Background

The presence of sesame allergy and its importance are increasing.

Objective

To determine the results of sesame and tahini oral food challenges (OFCs) and whether sesame-specific immunoglobulin E and skin prick tests (SPTs) accurately predicted sesame allergy in children.

Methods

Patients with suspected sesame allergy between June 1, 2018, and June 1, 2020, were examined.

Results

Of 92 patients (n = 65, 70.7% of the patients were boys) with a median age of 2 years (interquartile range, 1.2-3.8 years), 64 were reactive to tahini. Of 64 patients, 41 had a positive OFC result and 23 had a consistent history. Of 54 sesame OFCs, 10 patients had a positive outcome. Of 44 with a negative outcome of sesame OFC, 4 experienced allergic reactions with tahini at home and 22 patients had a positive result for tahini OFC. In multivariate logistic regression analysis, clinical reactivity of sesame (either a consistent history or a positive OFC) was positively associated with sesame SPT (odds ratio, 2.120; 95% confidence interval, 1.136-3.957; P = .01) and tahini SPT (odds ratio, 1.661; 95% confidence interval, 1.143-2.413; P = .008). Nevertheless, sesame-specific immunoglobulin E did not predict clinical reactivity. Tahini OFC outcomes were well predicted for both sesame and tahini SPTs (area under the curves of 0.937 and 0.896, respectively, P < .001 for both). A sesame SPT wheal size of 5.25 mm had 90.6% sensitivity, 82.1% specificity, and 5.1 positive likelihood ratio. For tahini SPT, the 6-mm threshold had 100% sensitivity, 82.1% specificity, and 5.6 positive likelihood ratio.

Conclusion

In the OFC, tahini emerged as a more optimal diagnostic tool to avoid false negatives. Furthermore, both high sesame and tahini SPT levels individually can help predict the diagnosis of sesame allergy.

中文翻译：

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诊断测试和口服食物挑战结果在预测芝麻过敏中的作用

背景

芝麻过敏的存在及其重要性正在增加。

客观的

确定芝麻和芝麻酱口服食物挑战 (OFC) 的结果，以及芝麻特异性免疫球蛋白 E 和皮肤点刺试验 (SPT) 是否准确预测儿童芝麻过敏。

方法

对 2018 年 6 月 1 日至 2020 年 6 月 1 日期间疑似芝麻过敏的患者进行了检查。

结果

在中位年龄为 2 岁（四分位间距，1.2-3.8 岁）的 92 名患者（n = 65，70.7% 的患者为男孩）中，64 名患者对芝麻酱有反应。在 64 名患者中，41 名 OFC 结果为阳性，23 名有一致的病史。在 54 个芝麻 OFC 中，有 10 个患者的结果为阳性。在芝麻 OFC 结果为阴性的 44 名患者中，有 4 名在家中对芝麻酱产生过敏反应，22 名患者对芝麻酱 OFC 结果为阳性。在多变量逻辑回归分析中，芝麻的临床反应性（一致病史或 OFC 阳性）与芝麻 SPT（比值比，2.120；95% 置信区间，1.136-3.957；P  = .01）和芝麻酱 SPT（比值比，1.661；95% 置信区间，1.143-2.413；P =.008）。然而，芝麻特异性免疫球蛋白 E 并不能预测临床反应性。芝麻酱和芝麻酱 SPT 的芝麻酱 OFC 结果都得到了很好的预测（曲线下面积分别为 0.937 和 0.896，两者的P < .001）。大小为 5.25 mm 的芝麻 SPT 风团具有 90.6% 的敏感性、82.1% 的特异性和 5.1 的阳性似然比。对于芝麻酱 SPT，6 毫米阈值具有 100% 的敏感性、82.1% 的特异性和 5.6 的阳性似然比。

结论

在 OFC 中，芝麻酱成为避免假阴性的更佳诊断工具。此外，单独的高芝麻和芝麻酱 SPT 水平可以帮助预测芝麻过敏的诊断。