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Kate A, Shanbhag SS, Gattu J, Basu S. Allergen Testing: A Review of the Indications, Procedures, and Limitations in Ocular Allergy. Clin Rev Allergy Immunol 2024:10.1007/s12016-024-09002-5. [PMID: 39276294 DOI: 10.1007/s12016-024-09002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/16/2024]
Abstract
Allergen-based diagnostics are essential in the management algorithm of allergic diseases. Unlike systemic allergy, where the indications and interpretation of these diagnostic modalities are well established, their utility in ocular allergy is not well-defined. With the rising prevalence of ocular allergies and the need for personalized treatment strategies, there is a growing demand for precision allergen diagnostics. This review describes the commonly used tests with their indications, procedures, and limitations. A review of the literature was carried out on articles on allergen diagnostics in ocular allergy, and after excluding articles that were not relevant, 82 papers were included in the current review. IgE-mediated pathways contribute significantly to seasonal and perennial ocular allergy and partly to vernal keratoconjunctivitis. Most diagnostic techniques aim to detect IgE sensitization. In vivo tests include skin prick (SPT), intradermal, and patch tests. SPT is considered the gold standard and directly evaluates the presence of allergen-specific IgE in the skin. In vitro tests measure total and specific IgE from either tears or sera. Tear IgE measurement is relatively specific for allergic conjunctivitis and can provide insight into the potential allergens responsible for local sensitization. The conjunctival provocation test can help establish true allergy, especially in patients with polysensitization. This review also provides an overview of evidence in literature segregated based on the test employed. This includes 17 studies on only SPT; 42 studies on IgE measured in serum, tears, or both; and 20 studies which have evaluated both SPT and IgE. The pattern of allergen sensitization can guide recommendations for avoidance measures and immunotherapy. Thus, this could create a corticosteroid-sparing therapy avenue in these patients, reducing disease severity and resulting visual morbidity.
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Affiliation(s)
- Anahita Kate
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India.
| | - Swapna S Shanbhag
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jyothirmai Gattu
- Academy for Eye Care Education, LV Prasad Eye Institute, Hyderabad, India
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India
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Cacheiro-Llaguno C, Mösges R, Calzada D, González-de la Fuente S, Quintero E, Carnés J. Polysensitisation is associated with more severe symptoms: The reality of patients with allergy. Clin Exp Allergy 2024; 54:607-620. [PMID: 38676405 DOI: 10.1111/cea.14486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Studying the sensitisation profiles of patients with allergies allows for a deeper understanding of the disease which may facilitate the selection of the best-personalised allergen immunotherapy. This observational, cross-sectional, multicentre study aimed to demonstrate the heterogeneity of the German population with allergies by analysing specific immunoglobulin E (sIgE) patterns towards aeroallergens and exploring the relationship between sensitisation and clinical symptoms. METHODS In total, 500 patients with allergies from different regions of Germany were recruited based on their case histories, clinical allergic symptoms and skin prick test data for aeroallergens. Serum samples were analysed using ImmunoCAP assays to determine sIgE levels for 33 allergenic sources and 43 molecular allergens. RESULTS Most patients (81%) were polysensitised. Betula verrucosa pollen was the most common cause of sensitisation (59%), followed by Phleum pratense (58%) and Dermatophagoides pteronyssinus (44%). The highest prevalence rates of molecular allergens were observed for Bet v 1 (84%) from birch pollen, Phl p 1 from grass pollen (82%), Der p 2 (69%) from mites and Fel d 1 (69%) from cat. Polysensitisation was significantly associated with the presence of asthma and the severity of rhinitis symptoms. CONCLUSIONS Our findings show a high rate of polysensitisation and emphasise the importance of molecular diagnosis for more precise and comprehensive insights into sensitisation patterns and their association with clinical symptoms. These data may help improve personalised diagnosis and immunotherapy adapted to the needs of individual patients in the region.
