Abstract:
Background: The European Academy of Allergy and Clinical
Immunology’s (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.
Methods : We searched three databases (Cochrane CENTRAL
(Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy
studies published between 1st October 2012 and
30th 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
combination where 3 or more studies were available.
Results : 149 studies comprising 24,489 patients met the
inclusion criteria and were generally heterogeneous. 60.4% of studies
were in children ≤12 years of age, 54.3% undertaken in Europe, ≥95%
conducted in a specialized pediatric or allergy clinical setting and all
included oral food challenge in at least a percentage of enrolled
patients, in 21.5% DBPCFC. 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 to individual components had high specificity:
Ara h 2 had 92%, Cor a 14 95%, Ana o 3 94%, casein 93%, ovomucoid
92/91% for the diagnosis of peanut, hazelnut, cashew, cow’s milk and
raw/cooked egg allergies, respectively. BAT was highly specific for the
diagnosis of peanut (90%) and sesame (93%) allergies.
Conclusions: 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.
PROSPERO registration: CRD42021259186
Funding: European Academy of Allergy (EAACI).
Keywords : Food allergy, IgE-mediated, diagnosis, diagnostic
tests, skin prick test, specific IgE, component-resolved diagnostics,
basophil activation test, sensitivity, specificity