrics, and ACAAI; and has served as Committee Chair for the AAAAI and ACAAI. Dana Wallace has received financial support from Mylan, Kaleo, Optinose, ALK-Abelló, Bryan, and Sanofi. The rest of the authors declare that they have no relevant conflicts of interest. Publisher Copyright: © 2020 American Academy of Allergy, Asthma & Immunology
PY - 2020/12
Y1 - 2020/12
N2 - Given the burden of disease and the consequences of a diagnosis of peanut allergy, it is important that peanut allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is peanut sensitization present (eg, a “positive” test) is not always associated with clinical reactivity. This practice parameter addresses the diagnosis of IgE-mediated peanut allergy, both in children and adults, as pertaining to 3 fundamental questions, and based on the systematic reviews and meta-analyses, makes recommendations for the clinician who is evaluating a patient for peanut allergy. These questions relate to when diagnostic tests should be completed, which diagnostic tests to utilize, and the utility (or lack thereof) of diagnostic testing to predict the severity of a future allergic reaction to peanut.
AB - Given the burden of disease and the consequences of a diagnosis of peanut allergy, it is important that peanut allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is peanut sensitization present (eg, a “positive” test) is not always associated with clinical reactivity. This practice parameter addresses the diagnosis of IgE-mediated peanut allergy, both in children and adults, as pertaining to 3 fundamental questions, and based on the systematic reviews and meta-analyses, makes recommendations for the clinician who is evaluating a patient for peanut allergy. These questions relate to when diagnostic tests should be completed, which diagnostic tests to utilize, and the utility (or lack thereof) of diagnostic testing to predict the severity of a future allergic reaction to peanut.
KW - Ara h 2
KW - GRADE analysis
KW - Peanut allergy
KW - cost-effectiveness analysis
KW - diagnosis
KW - evidence to recommendation
KW - likelihood ratio
KW - meta-analysis
KW - peanut components
KW - practice parameter update
KW - serologic IgE testing
KW - skin prick testing
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85092924767&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2020.07.031
DO - 10.1016/j.jaci.2020.07.031
M3 - Article
C2 - 32810515
AN - SCOPUS:85092924767
SN - 0091-6749
VL - 146
SP - 1302
EP - 1334
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 6
ER -