While symptoms of food allergy range from mild to severe, patients with peanut allergy are at the highest risk of a potentially life threatening reaction known as anaphylaxis affecting up to half of all individuals who are allergic to peanut. 

While there are hypotheses, the true mechanisms that drive tolerance and allergy remain elusive. As such, there is a growing need for improved diagnostic biomarkers to clarify childhood food allergy and improve patient safety. 

Currently the gold standard for allergy diagnosis is to feed the child peanut in a hospital setting where anaphylactic attacks can be clinically managed when they occur. This approach is a stressful and often traumatic experience for the children being tested. Testing also places a significant burden on the public health system, which is struggling to keep pace with increasing demand due to the staffing required to monitor for and manage life-threatening allergic reactions. Due to the severity of the test many children do not have any ongoing monitoring of their allergy and continue to avoid peanut for the rest of their lives. 

We recently performed a study at John Hunter Children’s Hospital and HMRI which identified the fraction of exhaled nitric oxide (FeNO) in patient’s breath as a significantly better predictor of peanut allergy status than either skin prick test or the optimal blood test. We were able to show that this biomarker could differentiate, not only between allergic and non-allergic reactions, but also capable of differentiating between those who will have an anaphylactic vs clinically significant but not anaphylactic response to peanuts. 

Successful completion of this study will be a significant breakthrough in the area of food allergy. This will be the first report of a biomarker capable of differentiating between allergic patients who are at risk of a life-threatening anaphylactic response upon exposure to peanut vs less severe clinically significant allergy


Dr Adam Collison, Dr Rani Bhatia

Project type 
Project Grant
Year of funding