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.

• Authors: Carmen Riggioni, Cristian Ricci, Beatriz Moya, Dominic Wong, Evi van Goor, Irene Bartha, Betul Buyuktiryaki, Mattia Giovannini, Sashini Jayasinghe, Hannah Jaumdally, Andreina Marques-Mejias, Alexandre Piletta-Zanin, Anna Berbenyuk, Margarita Andreeva, Daria Levina, Ekaterina Iakovleva, Graham Roberts, Derek Chu, Rachel Peters, George du Toit, Isabel Skypala, Alexandra F Santos
• Journal: Allergy (Allergy) (Nov 27 2023) ISSN: 1398-9995 [Electronic] Denmark
• PMID: 38009299 (Publication Type: Journal Article, Review)
• Copyright: © 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.