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

K. Soares-Weiser, Y. Takwoingi, S. S. Panesar, A. Muraro, T. Werfel, K. Hoffmann-Sommergruber, G. Roberts, S. Halken, L. Poulsen, R. van Ree, B. J. Vlieg-Boerstra, A. Sheikh, EAACI Food Allergy Anaphylaxis Gui

Research output: Contribution to journalArticlepeer-review

Abstract

BackgroundWe investigated the accuracy of tests used to diagnose food allergy.

MethodsSkin 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.

ResultsTwenty-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.

ConclusionsThe 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.

Original languageEnglish
Pages (from-to)76-86
Number of pages11
JournalAllergy
Volume69
Issue number1
DOIs
Publication statusPublished - 14 Dec 2013

Keywords

  • atopy patch test
  • component-specific-IgE
  • food allergy
  • skin prick test
  • specific-IgE
  • SKIN PRICK TESTS
  • PEANUT-SENSITIZED CHILDREN
  • ATOPY PATCH TEST
  • EGG-SPECIFIC IGE
  • DOUBLE-BLIND
  • HAZELNUT ALLERGY
  • PREDICTIVE-VALUE
  • HENS EGG
  • CHALLENGES
  • DERMATITIS

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