Diagnostic evaluation of food-related allergic diseases
John Eckman1, Sarbjit S Saini1 and Robert G Hamilton
Abstract
Food allergy is a serious and potentially life-threatening problem for an estimated 6% of children and 3.7% of adults. This review examines the diagnostic process that begins with a patient's history and physical examination. If the suspicion of IgE-mediated food allergy is compelling based on the history, skin and serology tests are routinely performed to provide confirmation for the presence of food-specific IgE antibody. In selected cases, a provocation challenge may be required as a definitive or gold standard reference test for confirmation of IgE mediated reactions to food. Variables that influence the accuracy of each of the diagnostic algorithm phases are discussed. The clinical significance of food allergen-specific IgE antibody cross-reactivity and IgE antibody epitope mapping of food allergens is overviewed. The advantages and limitations of the various diagnostic procedures are examined with an emphasis on future trends in technology and reagents.
Food allergy is a serious and potentially life-threatening problem for an estimated 6% of children and 3.7% of adults. This review examines the diagnostic process that begins with a patient's history and physical examination. If the suspicion of IgE-mediated food allergy is compelling based on the history, skin and serology tests are routinely performed to provide confirmation for the presence of food-specific IgE antibody. In selected cases, a provocation challenge may be required as a definitive or gold standard reference test for confirmation of IgE mediated reactions to food. Variables that influence the accuracy of each of the diagnostic algorithm phases are discussed. The clinical significance of food allergen-specific IgE antibody cross-reactivity and IgE antibody epitope mapping of food allergens is overviewed. The advantages and limitations of the various diagnostic procedures are examined with an emphasis on future trends in technology and reagents.
Introduction
Approximately 6% of children and 3.7% of adults experience IgE-mediated allergic symptoms following the ingestion of food. This contrasts with approximately 20% of the population that alters their diet for a perceived adverse reaction to food. The allergist has the challenge of accurately identifying immunologically and non-immunologically-mediated reactions in the setting of this perception using information provided by the patient's history, skin and serology testing for food-specific IgE and food challenges.
A number of general issues must be considered when reviewing studies on the diagnosis of food allergy. These considerations include the characteristics of the patientpopulation in individual studies, the instrumentation and interpretation of allergen-specific IgE skin and serology testing and variations in food challenge protocols. This review examines the diagnostic process that begins with a patient's history and physical examination. We will overview considerations involved in skin testing and then focus on specific IgE testing, which has become of paramount importance in both diagnosing and following the natural history of food allergy. We highlight potential problems with the "gold standard" of food allergy diagnosis, the double-blinded, placebo-controlled food challenge.
We then review the importance of considering cross-reactivity in the interpretation of skin testing and specific-IgE testing while discussing new technologies that may help decipher the degree of cross-reactivity. Finally, we mention the experimental studies of food-allergen epitope mapping in predicting the natural history of milk and egg allergy.
DOWNLOAD COMPLETE PDF HERE
Approximately 6% of children and 3.7% of adults experience IgE-mediated allergic symptoms following the ingestion of food. This contrasts with approximately 20% of the population that alters their diet for a perceived adverse reaction to food. The allergist has the challenge of accurately identifying immunologically and non-immunologically-mediated reactions in the setting of this perception using information provided by the patient's history, skin and serology testing for food-specific IgE and food challenges.
A number of general issues must be considered when reviewing studies on the diagnosis of food allergy. These considerations include the characteristics of the patientpopulation in individual studies, the instrumentation and interpretation of allergen-specific IgE skin and serology testing and variations in food challenge protocols. This review examines the diagnostic process that begins with a patient's history and physical examination. We will overview considerations involved in skin testing and then focus on specific IgE testing, which has become of paramount importance in both diagnosing and following the natural history of food allergy. We highlight potential problems with the "gold standard" of food allergy diagnosis, the double-blinded, placebo-controlled food challenge.
We then review the importance of considering cross-reactivity in the interpretation of skin testing and specific-IgE testing while discussing new technologies that may help decipher the degree of cross-reactivity. Finally, we mention the experimental studies of food-allergen epitope mapping in predicting the natural history of milk and egg allergy.
DOWNLOAD COMPLETE PDF HERE
0 comments
Post a Comment