Three peanut allergic/sensitized phenotypes with gender difference

Abstract

Background

Peanut allergic reactions are heterogeneous ranging from mild symptoms to anaphylaxis.

Objective

Identify peanut allergic/sensitized phenotypes to personalize patient management.

Methods

A combined factor and cluster analysis was used to study the phenotypes of 696 patients diagnosed with peanut sensitization and enrolled in the MIRABEL survey. The method was first applied to the 247 patients with an Oral Food Challenge (OFC). It was then applied to the 449 patients without OFC to confirm the findings in an independent population.

Results

Three independent clusters emerged from the OFC subgroup. Cluster 1, "Severe peanut allergy with little allergic multimorbidity" (123 subjects), had the highest proportion of patients with positive OFC (92%), a medium level of peanut protein inducing a positive OFC (235 mg), lower percentage of allergic multimorbidity (2% asthma plus atopic dermatitis (A+AD), no cases of A+AD + multiple food allergies (MFA)). Cluster 2, "Severe peanut allergy with frequent allergic multimorbidity" (62 subjects), had a high proportion of patients with positive OFC (85%) with the lowest level of peanut protein inducing a positive OFC (112mg), 89% allergic subjects, 100% with allergic multimorbidity (A+AD) and 84% with A+AD+MFA. Cluster 3, "Mild peanut allergic/sensitized phenotype" (62 subjects), had the lowest mean age, the lowest proportion of patients with positive OFC (53%) with a high level of peanut protein inducing a positive OFC (770 mg), a low percentage of allergic multimorbidity (48% A+AD+MFA). The two severe peanut allergy phenotypes were more frequent in girls. The same clusters were found in the subgroup of patients without OFC.

Conclusion & Clinical Relevance

Besides the classic markers associated with lower threshold doses of OFC (such as SPT and rAra h2), allergic multimorbidity and female gender should also be taken into account to better adapt the progressive dosage of provocation tests.

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