The diagnosis of food allergy: a systematic review and meta‐analysis

Abstract

Background: We investigated the accuracy of tests used to diagnose food allergy. Methods: Skin prick tests (SPT), specific-IgE (sIgE), component-resolved diagnosis and the atopy patch test (APT) were compared with the reference standard of double-blind placebo-controlled food challenge. Seven databases were searched and international experts were contacted. Two reviewers independently identified studies, extracted data, and used QUADAS-2 to assess risk of bias. Where possible, meta-analysis was undertaken. Results: Twenty-four (2831 participants) studies were included. For cows' milk allergy, the pooled sensitivities were 53% (95% CI 33-72), 88% (95 % CI 76-94), and 87% (95% CI 75-94), and specificities were 88% (95% CI 76-95), 68% (95% CI 56-77), and 48% (95% CI 36-59) for APT, SPT, and sIgE, respectively. For egg, pooled sensitivities were 92% (95% CI 80-97) and 93% (95% CI 82-98), and specificities were 58% (95% CI 49-67) and 49% (40-58%) for skin prick tests and specific-IgE. For wheat, pooled sensitivities were 73% (95% CI 56-85) and 83% (95% CI 69-92), and specificities were 73% (95% CI 48-89) and 43% (95% CI 20-69%) for SPT and sIgE. For soy, pooled sensitivities were 55% (95% CI 33-75) and 83% (95% CI 64-93), and specificities were 68% (95% CI 52-80) and 38% (95% CI 24-54) for SPT and sIgE. For peanut, pooled sensitivities were 95% (95% CI 88-98) and 96% (95% CI 92-98), and specificities were 61% (95% CI 47-74), and 59% (95% CI 45-72) for SPT and sIgE. Conclusions: The evidence base is limited and weak and is therefore difficult to interpret. Overall, SPT and sIgE appear sensitive although not specific for diagnosing IgE-mediated food allergy.

EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

“…The first principle is correct diagnosis of the allergy by clinical history, serum-specific IgE and skin prick testing and challenge, if necessary, to identify relevant trigger and tolerated foods (33,34). The allergist and/or the dietitian should provide comprehensive advice on allergenic foods to be avoided, interpretation of food allergen labeling (including precautionary labeling), and identification of potential sources of cross-contamination.…”

Current Trends and Investigative Developments in Wheat Allergy

“…sIgE evaluation showed high sensitivity, negative predictive values and a low positive predictive value [17]. sIgE detection by the use of the immunoblot analysis compared to skin prick tests showed 83% (95% CI 69-92%) and 73% (95% CI 56-85%) sensitivity and 43% (95% CI 20-69%) and 73% specificity (95% CI 48-89%) [18]. 3.…”

Food Allergy: Strategy and Tactics of Management of Patients in Terms of Evidence-Based Medicine

“…В настоящее время не существует единого общепризнанного диагно-стического теста, на основании которого мог бы быть поставлен диагноз пищевой аллергии. Двойная слепая плацебоконтролируемая проба остается «золотым стан-дартом» диагностики пищевой аллергии [6][7][8], однако техническая сложность проведения процедуры, а так-же риск возникновения тяжелых реакций заставляют искать более простые и доступные для практики методы и алгоритмы.…”