Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul 21:16:64.
doi: 10.1186/s13223-020-00464-8. eCollection 2020.

Change in exhaled nitric oxide during peanut challenge is related to severity of reaction

Elizabeth Percival  1   2   3 , Rani Bhatia  4   3 , Kahn Preece  4   3 , Mark McEvoy  3 , Adam Collison  1   3 , Joerg Mattes  1   3   5
Affiliations

Change in exhaled nitric oxide during peanut challenge is related to severity of reaction

Elizabeth Percival et al. Allergy Asthma Clin Immunol. .

Abstract

Background: Peanut allergy affects 3% of Australian children and has a higher risk of anaphylaxis than most food allergies. Predicting who is likely to develop anaphylaxis is still an inexact science. The fraction of exhaled nitric oxide (FeNO) shows promise as a biomarker involved in peanut allergy, as nitric oxide plays a role in inhibiting mast cell degranulation which is relevant in anaphylaxis, where mast cell degranulation plays a mediator role. The aim of this study was to assess the change in FeNO in children during peanut challenge.

Methods: Thirty-six children aged from 5 to 17 years were recruited for open-labelled peanut challenge. Participants had skin prick test to peanut performed, and serum collected for Ara h2 specific IgE and peanut specific IgE. FeNO was measured by portable device (NIOX VERO) prior to and throughout the peanut challenge.

Results: When grouped according to reaction type at peanut challenge (anaphylaxis, clinical allergy not anaphylaxis and tolerant), there were significant differences in the mean change in FeNO measurement between the anaphylaxis group and the clinical allergy, not anaphylaxis group (p = 0.005), and between the anaphylaxis group and tolerant group (p < 0.0001).

Conclusions: FeNO decreased more significantly in those who subsequently developed anaphylaxis than in those with clinical allergy, not anaphylaxis or negative peanut challenge (tolerance). As a bedside test that can be used in children, it has potential for further research into mechanisms of anaphylaxis in food allergy and potentially assists in predicting an imminent anaphylactic reaction in some patients.Trial registration ClinicalTrials.gov: PEAnut Anaphylaxis Predictors (PEAAP) NCT02424136.

Keywords: Allergy; Anaphylaxis; Ara h2 sIgE; FeNO; Fraction exhaled nitric oxide; Peanut; Peanut sIgE; Skin prick test.

PubMed Disclaimer

Conflict of interest statement

Competing interestsThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Mean change in FeNO (p.p.b) at each increment. Grouped according to reaction type at challenge
Fig. 2
Fig. 2
Mean percentage change in FeNO (p.p.b) at each increment. Grouped according to reaction type at challenge
Fig. 3
Fig. 3
Comparison of combined diagnostic methods by logistic regression analysis, then ROC curve generation for clinical allergy
Fig. 4
Fig. 4
Comparison of combined diagnostic methods by logistic regression analysis, then ROC curve generation for anaphylaxis
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Exhaled Nitric Oxide as Biomarker of Type 2 Diseases.
    Maniscalco M, Fuschillo S, Mormile I, Detoraki A, Sarnelli G, Paulis A, Spadaro G, Cantone E; PATH-2 TASK FORCE. Maniscalco M, et al. Cells. 2023 Oct 25;12(21):2518. doi: 10.3390/cells12212518. Cells. 2023. PMID: 37947596 Free PMC article. Review.

References

    1. Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011;127(3):668–676.e1–2. - PubMed
    1. Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001;107(1):191–193. - PubMed
    1. Flom JD, Sicherer SH. Epidemiology of cow’s milk allergy. Nutrients. 2019;11(5):1051. - PMC - PubMed
    1. Savage J, Johns CB. Food allergy: epidemiology and natural history. Immunol Allergy Clin N Am. 2015;35(1):45–59. - PMC - PubMed
    1. Lifschitz C, Szajewska H. Cow’s milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr. 2015;174(2):141–150. - PMC - PubMed

Associated data