Details

Autor(en) / Beteiligte

• Brettig, Tim
• Koplin, Jennifer J.
• Dang, Thanh
• Lange, Lars
• McWilliam, Vicki
• Sato, Sakura
• Savvatianos, Savvas
• Perrett, Kirsten P.

Titel

Cashew allergy diagnosis: A two-step algorithm leads to fewer oral food challenges

Ist Teil von

• The journal of allergy and clinical immunology in practice (Cambridge, MA), 2022-06, Vol.10 (6), p.1652-1654.e2

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2022

Quelle

MEDLINE

Beschreibungen/Notizen

• Oral food challenges provide a definitive diagnosis of food allergy but are limited in availability and are expensive and labor-intensive.1 Specific IgE to cashew nut component Ana o 3 is a potential tool to improve cashew allergy diagnosis.2 A two-step diagnostic algorithm using cashew sIgE followed by Ana o 3 may lead to more efficient use of OFCs compared with cashew SPT alone. Six relevant studies were identified through a systematic review searching four databases (Ovid Medline, Embase, Cochrane Library, and PubMed) for studies reporting sensitivity, specificity, positive predictive value (PPV), and negative predictive value for diagnostic tests (SPT and sIgE to cashew or Ana o 3) for cashew allergy diagnosis.7 All studies had, or provided upon request, individual patient results for SPT, or paired sIgE to cashew and Ana o 3, as well as OFC outcomes or a clear clinical history of reaction or tolerance to cashew. The two-step algorithm (sIgE cashew/Ana o 3), included 271 participants (57.6% allergic and 42.4% tolerant).2,6,8,9 Up to 11.4% of participants required an OFC to determine their allergy status, a reduction of 80.4% compared with the SPT pathway. [...]74.5% required Ana o 3 to be performed. [...]research including a cost-reduction analysis of these pathways is needed.Online Repository Diagnostic pathway Allergic participants, n (%) Participants requiring oral food challenge Correct diagnosis False positive False negative Cashew skin prick test 567 (34.9%) 58.4% 97.2% 0.5% 2.3% Two-step algorithm (sIgE cashew/Ana o3) 271 (57.6%) 11.4% 91.1% 8.1% 1.1% sIgE Ana o3 271 (57.6%) 12.2% 91.9% 7.0% 1.1% sIgE Cashew 271 (57.6%) 74.5% 98.2% 1.5% 0.4% Table I Outcomes of each cashew allergy diagnostic pathway Author SPT pathway Serum IgE pathways (to cashew and Ana o 3) McWilliam Elizur Lange Sato Savvatianos Dang Year published 2020 2018 2017 2019 2015 2021 Data collection years 2011-2016 2016-2017 — 2010-2016 2010-2012 2012-2015 Population Retrospective and population cohorts Outpatient Outpatient Outpatient Outpatient Population Country Australia Israel Germany Japan Greece Australia Reference standard Open OFC or clinical history Open OFC or clinical history Double-blinded, placebo-controlled OFC or clinical history Open OFC Open OFC or clinical history Open OFC or clinical history Age, y Mean (population cohort) 7.2; – mean (outpatient cohort) 7.9; – 8.7; range, 3-24 Allergic 3.8; interquartile range, 2.2-6.3; tolerant 6.7; interquartile range, 3.5-13.2 7; range, 2-26 Allergic 6.5; range, 4.1-9.1; tolerant 9.8; range, 5.8-13.3 Allergic 5.2; SD, 1.1; tolerant 4.6; SD, 0.8 Participants; % allergic (95% confidence interval) 505; 33.1% (29.0-37.2) 62, 50% (37.6-62.5%) 61; 68.9% (57.2-80.5) 63; 27.0% (16.0-37.9) 99; 63.6% (54.2-73.1) 48; 70.8% (57.9-83.7) Coexisting food allergy 60.1% — 57.4% — 72.6% 59.6% Eczema 54.8% 37.3% 49.2% — 67.4% 40.4% Asthma 50.8% 39.8% 16.9% 39.7% 32.6% 53.2% Allergic rhinitis 39.0% - 30.5% - 34.7% 27.7% Diagnostic test reported Cashew SPT Cashew SPT sIgE cashew; sIgE Ana o 3 sIgE cashew; sIgE Ana o 3 sIgE cashew; sIgE Ana o 3