ImmunoCAP ISAC in food allergy diagnosis: a systematic review of diagnostic test accuracy

Maesa, José-María; Dobrzynska, Agnieszka; Baños‐Álvarez, Elena; Isabel‐Gómez, Rebeca; Blasco‐Amaro, Juan Antonio

doi:10.1111/cea.13871

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…sIgE can have a high negative predictive value. 26,27 This is not routinely used to stratify risk of reaction at OFC in our practice, partly due to reluctance for venepuncture in children. For certain foods such as peanut and egg, basophil activation testing can achieve high positive predictive value, but it is non-standardised, resource intensive and not available in diagnostic laboratories in Australia.…”

Section: Discussionmentioning

confidence: 99%

Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5‐year experience

Jacob

Fernando

Nickolls

et al. 2023

J Paediatrics Child Health

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Aim Oral food challenges (OFC) are an important tool in the assessment of food allergy. We sought to identify factors available at initial assessment visit which were associated with successful outcome or challenge failure in Australian children. Methods We conducted a retrospective review of all paediatric patients who underwent OFC in our allergy service over a 5‐year period. Clinical data comprising patient demographics, co‐morbidities, skin prick test (SPT) results, nature of previous reactions, elapsed time since previous reactions and outcome at OFC were recorded. Results Four hundred and fifty‐six OFCs were conducted, with 56 cases (12.3%) resulting in a reaction. Likelihood of reaction at OFC was significantly increased for patients with atopic dermatitis (odds ratio 1.99). When stratified by food substance, atopic dermatitis had the strongest association with reaction within the peanut group (odds ratio 3.2), and no association was demonstrated for soy or prawn. Increasing SPT wheal size (P < 0.001) and previous history of anaphylaxis to the challenge food (P < 0.001) correlated with failure at OFC. A low‐risk group was identified, of patients with no clear history of prior reaction to the challenge food, and SPT result <3 mm. Conclusions Factors identified at assessment visit which correlated with reaction at OFC are atopic dermatitis, prior history of anaphylaxis, and increasing SPT wheal size. Domiciliary OFC could be considered in a select low‐risk group of patients undergoing food challenge. This study was performed at a single centre with limited sample size, further large‐scale and multicentre study verification of our data will provide more accurate representation of the Australian demographic.

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Section: Discussionmentioning

confidence: 99%

Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5‐year experience

Jacob

Fernando

Nickolls

et al. 2023

J Paediatrics Child Health

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“…It is also worth noting, that two of the studies employed ISAC, which, due to lower sensitivity, increases the risk of underestimating the point prevalence compared to ImmunoCAP. 34 Finally, results may have been affected by the composition of the test material, particularly from varying amounts of cross‐reactive carbohydrate determinants (CCDs). 8 Even in recombinant allergens, false positive results may have occurred in individuals with high anti‐CCD IgE levels, due to CCDs in solid‐phase allergen carriers of cellulose.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, four out of the five studies only presented data on children/adolescents, and four studies only presented data from North‐western Europe, further narrowing the representativeness of the data. It is also worth noting, that two of the studies employed ISAC, which, due to lower sensitivity, increases the risk of underestimating the point prevalence compared to ImmunoCAP 34 . Finally, results may have been affected by the composition of the test material, particularly from varying amounts of cross‐reactive carbohydrate determinants (CCDs) 8 .…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of sensitization to molecular food allergens in Europe: A systematic review

Lisik

Ioannidou

Spolidoro

et al. 2022

Clinical & Translational All

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Background Recent reports indicate that the prevalence of food allergy is increasing, but accurate estimates remain a challenge due to cross‐reactivity and limited use of precise diagnostic methods. Molecular allergy diagnostics, in which sensitization to individual molecular allergens is measured, is emerging as a promising tool for evaluation of sensitization profiles. In this systematic review, we summarized estimates of prevalence of sensitization to molecular food allergens in the general population in Europe. Methods Following a protocol prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; reference CRD42021266657), we searched seven databases with no restrictions on publication date or language. Two reviewers independently screened the literature, extracted data, and appraised the risk of bias in the included studies. The findings were synthesized narratively. Results From 4776 de‐duplicated records, five studies, with low to moderate overall risk of bias, were included. Forty‐six molecular allergens from 18 foods were investigated. Overall, the prevalence of sensitization was low, particularly for major allergens, and non‐existent for 10 molecular allergens (0% [95% CI 0–0.8]). The highest prevalence was seen for PR‐10 proteins, such as Cor a 1.04 (13.6% [95% CI 10.9–16.9]). Conclusions Available data, primarily from North‐western Europe, indicate that sensitization to molecular food allergens is overall low. The highest estimates were found for cross‐reactive PR‐10 proteins. There were not enough studies to discern regional differences or perform meta‐analysis, highlighting the need for more population‐representative studies in order to elucidate patterns of sensitization to molecular food allergens in Europe.

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“…The first steps in the work-up of food allergies is establishing a good clinical history and conducting skin testing and allergen specific IgE measurements ( 5 ). Although these testing procedures have demonstrated good sensitivity for detecting allergic individuals, their specificity is low, and they lack reliable threshold values ( 6 , 7 ). For this reason, physicians treating food allergies often base their decisions on personal experience, which can vary significantly, and on anecdotal information.…”

Section: Introductionmentioning

confidence: 99%

Towards an FDA-cleared basophil activation test

Alpan¹,

Wasserman

Kim³

et al. 2023

Front. Allergy

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Food allergy is a global health problem affecting up to 10% of the world population. Accurate diagnosis of food allergies, however, is still a major challenge in medical offices and for patients seeking alternative avenues of diagnosis. A flawless test to confirm or rule out a food allergy does not exist. The lack of optimum testing methods to establish precise clinical correlations remains a major obstacle to effective treatment. Certain IgE measurement methods, including component testing, have received FDA clearance, but they have been used primarily as an analytical tool and not to establish clinical correlations. Most allergy tests are still carried out within the laboratory, and skin tests outside a laboratory setting that are used for food allergy diagnosis rely on non-standardized allergens, according to the FDA definition. Epitope mapping and basophil activation test (BAT) have recently been proposed as a means of establishing better clinical correlations. Yet neither have received FDA clearance for widespread distribution. Of the two methods, the BAT has the advantage of being a functional assay. Over the past few years, several large private practice groups in the United States, have developed BAT as a clinical assay and have started using it in patient care. Given this clinical experience, the vast number of papers published on BAT (more than 1,400 as of 2022) and the trend toward increasing FDA regulation, it is essential to understand the roadmap for regulatory clearance of this assay.

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ImmunoCAP ISAC in food allergy diagnosis: a systematic review of diagnostic test accuracy

Cited by 12 publications

References 27 publications

Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5‐year experience

Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5‐year experience

Prevalence of sensitization to molecular food allergens in Europe: A systematic review

Towards an FDA-cleared basophil activation test

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