Purpose of review: To review and discuss recent studies on molecular diagnosis of peanut and other legume allergy.
Recent findings: Studies from the UK and France suggest that quantification of Ara h 2-specific IgE may accurately discriminate peanut allergy from tolerance. However, the pattern of allergenic component recognition in peanut-sensitized patients from different populations or geographical areas varies, reflecting different pollen and dietary exposures. In the USA, peanut-allergic patients are commonly sensitized to Ara h 1–3, in Spain to Ara h 9 and in Sweden to Ara h 8. Patients with soybean allergy sensitized to Gly m 5 or Gly m 6 allergens may be at greater risk of experiencing severe allergic reactions.
Summary: Accurate diagnosis of peanut and legume allergy is challenging and essential. Measurement of IgE response to specific allergenic molecules may be more useful in predicting the presence and severity of clinical allergy than currently used skin or blood tests based on whole extracts. However, given the heterogeneity in component recognition patterns observed in different geographical areas, further studies are essential to identify and confirm potentially useful molecular diagnostic and prognostic markers. Until such markers are confirmed and replicated in different age groups, oral food challenge (OFC) remains the gold standard for accurate diagnosis.