Introduction: There is limited knowledge on the sensitization patterns to peanut proteins and food allergy in the Middle East. The objective of this study is to analyze the relationship between sensitization patterns to peanut proteins and clinical symptoms in a group of patients with physician-diagnosed peanut allergy (PA) in Kuwait. Methods: PA patients were evaluated by the skin prick test (SPT), serum total IgE, peanut-specific IgE (sIgE), and sIgE against Ara h 1–3, 8, and 9, and clinical data were collected. Results: Sixty-nine patients were included. A positive correlation between peanut SPT and sIgE was detected for all 3 storage proteins (Ara h 1–3) in patients <6 years old and for Ara h 1 and 2 in older patients. ROC analysis of positive correlations showed that oral food challenge should be considered for definite diagnosis of PA only if the level of Ara h 2 is <22.25 KUA/L, with level of Ara h 2 ≥15.4 allowing the detection of systemic reactions with a sensitivity of 55.56%. Patients presenting with systemic reactions more frequently had positive Ara h 1 (88.9%) and Ara h 2 (83.3%), compared with 44.1% and 52.9% in those with local reaction (p = 0.0046 and p = 0.0378). The levels of Ara h 1 and 2 were also significantly higher in patients with systemic reactions compared to those with a local reaction, with those differences being especially relevant for Ara h 2 (15.9 vs. 0.4) (p = 0.0005). Conclusions: The pattern of sensitization to peanut proteins in the Middle East is similar to that of the Western world. Measurement of sIgE antibodies to Ara h 1, 2, and 3 is useful in the diagnosis of PA and in the investigation of reactions to raw and roasted peanuts.

Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up.
J Allergy Clin Immunol
. 2010 Jun;125(6):1322–6.
Suratannon N, Ngamphaiboon J, Wongpiyabovorn J, Puripokai P, Chatchatee P. Component-resolved diagnostics for the evaluation of peanut allergy in a low-prevalence area.
Pediatr Allergy Immunol
. 2013 Nov;24(7):665–70.
Liew WK, Chiang WC, Goh AE, Lim HH, Chay OM, Chang S, et al. Paediatric anaphylaxis in a Singaporean children cohort: changing food allergy triggers over time.
Asia Pac Allergy
. 2013 Jan;3(1):29–34.
Loh W, Tang MLK. The Epidemiology of food allergy in the global context.
Int J Environ Res Public Health
. 2018 Sep 18;15(9):2043.
Custovic A, Nicolaou N. Peanut allergy: overestimated in epidemiology or underdiagnosed in primary care?
J Allergy Clin Immunol
. 2011 Mar;127(3):631–2.
Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy.
. 2014 Aug;69(8):1008–25.
Koppelman SJ, Wensing M, Ertmann M, Knulst AC, Knol EF. Relevance of Ara h1, Ara h2 and Ara h3 in peanut-allergic patients, as determined by immunoglobulin E Western blotting, basophil-histamine release and intracutaneous testing: Ara h2 is the most important peanut allergen.
Clin Exp Allergy
. 2004 Apr;34(4):583–90.
Nicolaou N, Custovic A. Molecular diagnosis of peanut and legume allergy.
Curr Opin Allergy Clin Immunol
. 2011 Jun;11(3):222–8.
Schussler E, Kattan J. Allergen component testing in the diagnosis of food allergy.
Curr Allergy Asthma Rep
. 2015 Sep;15(9):55.
Klemans RJ, Otte D, Knol M, Knol EF, Meijer Y, Gmelig-Meyling FH, et al. The diagnostic value of specific IgE to Ara h 2 to predict peanut allergy in children is comparable to a validated and updated diagnostic prediction model.
J Allergy Clin Immunol
. 2013 Jan;131(1):157–63.
Klemans RJ, van Os-Medendorp H, Blankestijn M, Bruijnzeel-Koomen CA, Knol EF, Knulst AC. Diagnostic accuracy of specific IgE to components in diagnosing peanut allergy: a systematic review.
Clin Exp Allergy
. 2015 Apr;45(4):720–30.
Flores Kim J, McCleary N, Nwaru BI, Stoddart A, Sheikh A. Diagnostic accuracy, risk assessment, and cost-effectiveness of component-resolved diagnostics for food allergy: a systematic review.
. 2018 Aug;73(8):1609–21.