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Affiliation(s)
| | - Ralph Mösges
- IMSB, Faculty of Medicine, University of Cologne, Cologne, Germany
- ClinCompetence Cologne GmbH, Cologne, Germany
| | - David Calzada
- R&D Allergy and Immunology Unit, LETI Pharma, Madrid, Spain
| | | | - Eliana Quintero
- IMSB, Faculty of Medicine, University of Cologne, Cologne, Germany
- Praxis Dr. Kasche und Kollegen, Hamburg, Germany
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Warner JO. Ockham's Razor: The Application of Parsimonious Medicine in Allergy/Immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1150-1152. [PMID: 38316183 DOI: 10.1016/j.jaip.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
The spectacular advances of modern medicine have distracted clinicians from applying the age-old principles of thorough history and examination followed by only ordering tests relevant to the patient's presentation. The most obvious diagnosis is the most likely and should be addressed first. Ockham's razor, or parsimonious medicine, should be applied because plurality of diagnoses is less likely than a single explanation. Component-resolved diagnostics and biological therapies for allergy/immune-mediated diseases have been highly effective when used by specialist allergy services. However, they are accessed too easily and frequently, either before diagnostically appropriate allergy skin testing and challenge have been employed or before the reasons for poor disease control have been investigated. The current fashion to test for vitamin D insufficiency in patients with poorly controlled allergic diseases has rarely achieved benefit but significantly increased costs. There are considerable health/economic benefits from following the proven value of a thorough clinical history, examination, focused allergy/immunology testing, and the judicious use of Ockham's razor.
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Affiliation(s)
- John O Warner
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; Department of Paediatrics, University of Cape Town, Cape Town, South Africa.
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Kallen EJJ, Revers A, Fernández-Rivas M, Asero R, Ballmer-Weber B, Barreales L, Belohlavkova S, de Blay F, Clausen M, Dubakiene R, Ebisawa M, Fernández-Perez C, Fritsche P, Fukutomi Y, Gislason D, Hoffmann-Sommergruber K, Jedrzejczak-Czechowicz M, Knulst AC, Kowalski ML, Kralimarkova T, Lidholm J, Metzler C, Mills ENC, Papadopoulos NG, Popov TA, Purohit A, Reig I, Seneviratne SL, Sinaniotis A, Takei M, Versteeg SA, Vassilopoulou AE, Vieths S, Welsing PMJ, Zwinderman AH, Le TM, Van Ree R. A European-Japanese study on peach allergy: IgE to Pru p 7 associates with severity. Allergy 2023; 78:2497-2509. [PMID: 37334557 DOI: 10.1111/all.15783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Pru p 3 and Pru p 7 have been implicated as risk factors for severe peach allergy. This study aimed to establish sensitization patterns to five peach components across Europe and in Japan, to explore their relation to pollen and foods and to predict symptom severity. METHODS In twelve European (EuroPrevall project) and one Japanese outpatient clinic, a standardized clinical evaluation was conducted in 1231 patients who reported symptoms to peach and/or were sensitized to peach. Specific IgE against Pru p 1, 2, 3, 4 and 7 and against Cup s 7 was measured in 474 of them. Univariable and multivariable Lasso regression was applied to identify combinations of parameters predicting severity. RESULTS Sensitization to Pru p 3 dominated in Southern Europe but was also quite common in Northern and Central Europe. Sensitization to Pru p 7 was low and variable in the European centers but very dominant in Japan. Severity could be predicted by a model combining age of onset of peach allergy, probable mugwort, Parietaria pollen and latex allergy, and sensitization to Japanese cedar pollen, Pru p 4 and Pru p 7 which resulted in an AUC of 0.73 (95% CI 0.73-0.74). Pru p 3 tended to be a risk factor in South Europe only. CONCLUSIONS Pru p 7 was confirmed as a significant risk factor for severe peach allergy in Europe and Japan. Combining outcomes from clinical and demographic background with serology resulted in a model that could better predict severity than CRD alone.
