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Meet Caroline & Emma

Caroline and Emma, both 16 years old, both of whom possess known peanut allergies visit their healthcare professional after experiencing nasal obstruction in combination with irritated, itchy eyes and sometimes local reaction in the mouth.

Caroline and Emma's healthcare professional conducts a full clinical history and physical examination and decides to test using peanut components.

Patient History – Caroline

Family history

None 

Personal history 

  • Eczema during infancy; outgrown at school age 
  • Rhinitis and conjunctivitis during pollen season, since school age
Skin prick test results – age 5
Test Type Results
Peanut Whole Allergen +4


Her previous physician recommended that Caroline remove peanut entirely from her diet.

Patient History – Emma

Family history

  • None 

Personal history 

  • Eczema during infancy, outgrown at school age 
  • Rhinitis and conjunctivitis during pollen season, since school age
Skin prick test results – age 5
Test Type Results
Peanut Whole Allergen +4


Her previous physician recommended that Emma remove peanut entirely from her diet.

New Test results – Caroline

These results, together with this patient's case history and symptoms, help confirm the diagnosis.  

ImmunoCAPTM results (kUA /l)
Test Type Results
Peanut Whole Allergen 26
Ara h 1 Allergen Component <0.1 
Ara h 2 Allergen Component <0.1 
Ara h 3 Allergen Component <0.1 
Ara h 8 Allergen Component 33
Ara h 9 Allergen Component <0.1

New Test results – Emma

These results, together  with this patient's case history and symptoms, help confirm the diagnosis. 

ImmunoCAP results (kUA /l)
Test Type Results
Peanut Whole Allergen 28
Ara h 1 Allergen Component 2.1
Ara h 2 Allergen Component 12.3
Ara h 3 Allergen Component 3.3
Ara h 8 Allergen Component 10.3
Ara h 9 Allergen Component <0.1

Differential diagnosis - Caroline

Caroline has no detectable IgE levels to any of the species-specific markers in peanut allergy; Ara h 1, Ara h 2, and Ara h 3. Also, Ara h 9 is negative. She has however, high levels of antibodies recognizing Ara h 8 indicating a pollen-related food allergy, which is in line with her symptoms during spring season.1-4

Caroline’s refined diagnosis:

  • Birch allergy and a pollen-related food allergy

Healthcare professional's management plan for Caroline

  • Her healthcare professional advises Caroline that she may be an ideal candidate for a supervised oral food challenge.
  • Her healthcare professional refers Caroline to an allergy specialist for a supervised oral food challenge with peanut
  • The allergy specialist performs a supervised oral food challenge with peanut, which Caroline passes without any symptoms.

Follow Up

Peanut is now part of Caroline’s diet and she is doing well.

Differential diagnosis - Emma

Emma has significant/high IgE levels to species specific markers for peanut allergy often associated with systemic reactions.1-4

Emma's refined diagnosis:

  • Emma's component sensitization profile confirms a clinical peanut allergy.

Healthcare professional's management plan for Emma

  • Her healthcare professional advises Emma to continue to strictly avoid peanuts
  • Her healthcare professional also advises Emma to always carry her emergency adrenaline autoinjector

Follow Up

Emma has continued to avoid peanut in all forms and is fit and well. Her autoinjector technique is satisfactory.

Refrences
  1. Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol. 2012;130(2):468-472

  2. Peeters KA, Koppelman SJ, van Hoffen E, et al. Does skin prick test reactivity to purifed allergens correlate with clinical severity of peanut allergy? Clin Exp Allergy. 2007;37(1):108-115.

  3. Asarnoj A, Movérare R, Östblom E, et al. IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization in 8-year-olds. Allergy. 2010;65(9):1189-1195.

  4. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, et al. EAACI Molecular Allergology User’s Guide. Pediatr Allergy Immunol. 2016;27 Suppl 23:1-250.