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

Abstract

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.

BAT and MAT for diagnosis of peanut allergy: A systematic review and meta‐analysis

“…To our knowledge, this is the second review and meta‐analysis examining the specificity and sensitivity of BAT for the diagnosis of peanut allergy, following the study by Riggioni et al 23 . Our results show however superior outcomes than theirs (90% specificity and 84% sensitivity).…”

Feast for thought: A comprehensive review of food allergy 2021-2023

“…A comprehensive SR and meta-analyses of studies on the utility of tests to support the diagnosis of FA, in which at least a proportion of patients underwent OFC, has recently generated useful indicative cut-offs with sensitivity and specificity that can be used to guide interpretation of allergy test results. 98 Novel diagnostic in vitro tests with promising results include cellular tests, namely, the BAT and MC activation test (MAT), and serologic tests such as measurement of epitope-specific IgE level. These tests are promising future diagnostic tools for FA, with the BAT having an advantage over epitope-specific IgE testing for being a functional assay that combines all IgE characteristics.…”

“… Data from Santos et al 93 and Riggioni et al. 98 Ana o , Anacardium occidentale ; Cor a , Corylus avellana ; Pen a , Penaeus aztecus ; SPT, skin prick test . …”

Editorial on the virtual issue “Food allergy”

“…PAI has published several articles in this field, including studies assessing the diagnostic utility of skin prick tests, serum‐specific IgE to whole foods and individual components, and the basophil activation test, either in isolation or combinations of these tests. Further studies have assessed the cost‐effectiveness of combined approaches and reproducibility of the basophil activation test, a diagnostic test suggested by the EAACI for diagnosing peanut and sesame allergy in equivocal cases 23–28 …”

“…Further studies have assessed the cost-effectiveness of combined approaches and reproducibility of the basophil activation test, a diagnostic test suggested by the EAACI for diagnosing peanut and sesame allergy in equivocal cases. [23][24][25][26][27][28] To the horizon, a new birth cohort study, the Systems Biology of Early Atopy SUNBEAM birth cohort, has been developed to prospectively collect a vast amount of biological, clinical, and environmental data from 2500 pregnant women from 12 diverse metropolitan areas for 36 months of infant observation. 29 SUNBEAM even aimed to comprehensively phenotype children with food allergies using genomic, epigenomic, transcriptomic, proteomic, metabolomic, and microbiome analyses.…”