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Affiliation(s)
- E J J Kallen
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A Revers
- Epidemiology and Data Science (EDS), Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands
| | - M Fernández-Rivas
- Department of Allergy, Hospital Clinico San Carlos, Universidad Complutense, IdISSC, ARADyAL, Madrid, Spain
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
- Faculty of Medicine, University of Zürich, Zürich, Switzerland
- Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - L Barreales
- Department of Allergy, Hospital Clinico San Carlos, Universidad Complutense, IdISSC, ARADyAL, Madrid, Spain
| | - S Belohlavkova
- Medical Faculty Pilsen, Charles University Prague, Prague, Czech Republic
| | - F de Blay
- Allergy Division, Chest Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - M Clausen
- Landspitali University Hospital, University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - R Dubakiene
- Clinic of Chest diseases, Allergology and Immunology Institute of Clinic al Medicine Medical Faculty Vilnius University, Vilnius, Lithuania
| | - M Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - C Fernández-Perez
- Servicio de Medicina Preventiva, Area De Santiago de Compostela y Barbanza, Instituto de Investigación Sanitaria de Santiago (IDIS) A Coruña, Santiago, Spain
| | - P Fritsche
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - Y Fukutomi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - D Gislason
- Landspitali University Hospital, University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - K Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - M Jedrzejczak-Czechowicz
- Department of Immunology and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - A C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M L Kowalski
- Department of Immunology and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - T Kralimarkova
- Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - J Lidholm
- Thermo Fisher Scientific, Uppsala, Sweden
| | - C Metzler
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - E N C Mills
- Division of Infection, Immunity and Respiratory Medicine, Manchester Institute of Biotechnology & Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - T A Popov
- Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - A Purohit
- Allergy Division, Chest Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - I Reig
- Allergist and Pediatrician, Nápoles y Sicilia Health Center, Valencia, Spain
| | - S L Seneviratne
- Institute of Immunity and Transplantation, University College London, London, UK
| | - A Sinaniotis
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - M Takei
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - S A Versteeg
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A E Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - S Vieths
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - P M J Welsing
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A H Zwinderman
- Epidemiology and Data Science (EDS), Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands
| | - T M Le
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R Van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Özuygur Ermis SS, Norouzi A, Borres MP, Basna R, Ekerljung L, Malmhäll C, Goksör E, Wennergren G, Rådinger M, Lötvall J, Kankaanranta H, Nwaru BI. Sensitization patterns to cat molecular allergens in subjects with allergic sensitization to cat dander. Clin Transl Allergy 2023; 13:e12294. [PMID: 37632243 PMCID: PMC10422092 DOI: 10.1002/clt2.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The use of molecular allergology has increasingly become common in the diagnosis and management of allergic diseases. However, there is still a lack of data on cat molecular allergens in adults. Therefore, we aimed to uncover the sensitization patterns to cat molecular allergens. METHODS Participants were recruited from the West Asthma Sweden Study, a population-based study enriched with asthma subjects aged 16-75 years. Of 1872, 361 individuals were positive for cat dander immunoglobulin E and were further analysed for cat molecular allergens (Fel d 1/2/4/7). Sensitization patterns were classified as monosensitization, polysensitization, and concomitant sensitization, and were related to demographic and clinical measurements. RESULTS Among cat-sensitized subjects, 84.2% were sensitized to secretoglobin, while 42.4% were sensitized to lipocalins. Nearly half of the subjects were monosensitized to Fel d 1. Polysensitization was observed in 20.2%, and concomitant sensitization to protein families was seen in 7.2%. Asthma prevalence, cat exposure, and rural living were associated with poly- and concomitant sensitization to protein families. Concomitant sensitization to single allergens was more common in those with asthma than in those without, while concomitant sensitization to both Fel d 1 and Fel d 4 was the most common pattern in individuals with asthma. Sensitization patterns also differed according to cat ownership and the degree of urbanization. CONCLUSION Sensitization to molecular allergens was observed in 90.9% of cat-sensitized subjects and showed variations across participants' background characteristics and the presence of asthma. Identification of sensitization patterns to cat allergens might provide better characterization of cat-allergic subjects.
