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. 2022 May;77(5):1559-1569.
doi: 10.1111/all.15166. Epub 2021 Nov 16.

Measurement of IgE to hazelnut allergen components cannot replace hazelnut challenge in Dutch adults

Sarah A Lyons  1 , Paco M J Welsing  2 , Mariam Hakobyan  1 , Hannah M Kansen  1   3 , Edward F Knol  1   4 , Henny G Otten  4 , Ronald van Ree  5   6 , André C Knulst  1   4 , Thuy-My Le  1   4
Affiliations

Measurement of IgE to hazelnut allergen components cannot replace hazelnut challenge in Dutch adults

Sarah A Lyons et al. Allergy. 2022 May.

Abstract

Background: Component-resolved diagnostics (CRD) help predict hazelnut allergy (HA) in children, but are of unknown diagnostic value in adults. This study aimed to evaluate the diagnostic accuracy of IgE to hazelnut extract and components in adults.

Methods: A Dutch population of consecutively presenting adults suspected of HA, who underwent a double-blind placebo-controlled food challenge, were included. Serum IgE to hazelnut extract and Cor a 1, 8, 9, and 14 was measured on ImmunoCAP. Diagnostic accuracy was assessed by area under the curve (AUC) analysis.

Results: Of 89 patients undergoing challenge, 46 had challenge-confirmed HA: 17 based on objective and 29 based on subjective symptoms. At commonly applied cutoffs 0.1 and 0.35 kUA /L, high sensitivity was observed for IgE to hazelnut extract and Cor a 1 (range 85-91%), and high specificity for IgE to Cor a 8, 9 and 14 (range 77-95%). However, the AUCs for hazelnut extract and components were too low for accurate prediction of HA (range 0.50-0.56). Combining hazelnut extract and component IgE measurements did not significantly improve accuracy. Higher IgE levels to Cor a 9 and 14 were tentatively associated with HA with objective symptoms, but the corresponding AUCs still only reached 0.68 and 0.63, respectively.

Conclusions: Although hazelnut allergic adults are generally sensitized to hazelnut extract and Cor a 1, and hazelnut tolerant adults are usually not sensitized to Cor a 8, 9, or 14, challenge testing is still needed to accurately discriminate between presence and absence of HA in adults from a birch-endemic country.

Keywords: IgE; adults; component-resolved diagnostics; diagnostic value; hazelnut allergy.

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Conflict of interest statement

ImmunoCAP material was provided by Thermo Fisher Scientific. All authors declare no further conflicts of interest in relation to this study. Outside submitted work, Dr. Knol reports personal fees from Thermo Fisher Scientific, and Dr. Van Ree reports personal fees from HAL Allergy BV, Citeq BV, Angany Inc., Thermo Fisher Scientific; and grants from the Dutch Science Foundation, European Commission, and Health Holland.

Figures

FIGURE 1
FIGURE 1
Percentage of patients with sensitization to hazelnut extract or components and corresponding IgE levels, stratified to hazelnut challenge outcome. Sensitization was considered present if IgE ≥0.35kUA/L. For IgE levels, medians and interquartile ranges are displayed on a logarithmic scale (base 10)
FIGURE 2
FIGURE 2
ROC curves of serology tests for predicting presence of allergy (A) and objective symptoms (B) during hazelnut challenge. Area under the curve (95% confidence interval) is presented in the plot legends. In Figure A, the full model contains IgE to hazelnut extract, Cor a 1, Cor a 8, Cor a 9, and Cor a 14. All IgE variables were also selected in the Lasso regression model. No multivariable models were developed for outcome B due to the small number of subjects with the outcome of interest (N=17 with objective symptoms). ROC, receiver‐operating characteristic
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