Protocol for a systematic review of the diagnostic test accuracy of tests for IgE‐mediated food allergy

Genuneit, Jon; Jayasinghe, Sashini; Riggioni, Carmen; Peters, Rachel L.; Chu, Derek K.; Munblit, Daniel; Boyle, Robert; Toit, George Du; Skypala, Isabel; Santos, Alexandra F.

doi:10.1111/pai.13684

Cited by 9 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Determining the sensitivity and specificity of BAT is a crucial step in clinical Allergen stimulation divided by negative control validation. Although demonstrating variations between foods, BAT has a high sensitivity and specificity for food allergies [27][28][29][30]. The sensitivity of BAT for drug allergies is lower, but it can still be very helpful before considering provocation tests in cases of life-threatening drug allergies where patients cannot be rechallenged or in cases of drugs for which there are no other tests available or their results are ambiguous [1].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions

Koumaki,

Gregoriou,

Evangelou

et al. 2023

Dermatol Ther (Heidelb)

View full text Add to dashboard Cite

Introduction:The basophil activation test (BAT) is a flow cytometry laboratory technique that assesses the level of activation indicators expressed on the surface of basophils. We conducted a real-life study in a prospective cohort of patients with reported drug hypersensitivity reactions to determine the true relevance of BAT as a diagnostic tool for assessing immediate hypersensitivity reactions to medicines. Methods: We prospectively assessed individuals with clinical suspicion of immediate hypersensitivity reactions to drugs over a 2-year period.The allergological evaluation was carried out in accordance with European Academy of Allergy and Clinical Immunology (EAACI) guidance. All patients underwent BAT using the activation marker CD63. Results: In total 13 patients with 54 reported immediate drug hypersensitivity reactions to medications were included in this study. Twelve were female (92.3%) and one was male (7.70%). The mean ± SD age of the patients was 47.31 ± 19.94 years. Antibiotics were tested in 35.2% (19/54) of patients, corticosteroids in 24.1% (13/54), iodinated contrast medium in 14.8% (8/54), and NSAIDs in 5.6% (3/54). There was no correlation between the BAT results and the age of patients, gender, type of medication, or time interval between the allergic reaction and BAT procedure. The sensitivity of BAT 5% CD63 ? basophils to drugs was 97.6%, specificity was 96% for drug allergies, positive predictive value (PPV) was 94.3%, and negative predictive value (NPV) was 95.2%. Conclusions: The sensitivity of BAT for drug allergies is limited, but it can nevertheless be very helpful before contemplating provocation testing in cases of life-threatening drug allergies where patients cannot be rechallenged or in cases of medications for which no other tests are available or their results are ambiguous.

show abstract

Section: Discussionmentioning

confidence: 99%

Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions

Koumaki,

Gregoriou,

Evangelou

et al. 2023

Dermatol Ther (Heidelb)

View full text Add to dashboard Cite

show abstract

“…The methods are described in brief here, and a full review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO registration: CRD42021259186) and previously published 12 . We report our findings herein according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) 13 …”

Section: Methodsmentioning

confidence: 99%

“…10,11 To inform the EAACI guidelines on FA diagnosis, we undertook a SR and meta-analyses about the accuracy of index tests to support the diagnosis of IgE-mediated FA, following a previously registered and published protocol. 12 This SR addresses the question: What is the diagnostic accuracy measured by the sensitivity and specificity of any index test for IgE-mediated FA to any food compared with the reference standard OFC (in at least a subset of patients) or previous clear history of immediate reaction to the food and evidence of IgE sensitization?…”

Section: Introductionmentioning

confidence: 99%

“…A systematic review (SR) of index tests is the most reliable form of evidence in the diagnostic field and enables clinicians and other healthcare professionals to make well‐informed decisions 10,11 . To inform the EAACI guidelines on FA diagnosis, we undertook a SR and meta‐analyses about the accuracy of index tests to support the diagnosis of IgE‐mediated FA, following a previously registered and published protocol 12 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review and meta‐analyses on the accuracy of diagnostic tests for IgE‐mediated food allergy

Riggioni,

Ricci,

Moya

et al. 2023

Allergy

Self Cite

View full text Add to dashboard Cite

The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta‐analyses to assess the accuracy of diagnostic tests for IgE‐mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta‐analyses were undertaken for food‐test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double‐blind placebo‐controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2‐sIgE had 92%, Cor a 14‐sIgE 95%, Ana o 3‐sIgE 94%, casein‐sIgE 93%, ovomucoid‐sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies.

show abstract

“…A diagnosis of IgE-dependent allergy is founded on the association of a convincing clinical history and proven sensitization to the culprit allergen. The gold standard for allergy diagnosis is a positive challenge test reaction to a culprit allergen, e.g., nasal allergen challenge or oral food allergen challenge test [ 139 , 140 , 141 ]; a positive test, i.e., yielding a reaction to the culprit allergen, is a reliable proof of genuine allergy. However, challenge tests bear a non-negligible risk of severe allergic reactions and therefore can only be performed by specialized medical staff in appropriate settings with high costs and lengthy delays [ 142 ].…”

Section: Hypersensitivities Induced By Nonadaptive Innate Mechanismsmentioning

confidence: 99%

Allergy, Anaphylaxis, and Nonallergic Hypersensitivity: IgE, Mast Cells, and Beyond

et al. 2022

View full text Add to dashboard Cite

IgE-mediated type I hypersensitivity reactions have many reported beneficial functions in the immune defense against parasites, venoms, toxins etc. However, they are best-known for their role in allergy affecting nowadays almost one third of the population worldwide. IgE-mediated allergic diseases result from a maladaptive type 2 immune response that promotes the synthesis of IgE antibodies directed to a special class of antigens called allergens. IgE antibodies bind to type I high affinity IgE receptors (FcepsilonRI) on mast cells and basophils licensing them to get triggered in a subsequent encounter with the cognate allergen. This promotes the release of a whole set of inflammatory mediators including histamine responsible for the symptoms of immediate hypersensitivity. The development of type 2 driven allergies are dependent on a complex interplay of genetic and environmental factors at barrier surfaces including the host microbiome that builds up during early life. While without doubt IgE-mediated immediate hypersensitivity reactions are at the origin of the majority of allergies it has become clear that similar responses and symptoms can be triggered by other types of adaptive immune responses mediated via IgG or complement involving other immune cells and mediators. Likewise, various innate triggers via receptors expressed on mast cells have been found either to directly launch an allergic reaction and/or to amplify existing IgE-mediated responses. This review summarizes recent findings on both IgE-dependent and IgE-independent mechanisms in the development of allergies and provides an update on allergy diagnosis.

show abstract

Protocol for a systematic review of the diagnostic test accuracy of tests for IgE‐mediated food allergy

Cited by 9 publications

References 28 publications

Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions

Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions

Systematic review and meta‐analyses on the accuracy of diagnostic tests for IgE‐mediated food allergy

Allergy, Anaphylaxis, and Nonallergic Hypersensitivity: IgE, Mast Cells, and Beyond

Contact Info

Product

Resources

About