Peanut component testing

Ara h8 Ara h9 Ara by the h1 Ara numbers h2

Ara h3

Detect sensitizations to the whole peanut to create personalized management plans for your patients. High levels of peanut IgE can predict the likelihood of peanut sensitivity, Ara but may not be solely h8 predictive of reactions or allergic response.1

LOWER RISK of systemic reaction2 • Risk of mild, localized symptoms, such as itching/tingling of the lips, mouth, and oropharynx3 Peanut allergen • Cross-reactive with pollens (e.g., birch)3 component testing

Measurement of specific IgE by blood Ara h8 Ara h9 Ara h1, 2, 3 Test interpretations and next steps test that provides objective assessment of sensitization to the whole peanut is the Oral food challenge (OFC) with a specialist may be recommended. High likelihood that first step in discovering the likelihood of patient may pass OFC. a systemic reaction and the necessary If patient passes an OFC: precautions that may be prescribed. • Foods prepared with or around + - - may be consumed Knowing to which protein your • Patient not restricted to patient is sensitized can help you peanut-free zones 1,2,8-10 develop a management plan. 5 If there is no clinical history of symptoms, please see considerations above +/- + - 6 If there is a clinical history of symptoms, please see considerations below

% of peanut sensitive patients • Choose peanut-free zones 77.6 may not be at risk for a for patient’s safety systemic reaction.1 • Prescribe auto-injector +/- +/- + • Family, colleagues, and teachers should be made aware of and have a plan Ara h1 Ara Determine which h2 proteins your patient Ara Ara is sensitized to. h9 h3

VARIABLE RISK HIGHER RISK of systemic reaction of systemic reaction Reduce patient including anaphylaxis4 including anaphylaxis6,7 anxiety with • Often accompanied by • Sensitization to Ara h2 is sensitization to other nearly always associated individualized peanut proteins5 with clinical peanut allergy2 management plans. • Cross-reactive with fruits with pits (e.g., peaches)4

Ara h8 Ara h9 Ara h1, 2, 3 Test interpretations and next steps

Oral food challenge (OFC) with a specialist may be recommended. High likelihood that patient may pass OFC. If patient passes an OFC: • Foods prepared with or around peanuts + - - may be consumed • Patient not restricted to peanut-free zones

5 If there is no clinical history of symptoms, please see considerations above +/- + - 6 If there is a clinical history of symptoms, please see considerations below

• Choose peanut-free zones for patient’s safety • Prescribe epinephrine auto-injector +/- +/- + • Family, colleagues, and teachers should be made aware of allergy and have a plan

As in all diagnostic testing, a diagnosis must be made by the physician based on test results, individual patient history, the physician’s knowledge of the patient, and the physician’s clinical judgement. Diagnose Assess Address Enable by the risks anxiety confidence numbers. for systemic with individualized in dietary and reactions and management plans. lifestyle choices. cross-reactivity.

