Abstract
The diagnosis of food allergy can have a major impact on the lives of patients and families, imposing dietary restrictions and limitations on social activities. On the other hand, misdiagnosis can place the patient at risk of a potentially severe allergic reaction. Therefore, an accurate diagnosis of food allergy is of utmost importance. The diagnosis of food allergy is often established by the combination of the clinical history and allergen-specific IgE; however, without a clear history of an allergic reaction, the interpretation of IgE sensitization tests can be difficult. There are also rare cases of clinical food allergy in the absence of IgE sensitization. For that reason, testing for suspected food allergy ideally requires access to oral food challenges (OFCs), which are currently the gold standard tests to diagnose food allergy. As OFCs are time consuming and involve the risk of acute allergic reactions of unpredictable severity, the question remains: how can we improve the accuracy of diagnosis before referring the patient for an OFC? Herein, we review the predictive value of different tests used to support the diagnosis of food allergy, discuss implications for therapy and prognosis, and propose a diagnostic approach to be applied in clinical practice.
Highlights
As oral food challenges (OFCs) are time consuming and involve the risk of acute allergic reactions of unpredictable severity, the question remains: how can we improve the accuracy of diagnosis before referring the patient for an OFC? we review the predictive value of different tests used to support the diagnosis of food allergy, discuss implications for therapy and prognosis, and propose a diagnostic approach to be applied in clinical practice
The basophil activation test (BAT) to peanut and hazelnut have showed higher diagnostic accuracy when compared with specific IgE (sIgE) to the respective components, namely Ara h 2 and Cor a 9/Cor a 14.10,72 In the Pronuts study, BAT to Ara h 2 had higher diagnostic accuracy than BAT to peanut, and in a Dutch study, stimulating the basophils with both Ara h 2 and Ara h 6 increased the sensitivity of the BAT to 79% from 72% for Ara h 2 alone and from 74% for Ara h 6 alone,[73] suggesting that the combined use of individual allergens and the BAT could lead to a better diagnostic tool for peanut allergy
If the combination of clinical history, skin prick test (SPT), and sIgE and/or IgE component testing including positive predictive value (PPV) cutoffs is suggestive of a high posttest probability of a reaction occurring, an OFC is unlikely to be recommended to confirm the diagnosis as the risk of reacting would be high and unlikely to change the management of the patient
Summary
Abbreviations used BAT- Basophil activation test CMA- Cow’s milk allergy CRD- Component-resolved diagnostics EPIT- Epicutaneous immunotherapy LBA- Luminex-based assay LTP- Lipid-transfer protein MAT- Mast cell activation test NPV- Negative predictive value OFC- Oral food challenge OIT- Oral immunotherapy PPV- Positive predictive value ROC- Receiver operating characteristic sIgE- Specific IgE SPT- Skin prick test. The diagnosis of food allergy is often established by the combination of the clinical history and allergen-specific IgE; without a clear history of an allergic reaction, the interpretation of IgE sensitization tests can be difficult. The diagnosis of food allergy can have a major impact on the lives of patients and their families, imposing dietary restrictions and often limitations on social and family activities. The diagnosis is often established by the combination of the history and allergen-specific IgE; without a clear history of an allergic reaction, the interpretation of IgE sensitization tests can be difficult. As OFCs are time consuming and involve the risk of acute allergic reactions of unpredictable severity, the question remains: how can we improve the accuracy of diagnosis before referring the patient for an OFC?
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