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.

• Authors: K Soares-Weiser, Y Takwoingi, S S Panesar, A Muraro, T Werfel, K Hoffmann-Sommergruber, G Roberts, S Halken, L Poulsen, R van Ree, B J Vlieg-Boerstra, A Sheikh, EAACI Food Allergy and Anaphylaxis Guidelines Group
• Journal: Allergy (Allergy) Vol. 69 Issue 1 Pg. 76-86 (Jan 2014) ISSN: 1398-9995 [Electronic] Denmark
• PMID: 24329961 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Immunoglobulin E

Topics

• Food Hypersensitivity (diagnosis, immunology)
• Humans
• Immunoglobulin E (immunology)
• Reproducibility of Results
• Sensitivity and Specificity
• Skin Tests