Test Name Test Code Test Name Test Code

Childhood Allergy Profile Profile w/Reflexes - D. pteronyssinus (House mite), (NTC-2721) d1; D. farinae (House - Contains all components of the Food Allergy Profile (NTC-10715) mite), (NTC-2722) d2; Cat dander, (NTC-2601) e1; Dog dander, with reflex to the following components, with reflex to Egg (NTC-2605) e5; Egg white, (NTC-2801) f1; Milk, (NTC-2802) f2; Component Panel, (NTC-91372); Ovomucoid, (NTC-3046) f233; 91682 Codfish, (NTC-2803) f3; Wheat, (NTC-2804) f4; Peanut, (NTC-2813) 10659 Ovalbumin, (NTC-2719) f232; Milk Component Panel, (NTC-91403); f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; , Casein, (NTC-2853) f78; Alpha-lactalbumin, (NTC-2851) f76; Beta- (NTC-3489) f256; Cockroach, (NTC-2736) i6; Cladosporium lactoglobulin, (NTC-2852) f77; Peanut Component Panel, (NTC- herbarum, (NTC-2702) m2; Alternaria alternata, (NTC-2706) m6; 91681) Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9 Total IgE Mix Group 18 Childhood Allergy Profile w/Reflexes - IgE allergy testing for: , (NTC-2820) f20; nut, (NTC- - Contains all components of the Childhood Allergy Profile (NTC- 2608) f202; Coconut, (NTC-2836) f36; , (NTC-2817) f17; 7918 10659) with reflex to the following components, Egg Component Peanut, (NTC-2813) f13; , (NTC-2864) f201; Sesame seed, Panel, (NTC-91372); Ovomucoid, (NTC-3046) f233; Ovalbumin, 91683 (NTC-2810) f10 (NTC-2719) f232; Milk Component Panel, (NTC-91403); Casein, (NTC-2853) f78; Alpha-lactalbumin, (NTC-2851) f76; Beta- Nut Panel lactoglobulin, (NTC-2852) f77; Peanut Component Panel, (NTC- -  nut, (NTC-38475); Pecan, (NTC-2864); , 91681) Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9 (NTC-2818); Walnut, (NTC-3489); Cashew nut, (NTC-2608); 94462 , (NTC-2726); Hazelnut, (NTC-2817); Almond, (NTC-2820); Food Allergy Panel Peanut—no reflexes (NTC-2813) - Milk, (NTC-2802) f2; IgE Egg white, (NTC-2801) f1; IgE Peanut, (NTC-2813) f13; IgE Walnut, (NTC-3489) f256; IgE Corn, (NTC-2808) 38767 Nut Panel w/Reflexes f8; IgE Wheat, (NTC-2804) f4; IgE Soybean, (NTC-2814) f14; IgE - Macadamia nut, (NTC-38475); Pecan, (NTC-2864); Brazil nut (with Codfish, (NTC-2803) f3; IgE Clam, (NTC-8929) f207; IgE Shrimp, reflex), (NTC-94464); Walnut (with reflex), (NTC-94467); Cashew 94463 (NTC-2824) f24; Total IgE nut (with reflex), (NTC-94465); Pistachio, (NTC-2726); Hazelnut (with reflex), (NTC-94468); Almond, (NTC-2820); Peanut (with Food Allergy Profile reflex), (NTC-91747) - Egg white, (NTC-2801) f1; Milk, (NTC-2802) f2; Codfish, (NCT-2803) f3; Wheat, (NTC-2804) f4; Corn, (NTC-2808) f8; Sesame seed, Peanut Component Panel 10715 91681 (NTC-2810) f10; Peanut, (NTC-2813) f13; Soybean, (NTC-2814) f14; - Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9 Shrimp, (NTC-2824) f24; Clam, (NTC-8929) f207; Walnut, (NTC- 3489) f256; Scallop, (NTC-273) f338 Peanut (Total) w/Reflex - Peanut, f13; *Positive result reflexes to 91681—Peanut 91747 Component Panel, (Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9) Multiple test codes are available. Refer to the Quest Diagnostics Directory of Services or the online Test Center (QuestDiagnostics.com /testcenter) for test information. NTC = National test code For more information about peanut component testing, contact your local sales representative.

References

1. Nicolaou N, Poorafshar M, Murray C, et al. Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol. 2010;125(1):191-197. 2. Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol. 2012;130(2):468-472. 3. Mittag D, Akkerdaas J, Ballmer-Weber BK, et al. Ara h 8, a Bet v 1-homologous allergen from peanut, is a major allergen in patients with combined birch pollen and peanut allergy. J Allergy Clin Immunol. 2004;114(6):1410-1417. 4. Lauer I, Dueringer N, Pokoj S, et al. The non-specific lipid transfer protein, Ara h 9, is an important allergen in peanut. Clin Exp Allergy. 2009;39(9):1427-1437. 5. Movérare R, Ahlstedt S, Bengtsson U, et al. Evaluation of IgE to recombinant peanut allergens in patients with reported reactions to peanut. Int Arch Allergy Immunol. 2011;156(3):282-290. 6. Peeters KA, Koppelman SJ, van Hoffen E, et al. Does skin prick test reactivity to purified allergens correlate with clinical severity of peanut allergy? Clin Exp Allergy. 2007;37(1):108-115. 7. Asarnoj A, Movérare R, Östblom E, et al. IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization in 8-year-olds. Allergy. 2010;65(9):1189-1195. 8. Dang TD, et al. Increasing the accuracy of peanut allergy diagnosis by using Ara h 2. J Allergy Clin Immunol. 2012;129(4):1056-1063. 9. Nicolaou N, et al. Quantification of specific IgE to whole peanut extract and peanut components in prediction of peanut allergy.J Allergy Clin Immunol. 2011:1-2. 10. Vereda A, et al. Peanut allergy: Clinical and immunologic differences among patients from 3 different geographic regions. J Allergy Clin Immunol. 2010;3(2):1-5.

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