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

doi:10.1111/all.12333

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

Applied Health Research

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140 Citations (Scopus)

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.

Original language	English
Pages (from-to)	76-86
Number of pages	11
Journal	Allergy
Volume	69
Issue number	1
DOIs	https://doi.org/10.1111/all.12333
Publication status	Published - Jan 2014

Bibliographical note

Keywords

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

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10.1111/all.12333

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Soares-Weiser, K., Takwoingi, Y., Panesar, S. S., Muraro, A., Werfel, T., Hoffmann-Sommergruber, K., Roberts, G., Halken, S., Poulsen, L., van Ree, R., Vlieg-Boerstra, B. J., Sheikh, A., EAACI Food Allergy and Anaphylaxis Group, & Takwoingi, Y. (2014). The diagnosis of food allergy: a systematic review and meta-analysis. Allergy, 69(1), 76-86. https://doi.org/10.1111/all.12333

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title = "The diagnosis of food allergy: a systematic review and meta-analysis",

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.",

keywords = "Food Hypersensitivity, Humans, Immunoglobulin E, Reproducibility of Results, Sensitivity and Specificity, Skin Tests",

author = "K Soares-Weiser and Y Takwoingi and Panesar, {S S} and A Muraro and T Werfel and K Hoffmann-Sommergruber and G Roberts and S Halken and L Poulsen and {van Ree}, R and Vlieg-Boerstra, {B J} and A Sheikh and {EAACI Food Allergy and Anaphylaxis Group} and Yemisi Takwoingi",

note = "{\textcopyright} 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",

year = "2014",

month = jan,

doi = "10.1111/all.12333",

language = "English",

volume = "69",

pages = "76--86",

journal = "Allergy",

issn = "0105-4538",

publisher = "Wiley",

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Soares-Weiser, K, Takwoingi, Y, Panesar, SS, Muraro, A, Werfel, T, Hoffmann-Sommergruber, K, Roberts, G, Halken, S, Poulsen, L, van Ree, R, Vlieg-Boerstra, BJ, Sheikh, A, EAACI Food Allergy and Anaphylaxis Group & Takwoingi, Y 2014, 'The diagnosis of food allergy: a systematic review and meta-analysis', Allergy, vol. 69, no. 1, pp. 76-86. https://doi.org/10.1111/all.12333

TY - JOUR

T1 - The diagnosis of food allergy

T2 - a systematic review and meta-analysis

AU - Soares-Weiser, K

AU - Takwoingi, Y

AU - Panesar, S S

AU - Muraro, A

AU - Werfel, T

AU - Hoffmann-Sommergruber, K

AU - Roberts, G

AU - Halken, S

AU - Poulsen, L

AU - van Ree, R

AU - Vlieg-Boerstra, B J

AU - Sheikh, A

AU - EAACI Food Allergy and Anaphylaxis Group

AU - Takwoingi, Yemisi

PY - 2014/1

Y1 - 2014/1

N2 - 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.

AB - 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.

KW - Food Hypersensitivity

KW - Humans

KW - Immunoglobulin E

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Skin Tests

U2 - 10.1111/all.12333

DO - 10.1111/all.12333

M3 - Article

C2 - 24329961

SN - 0105-4538

VL - 69

SP - 76

EP - 86

JO - Allergy

JF - Allergy

IS - 1

ER -

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

Abstract

Bibliographical note

Keywords

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