Utility of Peanut Component Testing in Children with Peanut Allergy
Monday, March 5, 2018
South Hall A2 (Convention Center)
Yasmin Hamzavi Abedi, MD, Cristina P. Sison, PhD, Punita Ponda, MD FAAAAI
RATIONALE: Peanut component testing is often used in clinical practice as an adjunct to peanut-specific-IgE(sP) and skin testing to better predict the likelihood of clinical reactivity.The purpose of this study was to examine the clinical utility of component-resolved-diagnostics(CRD) and associated healthcare costs in children with peanut allergy.

METHODS: This was a retrospective chart review of 199 patients(233 CRD tests done),ages 0 to 17 years,who were seen by an allergist for a food allergy evaluation at a large academic outpatient medical center.Charts were reviewed for subjects with sP and CRD done at the same visit.An expense report for sP and CRD was obtained from the lab(CRD:$121.70, Food-sIgE:$24).The Fisher’s exact test was used to assess the relationship between peanut component testing and the sP cut-off level of 14kUA/L.

RESULTS: Of the 233 CRD tests reviewed, 116 were done in patients with sP<14kUA/L and 117 in patients with sP≥14kUA/L. Of the CRD tests in patients with sP≥14kUA/L, 4 had Arah1,2,3 and 9 <0.35kUA/L and of the CRD tests in patients with sP<14kUA/L, 38 had Arah1,2,3 and 9 <0.35kUA/L(3% versus 33%, p<0.0001),regardless of Arah8. Similar results were found if the cutoff of Arah1,2,3 and 9 was increased to 1 or 2kUA/L.Calculations of the costs revealed that approximately $14,239 was spent on CRD in patients with sP≥14kUA/L.

CONCLUSIONS: CRD in patients with sP≥14kUA/L provides little clinical benefit due to significantly higher likelihood of Arah1,2,3 and 9 >0.35kUA/L,with less opportunity to offer an oral challenge.Thus, indiscriminant CRD should be avoided to prevent unnecessary blood draws and increased health care costs.