Nicolaou N, Poorafshar M, Murray C, Simpson A, Winell H, Kerry G, et al. Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics.
J Allergy Clin Immunol
. 2010 Jan;125(1):191–7.e1–13.
Hoffmann-Sommergruber K, Pfeifer S, Bublin M. Applications of molecular diagnostic testing in food allergy.
Curr Allergy Asthma Rep
. 2015 Sep;15(9):56.
Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et al. EAACI molecular allergology user’s guide.
Pediatr Allergy Immunol
. 2016 May;27 Suppl 23:1–250.
Vereda A, van Hage M, Ahlstedt S, Ibanez MD, Cuesta-Herranz J, van Odijk J, et al. Peanut allergy: clinical and immunologic differences among patients from 3 different geographic regions.
J Allergy Clin Immunol
. 2011 Mar;127(3):603–7.
Martinet J, Couderc L, Renosi F, Bobée V, Marguet C, Boyer O. Diagnostic value of antigen-specific immunoglobulin E immunoassays against Ara h 2 and Ara h 8 peanut components in child food allergy.
Int Arch Allergy Immunol
. 2016;169(4):216–22.
Ebisawa M, Movérare R, Sato S, Maruyama N, Borres MP, Komata T. Measurement of Ara h 1-, 2-, and 3-specific IgE antibodies is useful in diagnosis of peanut allergy in Japanese children.
Pediatr Allergy Immunol
. 2012 Sep;23(6):573–81.
Chiang WC, Pons L, Kidon MI, Liew WK, Goh A, Wesley Burks A. Serological and clinical characteristics of children with peanut sensitization in an Asian community.
Pediatr Allergy Immunol
. 2010 Mar;21(2 Pt 2):e429–38.
Ma S, Nie L, Li H, Wang R, Yin J. Component-resolved diagnosis of peanut allergy and its possible origins of sensitization in China.
Int Arch Allergy Immunol
. 2016;169(4):241–8.
Ziyab AH. Prevalence of food allergy among schoolchildren in Kuwait and its association with the coexistence and severity of asthma, rhinitis, and eczema: a cross-sectional study.
World Allergy Organ J
. 2019;12(4):100024.
Cianferoni A, Muraro A. Food-induced anaphylaxis.
Immunol Allergy Clin North Am
. 2012 Feb;32(1):165–95.
Codreanu F, Collignon O, Roitel O, Thouvenot B, Sauvage C, Vilain AC, et al. A novel immunoassay using recombinant allergens simplifies peanut allergy diagnosis.
Int Arch Allergy Immunol
. 2011;154(3):216–26.
Dang TD, Tang M, Choo S, Licciardi PV, Koplin JJ, Martin PE, et al. Increasing the accuracy of peanut allergy diagnosis by using Ara h 2.
J Allergy Clin Immunol
. 2012 Apr;129(4):1056–63.
Keet C, Plesa M, Szelag D, Shreffler W, Wood R, Dunlop J, et al. Ara h 2-specific IgE is superior to whole peanut extract-based serology or skin prick test for diagnosis of peanut allergy in infancy.
J Allergy Clin Immunol
. 2021 Mar;147(3):977–83 e2.
Pascal M, Munoz-Cano R, Reina Z, Palacin A, Vilella R, Picado C, et al. Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens.
Clin Exp Allergy
. 2012 Oct;42(10):1529–39.
Asero R, Piantanida M, Pinter E, Pravettoni V. The clinical relevance of lipid transfer protein.
Clin Exp Allergy
. 2018 Jan;48(1):6–12.
Zambrano Ibarra G, Fuentes Aparicio V, Infante Herrero S, Blanca M, Zapatero Remon L. Peanut allergy in Spanish children: comparative profile of peanut allergy versus tolerance.
Int Arch Allergy Immunol
. 2019;178(4):370–6.
Al-Ahmad M, Rodriguez-Bouza T, Fakim N, Pineda F. Extensive cross-reactivity between salsola kali and salsola imbricata.
J Investig Allergol Clin Immunol
. 2018;28(1):29–36.
Kansen HM, van Erp FC, Knulst AC, Ehlers AM, Lyons SA, Knol EF, et al. Accurate prediction of peanut allergy in one-third of adults using a validated Ara h 2 cutoff.
J Allergy Clin Immunol Pract
. 2021 Apr;9(4):1667–74 e3.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.