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Systematic Review and Meta-Analyses on the Accuracy of Diagnostic Tests for IgE-Mediated Food Allergy

Riggioni, Carmen, Ricci, Cristian, Moya, Beatriz, Wong, Dominic, van Goor, Evi, Bartha, Irene, Buyuktiryaki, Betul, Giovannini, Mattia, Jayasinghe, Sashini, Jaumdally, Hannah, Marques‐Mejias, Andreina, Piletta‐Zanin, Alexandre, Berbenyuk, Anna, Andreeva, Margarita, Levina, Daria, Iakovleva, Ekaterina, Roberts, Graham, Chu, Derek, Peters, Rachel, du Toit, George, Skypala, Isabel, Santos, Alexandra F.·2024·Allergy
DOI 10.1111/all.15939

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Abstract

The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta‐analyses to assess the accuracy of diagnostic tests for IgE‐mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta‐analyses were undertaken for food‐test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double‐blind placebo‐controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2‐sIgE had 92%, Cor a 14‐sIgE 95%, Ana o 3‐sIgE 94%, casein‐sIgE 93%, ovomucoid‐sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies.

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FIGURE 1 Flow chart of the identification and screening of studies to be included in the systematic literature review and meta-­ analyses of studies about the accuracy of diagnostic tests for IgE-­ mediated FA according to the Preferred Reporting Items for Systematic Reviews and Meta-­ analysis (PRISMA). **No automatization tools used. From: Ref. [ 13].
FIGURE 1 Flow chart of the identification and screening of studies to be included in the systematic literature review and meta-­ analyses of studies about the accuracy of diagnostic tests for IgE-­ mediated FA according to the Preferred Reporting Items for Systematic Reviews and Meta-­ analysis (PRISMA). **No automatization tools used. From: Ref. [ 13].CC-BY-NC · From the PDF
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TABLE 2 Estimates of the accuracy of diagnostic tests for IgE-­ mediated FA using reported optimal cut-­ off points.
TABLE 2 Estimates of the accuracy of diagnostic tests for IgE-­ mediated FA using reported optimal cut-­ off points.CC-BY-NC · From the PDF
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FIGURE 3 Forrest plots with sensitivity and specificity for the individual tests for the different foods (A: peanut, B: hen's egg, C: cow's milk, D: hazelnut, E: cashew nut, F: walnut G: sesame, H: soy, I: wheat, J: shrimp) For a test-­ food combination to be included in the meta-­ analyses, there needed to be a minimum of three studies. Data for hen's egg are showed separately for raw, cooked and baked egg allergies. Data for the cow's milk studies refer to fresh milk allergy.
FIGURE 3 Forrest plots with sensitivity and specificity for the individual tests for the different foods (A: peanut, B: hen's egg, C: cow's milk, D: hazelnut, E: cashew nut, F: walnut G: sesame, H: soy, I: wheat, J: shrimp) For a test-­ food combination to be included in the meta-­ analyses, there needed to be a minimum of three studies. Data for hen's egg are showed separately for raw, cooked and baked egg allergies. Data for the cow's milk studies refer to fresh milk allergy.CC-BY-NC · From the PDF
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Image 13
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FIGURE 5 Accuracy of diagnostic tests for IgE-­ mediated FA according to geographical region. Abbreviations: sIgE, specific IgE; Ara h 2, Ara h 2-­ specific IgE; SPT, skin prick test.
FIGURE 5 Accuracy of diagnostic tests for IgE-­ mediated FA according to geographical region. Abbreviations: sIgE, specific IgE; Ara h 2, Ara h 2-­ specific IgE; SPT, skin prick test.CC-BY-NC · From the PDF
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Metadata

Authors
Riggioni, C., Ricci, C., Moya, B., Wong, D., van Goor, E., Bartha, I., Buyuktiryaki, B., Giovannini, M., Jayasinghe, S., Jaumdally, H., Marques‐Mejias, A., Piletta‐Zanin, A., Berbenyuk, A., Andreeva, M., Levina, D., Iakovleva, E., Roberts, G., Chu, D., Peters, R., du Toit, G., Skypala, I., & Santos, A. F.
Affiliations
  • Department of Paediatrics, Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
  • Africa Unit for Transdisciplinary Health Research (AUTHeR) North‐WEst University Potchefstroom South Africa
  • Department of Allergy Hospital Universitario 12 de Octubre Madrid Spain
  • Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK
  • Division of Pediatric Allergy, Department of Pediatrics Koc University School of Medicine Istanbul Turkey
  • Allergy Unit Meyer Children's Hospital IRCCS Florence Italy
  • Division of Pediatric Specialties, Department of Women, Children and Adolescents Geneva University Hospitals Geneva Switzerland
  • Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health Sechenov First Moscow State Medical University (Sechenov University) Moscow Russia
  • Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine University of Southampton Southampton UK
  • Department of Medicine McMaster University Hamilton Ontario Canada
  • Murdoch Children's Research Institute Melbourne Melbourne Victoria Australia
  • National Heart & Lung Institute, Imperial College London London UK
ORCID
Venue
Allergy
Publisher
Wiley
Published
2023-11-27
Volume
79
Issue
2
Pages
324-352
ISSN
  • 0105-4538
  • 1398-9995
DOI
10.1111/all.15939
Cited by
144
References
5
Language
en
Licence
creativecommons.org/licenses/by-nc/4.0/ (vor)
Funders
European Academy of Allergy and Clinical Immunology

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Riggioni, C., Ricci, C., Moya, B., Wong, D., van Goor, E., Bartha, I., Buyuktiryaki, B., Giovannini, M., Jayasinghe, S., Jaumdally, H., Marques‐Mejias, A., Piletta‐Zanin, A., Berbenyuk, A., Andreeva, M., Levina, D., Iakovleva, E., Roberts, G., Chu, D., Peters, R., . . . Santos, A. F. (2024). Systematic Review and Meta-Analyses on the Accuracy of Diagnostic Tests for IgE-Mediated Food Allergy. Allergy. https://doi.org/10.1111/all.15939