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

Authors

  • K. Soares-Weiser,

    1. Enhance Reviews Ltd, Wantage, UK
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  • Y. Takwoingi,

    1. Public Health Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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  • S. S. Panesar,

    1. Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
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  • A. Muraro,

    1. Department of Pediatrics, Center for Food Allergy Diagnosis and Treatment, Veneto Region, University of Padua, Padua, Italy
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  • T. Werfel,

    1. Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
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  • K. Hoffmann-Sommergruber,

    1. Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
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  • G. Roberts,

    1. David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK
    2. NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
    3. Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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  • S. Halken,

    1. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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  • L. Poulsen,

    1. Laboratory of Medical Allergology, Allergy Clinic, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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  • R. van Ree,

    1. Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
    2. Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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  • B. J. Vlieg-Boerstra,

    1. Department of Pediatric Respiratory Medicine and Allergy, Academic Medical Center, Emma Children's Hospital, Amsterdam, the Netherlands
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  • A. Sheikh,

    Corresponding author
    1. Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
    2. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
    • Correspondence

      Aziz Sheikh, MD, FRCGP, FRCP, FRCPE, Director, Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Doorway 3, Teviot Place, Edinburgh EH8 9AG, UK.

      Tel.: +44 (0)131 651 4151

      Fax: +44 (0)131 650 9119

      E-mail: aziz.sheikh@ed.ac.uk

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  • and on behalf of the EAACI Food Allergy and Anaphylaxis Guidelines Group

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    • 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.

  • Review registration: PROSPERO registration number CRD42013003707.
  • Edited by: Pascal Demoly

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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