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The diagnosis of food allergy: a systematic review and meta-analysis

The diagnosis of food allergy: a systematic review and meta-analysis
The diagnosis of food allergy: a systematic review and meta-analysis

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.

atopy patch test, component-specific-IgE, food allergy, skin prick test, specific-IgE
0105-4538
76-86
Soares-Weiser, K.
68a861c3-99cf-4799-aa7e-a8828736d328
Takwoingi, Y.
d0c84b27-6305-404b-89ed-2bd110a569a4
Panesar, S. S.
700bc4a8-400e-42f1-a961-f60a7242e202
Muraro, A.
31a2d167-86e1-4e11-87ad-6ffb7e32cd47
Werfel, T.
257ddb96-94d9-4ed3-8fbf-7b490e3f9efa
Hoffmann-Sommergruber, K.
7b282387-19b5-4d07-bac8-1679f25197b7
Roberts, G.
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Halken, S.
6204ce6f-7b6e-4041-9da2-a5f250467fbb
Poulsen, L.
e39dd3ec-0baf-4273-b663-cc7f20a3a395
Van Ree, R.
4100f8ce-ece6-4ab0-9a4f-e0e862ef078d
Vlieg-Boerstra, B. J.
dc35ae65-880f-4788-b193-d4001acd1446
Sheikh, A.
f34621ac-f425-42fd-81e3-2057b1c9ce2f
Soares-Weiser, K.
68a861c3-99cf-4799-aa7e-a8828736d328
Takwoingi, Y.
d0c84b27-6305-404b-89ed-2bd110a569a4
Panesar, S. S.
700bc4a8-400e-42f1-a961-f60a7242e202
Muraro, A.
31a2d167-86e1-4e11-87ad-6ffb7e32cd47
Werfel, T.
257ddb96-94d9-4ed3-8fbf-7b490e3f9efa
Hoffmann-Sommergruber, K.
7b282387-19b5-4d07-bac8-1679f25197b7
Roberts, G.
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Halken, S.
6204ce6f-7b6e-4041-9da2-a5f250467fbb
Poulsen, L.
e39dd3ec-0baf-4273-b663-cc7f20a3a395
Van Ree, R.
4100f8ce-ece6-4ab0-9a4f-e0e862ef078d
Vlieg-Boerstra, B. J.
dc35ae65-880f-4788-b193-d4001acd1446
Sheikh, A.
f34621ac-f425-42fd-81e3-2057b1c9ce2f

Soares-Weiser, K., Takwoingi, Y., Panesar, S. S., Muraro, A., Werfel, T., Hoffmann-Sommergruber, K., Roberts, G., Halken, S., Poulsen, L., Van Ree, R., Vlieg-Boerstra, B. J. and Sheikh, A. (2014) The diagnosis of food allergy: a systematic review and meta-analysis. Allergy: European Journal of Allergy and Clinical Immunology, 69 (1), 76-86. (doi:10.1111/all.12333).

Record type: Review

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.

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More information

Published date: 1 January 2014
Keywords: atopy patch test, component-specific-IgE, food allergy, skin prick test, specific-IgE

Identifiers

Local EPrints ID: 445940
URI: http://eprints.soton.ac.uk/id/eprint/445940
ISSN: 0105-4538
PURE UUID: 1528d42e-6811-4445-b698-705c3bb09726
ORCID for G. Roberts: ORCID iD orcid.org/0000-0003-2252-1248

Catalogue record

Date deposited: 14 Jan 2021 19:16
Last modified: 15 Sep 2021 01:50

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Contributors

Author: K. Soares-Weiser
Author: Y. Takwoingi
Author: S. S. Panesar
Author: A. Muraro
Author: T. Werfel
Author: K. Hoffmann-Sommergruber
Author: G. Roberts ORCID iD
Author: S. Halken
Author: L. Poulsen
Author: R. Van Ree
Author: B. J. Vlieg-Boerstra
Author: A. Sheikh

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