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Affiliation(s)
- Saliha Selin Özuygur Ermis
- Krefting Research CentreInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | | | - Magnus P. Borres
- ImmunoDiagnosticsThermo Fisher ScientificUppsalaSweden
- Department of Maternal and Child HealthUppsala UniversityUppsalaSweden
| | - Rani Basna
- Krefting Research CentreInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Linda Ekerljung
- Krefting Research CentreInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Carina Malmhäll
- Krefting Research CentreInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Emma Goksör
- Department of PediatricsQueen Silvia Children's HospitalUniversity of GothenburgGothenburgSweden
| | - Göran Wennergren
- Department of PediatricsQueen Silvia Children's HospitalUniversity of GothenburgGothenburgSweden
| | - Madeleine Rådinger
- Krefting Research CentreInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Jan Lötvall
- Krefting Research CentreInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Hannu Kankaanranta
- Krefting Research CentreInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Faculty of Medicine and Life SciencesUniversity of TampereTampereFinland
- Department of Respiratory MedicineSeinäjoki Central HospitalSeinäjokiFinland
| | - Bright I. Nwaru
- Krefting Research CentreInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Wallenberg Centre for Molecular and Translational MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
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Lecolant S, Khelifi D, Neukirch C, Taillé C, Chabane H, Giboury Lafarge S, Sève E, Pham Thi N, Epstein M, Chollet Martin S, Nicaise Roland P. Comparaison des performances diagnostiques de deux biopuces IgE : ISAC® et ALEX2®. REVUE FRANÇAISE D'ALLERGOLOGIE 2023. [DOI: 10.1016/j.reval.2023.103289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Panaitescu C, Haidar L, Buzan MR, Grijincu M, Spanu DE, Cojanu C, Laculiceanu A, Bumbacea R, Agache IO. Precision medicine in the allergy clinic: the application of component resolved diagnosis. Expert Rev Clin Immunol 2022; 18:145-162. [PMID: 35078387 DOI: 10.1080/1744666x.2022.2034501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A precise diagnosis is key for the optimal management of allergic diseases and asthma. In vivo or in vitro diagnostic methods that use allergen extracts often fail to identify the molecules eliciting the allergic reactions. AREAS COVERED Component-resolved diagnosis (CRD) has solved most of the limitations of extract-based diagnostic procedures and is currently valuable tool for the precision diagnosis in the allergy clinic, for venom and food allergy, asthma, allergic rhinitis, and atopic dermatitis. Its implementation in daily practice facilitates: a) the distinction between genuine multiple sensitizations and cross-reactive sensitization in polysensitized patients; b) the prediction of a severe, systemic reaction in food or insect venom allergy; c) the optimal selection of allergen immunotherapy based on the patient sensitization profile. This paper describes its main advantages and disadvantages, cost-effectiveness and future perspectives. EXPERT OPINION The diagnostic strategy based on CRD is part of the new concept of precision immunology, which aims to improve the management of allergic diseases.
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Affiliation(s)
- Carmen Panaitescu
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | - Laura Haidar
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
| | - Maria Roxana Buzan
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | - Manuela Grijincu
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | | | - Catalina Cojanu
- Transylvania University Brasov - Faculty of Medicine, Brasov
| | | | - Roxana Bumbacea
- Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
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Genuneit J, Jayasinghe S, Riggioni C, Peters RL, Chu DK, Munblit D, Boyle RJ, Du Toit G, Skypala I, Santos AF. Protocol for a systematic review of the diagnostic test accuracy of tests for IgE-mediated food allergy. Pediatr Allergy Immunol 2022; 33:e13684. [PMID: 34674299 DOI: 10.1111/pai.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of updating the guidelines on the diagnosis and management of food allergy. The existing guidelines are based on a systematic review of the literature until 30 September 2012. Therefore, a new systematic review must be undertaken to inform the new guidelines. This systematic review aims to assess the accuracy of index tests to support the diagnosis of IgE-mediated food allergy. METHODS The databases Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID) will be searched for diagnostic test accuracy studies from 1 October 2012 to 30 June 2021. Inclusion and exclusion criteria will be used to select appropriate studies. Data from these studies will be extracted and tabulated, and then reviewed for risk of bias and applicability using the QUADAS-2 tool. All evaluations will be done in duplicate. Studies with a high risk of bias and low applicability will be excluded. Meta-analysis will be performed if there are three or more studies of the same index test and food. RESULTS A protocol for the systematic review and meta-analyses is presented and was registered using Prospero prior to commencing the literature search. DISCUSSION Oral food challenges are the reference standard for diagnosis but involve considerable risks and resources. This protocol for systematic review aims to assess the accuracy of various tests to diagnose food allergy, which can be useful in both clinical and research settings.
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Affiliation(s)
- Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sashini Jayasinghe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Carmen Riggioni
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore city, Singapore
| | - Rachel Louise Peters
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Derek K Chu
- Department of Medicine and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Robert J Boyle
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - George Du Toit
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, UK
| | - Isabel Skypala
- Department of Allergy and Clinical Immunology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alexandra F Santos
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
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