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 and Anaphylaxis Group, Yemisi Takwoingi

Research output: Contribution to journalArticlepeer-review

140 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)76-86
Number of pages11
Issue number1
Publication statusPublished - Jan 2014


  • Food Hypersensitivity
  • Humans
  • Immunoglobulin E
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Skin Tests


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