Peanut allergy may be overdiagnosed in younger siblings of those with confirmed peanut allergy
Notice bibliographique
Résumé
Siblings of children with peanut allergy (PNA) are reported to have a higher prevalence of PNA than the general population. This prevalence may have both genetic and environmental influences, but may also reflect incorrect PNA diagnoses with less rigorous usage of confirmatory tests in siblings. The Peanut Allergy Registry (PAR), a Canadian database of individuals with PNA, was used to assess whether siblings born after the diagnosis of PNA in the index case (i.e., child with PNA) were more likely to have never been exposed to peanut (PN) and to be diagnosed without an appropriate clinical history or testing. A questionnaire was distributed to all PAR families with at least one child with confirmed PNA. Data were collected on siblings’ history of exposure or allergic reaction to PN, and on the results of any confirmatory tests. Univariate and multivariate logistic regressions were performed to examine the association between characteristics of the index case/ siblings and the following outcomes in siblings: i) complete PN avoidance and ii) parent-reported diagnosis of PNA without corroborating positive diagnostic tests. Predictors included sibling age and gender; index case age at PNA diagnosis, co-morbidities, and severity of allergic reaction; parental education level and marital status, province of residence, and sibship size. A hierarchical model was generated using the WinBUGS program to account for potential clustering effects within families. Among 935 PAR families surveyed, 748 (80%) responded, representing 922 siblings, with median age 11.7 (IQR 7.4-16.3) years; 56.9% of siblings were younger than index cases. Eighty-three percent of siblings had been exposed to PN. Eighty (of 922) siblings were reported as having PNA (8.8%, CI 6.9,10.6). Of 80, 34 (42%) had no preceding allergic reaction to PN; in 5 of these 34, testing was either not performed or not supportive of the diagnosis. In multivariate analysis, siblings born after the diagnosis in the index PNA case were more likely (Odds Ratio (OR) 5.2, 95% CI 2.2, 12.9) to have completely avoided peanut. In univariate analysis, siblings born after the diagnosis in the index case were more likely to be diagnosed with PNA without a history or confirmatory testing (OR, 12.7 95% CI, 1.3, 120.7). This association was not significant in the multivariate analysis. Younger siblings of children with PNA may be at risk of being labeled with PNA without sufficient confirmatory testing. It is crucial to develop guidelines for both physicians and families that would prompt use of confirmatory tests to establish the diagnosis of PNA and advocate against unjustified PN avoidance.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».