On behalf of the EAACI Food Allergy and Anaphylaxis Group: C. A. Akdis, R. Alvarez, K. Beyer, C. Bindslev-Jensen, V. Cardona, P. Demoly, A. Dubois, P. Eigenmann, M. Fernandez Rivas, A. Høst, G. Lack, M. J. Marchisotto, B. Niggemann, C. Nilsson, N. Papadopoulos, I. Skypala, M. Worm.
The diagnosis of food allergy: a systematic review and meta-analysis
Article first published online: 14 DEC 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Special Issue: Atopic dermatitis
Volume 69, Issue 1, pages 76–86, January 2014
How to Cite
on behalf of the EAACI Food Allergy and Anaphylaxis Guidelines Group. The diagnosis of food allergy: a systematic review and meta-analysis. Allergy 2014; 69: 76–86., , , , , , , , , ,
Review registration: PROSPERO registration number CRD42013003707.
Edited by: Pascal Demoly
- Issue published online: 20 JAN 2014
- Article first published online: 14 DEC 2013
- Manuscript Accepted: 24 OCT 2013
- atopy patch test;
- food allergy;
- skin prick test;
We investigated the accuracy of tests used to diagnose food allergy.
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.
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.
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.