Diagnostic accuracy, risk assessment, and cost‐effectiveness of component‐resolved diagnostics for food allergy: A systematic review

Abstract

BackgroundComponent‐resolved diagnostics (CRD) are promising tools for diagnosing food allergy, offering the potential to determine specific phenotypes and to develop patient‐tailored risk profiles. Nevertheless, the diagnostic accuracy of these tests varies across studies; thus, their clinical utility remains unclear. Therefore, we synthesized the evidence from studies investigating the diagnostic accuracy, risk assessment ability, and cost‐effectiveness of CRD for food allergy.MethodsWe systematically searched 10 electronic databases and four clinical trial registries for studies published from January 2000 to February 2017. The quality of included studies was assessed using QUADAS‐2. Due to heterogeneity, we narratively synthesized the evidence.ResultsEleven studies met inclusion criteria, altogether recruiting 1098 participants. The food allergies investigated were cow's milk, hen's egg, peanut, hazelnut, and shrimp. The components with the highest diagnostic accuracy for each allergen, along with their sensitivity‐specificity pairs, were as follows: Bos d 4 for cow's milk (62.0% and 87.5%), Gal d 1 for hen's egg (84.2% and 89.8% for heated egg, and 60.6% and 97.1% for raw egg), Ara h 6 for peanut (94.9% and 95.1%), Cor a 14 for hazelnut (100% and 93.8%), and Lit v 1 for shrimp (82.8% and 56.3%) allergy.ConclusionSelected components of cow's milk, hen's egg, peanut, hazelnut, and shrimp allergen showed high specificity, but lower sensitivity. However, few studies exist for each component, and studies vary widely regarding the cutoff values used, making it challenging to synthesize findings across studies. Further research is needed to determine clinically appropriate cutoff values, risk assessment abilities, and cost‐effectiveness of CRD approaches.

Allergen components in diagnosing childhood hazelnut allergy: Systematic literature review and meta‐analysis

“…This likely reflects the role of storage proteins as early sensitizers and markers of hazelnut allergy . The results presented are the first meta‐analysis data focusing on hazelnut allergen components, but a previous systematic review on CRD in food allergies and studies on peanut and other tree nut allergies (cashew and walnut) together show that the respective 2S albumins have high accuracy in identifying children with allergies and objective symptoms …”

Accuracy of component‐resolved diagnostics in peanut allergy: Systematic literature review and meta‐analysis

“…Moreover, both DBPCFC and open challenges were accepted for defining peanut allergy, as it is acknowledged that DBPCFC are seldom performed in clinical practice. A recent systematic literature review on food components only allowed for DBPCFC as reference standard, resulting in the retrieval of only two studies, and hence, no meta‐analyses could be performed. In this study, we allowed for the inclusion of studies in which some patients were diagnosed as peanut‐allergic based on recent anaphylactic events, and this also ensured the inclusion of severely peanut‐allergic subjects, thus better representing the spectrum of patients suspected of peanut allergy who would present to clinical practice.…”

“…There have been recent attempts to systematically search the literature to summarize the diagnostic accuracy of peanut components through meta‐analyses; however, as too few studies met the inclusion criteria in those reviews, only narrative syntheses were presented. In light of the growing number of studies using CRD in the diagnosis of peanut allergy, we conducted a systematic literature review with the objective of assessing the quality and consistency of evidence that sensitization to components is helpful in reducing both the time to diagnosis and the need for oral food challenges (OFC).…”

Hen’s egg allergy: an update

“…По данным исследований, в США аллергия к яйцу диагностируется у 1% детей в возрасте от 0-2 лет Обзоры и лекции АЛЛЕРГЕНЫ КУРИНОГО ЯЙЦА В настоящее время в клиническую практику все более широко входит изучение сенсибилизации к тем или иным продуктам и (или) аллергенам с помощью компонентной аллергодиагностики. Так, с позиций молекулярной аллергологии в составе продуктов может содержаться множество белковых компонентов, способных вызывать развитие аллергических реакций [5,[17][18][19]. При ýтом сенсибилизация к каждому структурному компоненту имеет разную клиническую значимость, что обусловлено различными физико-химическими свойствами молекул: устойчивостью к термической обработке, воздействию пищеварительных ферментов [5,18,19].…”

“…Основным источником аллергенов считается белок куриного яйца. В желтке также описаны IgE-связывающие аллергены, но они обладают значительно меньшей клинической значимостью [5,19]. В яичном белке находится более 30 белковых компонентов, основными из которых являются овальбумин, кональбумин, овомукоид, лизоцим (табл.…”