Characteristics of Preschool Children with Peanut Sensitization,
Tolerant to Peanuts

Background: A recent history of an immediate reaction together with a positive test for peanut IgE via a skin or a serological test, is usually enough for the clinical diagnosis of IgE mediated peanut allergy in children.

Objective: Characterizing a population of preschool children with confirmed peanut sensitization but without peanut allergy.

Methods: In the context of an interventional trial for the treatment of peanut allergy in preschool children, patients less than 6 years of age, with a suggestive history of an immediate reaction to peanuts and evidence of IgE sensitization, underwent an open graduated challenge with peanut proteins in the form of Bamba.

Results: 73 preschoolers with an immediate type hypersensitivity and evidence of peanut sensitization were challenged. 24 passed the challenge without evidence of peanut allergy and continue to consume peanuts at home. Compared to the 49 exhibiting an immediate allergic reaction, tolerant children were younger, 32.5 mo Vs 42 mo, had less reported asthma 17% Vs 30% and less respiratory reactions to peanuts 8% Vs 16%. On average, skin tests with commercial peanut allergen extracts were lower 7.3mm Vs 10.5 and specific Arah2 IgE was 1.05 Vs 11.33 in allergic children, however a significant overlap for all test parameters was observed.

Conclusion: Almost 1/3 of peanut sensitized preschoolers with a suggestive history of peanut allergy still exhibit significant tolerance to peanuts. Introduction of peanut containing foods as early as possible in this population may prevent the future development of life threatening peanut allergy in these patients.