Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy
Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy
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.
basophil activation test, component-resolved diagnostics, diagnosis, diagnostic tests, food allergy, IgE-mediated, sensitivity, skin prick test, specific IgE, specificity
Riggioni, Carmen
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Ricci, Cristian
ae99ca5d-bf84-43ac-9446-618a5ee3fe8e
Moya, Beatriz
c43c8ae3-722d-4cbb-aca9-615cd98a5b99
Wong, Dominic
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Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
27 November 2023
Riggioni, Carmen
da7cc6aa-edde-49df-91ea-4676521d8d30
Ricci, Cristian
ae99ca5d-bf84-43ac-9446-618a5ee3fe8e
Moya, Beatriz
c43c8ae3-722d-4cbb-aca9-615cd98a5b99
Wong, Dominic
774f632f-f775-4412-829f-b7efebbf4b8b
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Riggioni, Carmen, Ricci, Cristian and Moya, Beatriz
,
et al.
(2023)
Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy.
Allergy: European Journal of Allergy and Clinical Immunology.
(doi:10.1111/all.15939).
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.
Text
Allergy - 2023 - Riggioni - Systematic review and meta‐analyses on the accuracy of diagnostic tests for IgE‐mediated food
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Accepted/In Press date: 22 October 2023
Published date: 27 November 2023
Additional Information:
Funding Information: Carmen Riggioni reports research funding from the Spanish Society of Paediatric Allergy and the National University of Singapore. She is an associate editor for PAI journal and a member of the Paediatric Board for the EAACI. Cristian Ricci, Beatriz Moya, Evi van Goor, Dominic Wong, Irene Bartha, Betul Buyuktiryaki, Mattia Giovannini, Sashini Jayasinghe, Hannah Jaumdally, Andreina Marques‐Mejias, Alexander Piletta‐Zanin, Anna Berbenyuk, Margarita Andreeva, Ekaterina Lakovleva and Derek Chu declare no conflicts of interest. Daria Levina reports a grant from the Moscow Health Department for the standardization of oral food challenges in the Russian Federation. Graham Roberts reports research funding from National Institute of Health and Food Standards Agency. He is president of British Society of Allergy and Clinical Immunology. Rachel Peters reports grants from the National Health & Medical Research Council of Australia. George Du Toit reports grants and personal fees from Aimmune, grants and personal fees from DBV, personal fees from FARE, grants from NIH‐NIAID, grants and personal fees from Novartis, outside the submitted work. Isabel Skypala reports honoraria from ThermoFisher, Royal College of General Practitioners and Touch Independent Medical Education. A.F. Santos reports grants from Medical Research Council (MR/M008517/1; MC/PC/18052; MR/T032081/1), FA Research and Education (FARE), the Immune Tolerance Network/National Institute of Allergy and Infectious Diseases (NIAID, NIH), Asthma UK (AUK‐BC‐2015‐01), BBSRC, Rosetrees Trust and the NIHR through the Biomedical Research Centre (BRC) award to Guy's and St Thomas' NHS Foundation Trust, during the conduct of the study; personal fees from Thermo Scientific, Nutricia, Infomed, Novartis, Allergy Therapeutics, Buhlmann, as well as research support from Buhlmann and Thermo Fisher Scientific through a collaboration agreement with King's College London. AFS is associate editor for Allergy, Clinical and Experimental Allergy and Frontiers in Allergy; and Editorial Board member for the Journal of Allergy and Clinical Immunology and Pediatric Allergy and Immunology.
Keywords:
basophil activation test, component-resolved diagnostics, diagnosis, diagnostic tests, food allergy, IgE-mediated, sensitivity, skin prick test, specific IgE, specificity
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Local EPrints ID: 486495
URI: http://eprints.soton.ac.uk/id/eprint/486495
ISSN: 0105-4538
PURE UUID: b240d883-c3e5-4458-8c5b-83b93b9a717a
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Date deposited: 24 Jan 2024 17:45
Last modified: 18 Mar 2024 03:01
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Carmen Riggioni
Author:
Cristian Ricci
Author:
Beatriz Moya
Author:
Dominic Wong
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