Diagnostic utility of allergy tests to predict baked egg and lightly cooked egg allergies compared to double-blind placebo-controlled food challenges.
baked egg allergy
basophil activation test
diagnosis
egg allergy
food allergy
ovalbumin
skin prick test
specific IgE
Journal
Allergy
ISSN: 1398-9995
Titre abrégé: Allergy
Pays: Denmark
ID NLM: 7804028
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
17
04
2023
received:
23
02
2023
accepted:
14
05
2023
medline:
4
9
2023
pubmed:
7
7
2023
entrez:
7
7
2023
Statut:
ppublish
Résumé
Double-blind placebo-controlled food challenges (DBPCFC) are the gold-standard to diagnose food allergy. However, they can cause allergic reactions of unpredictable severity. We assessed accuracy of current and new diagnostic tests compared to DBPCFC to baked egg (BE) and to lightly cooked egg (LCE). Children aged 6 months to 15 years were assessed for possible egg allergy as part of the BAT2 study (NCT03309488). They underwent clinical assessment, skin prick test (SPT), specific IgE (sIgE) and basophil activation test (BAT). The results of the tests were compared with DBPCFC outcomes to both BE and LCE. A total of 150 children underwent DBPCFC to BE, 60 (40%) reacted to and 85 (57%) tolerated BE and 5 (3%) had inconclusive oral food challenges (OFC). Seventy-seven children tolerant to BE had DBPCFC to LCE and 16 reacted. The test within each modality with the best diagnostic performance for BE allergy was as follows: SPT to egg white (EW) (AUC = 0.726), sIgE to EW (AUC = 0.776) and BAT to egg (AUC = 0.783). BAT (AUC = 0.867) was the best test in the younger than 2 years age group. Applying 100% sensitivity and 100% specificity cut-offs, followed by OFC, resulted in 100% diagnostic accuracy. BAT enabled the greatest reduction in OFC (41%). Using sIgE followed by BAT allowed to reduce the number of BATs performed by about 30% without significantly increasing the number of OFC. The best diagnostic test was BAT to egg in terms of diagnostic accuracy and reduction in number of OFC. Using sIgE to EW followed by BAT required fewer BATs with sustained OFC reduction and diagnostic accuracy.
Sections du résumé
BACKGROUND
Double-blind placebo-controlled food challenges (DBPCFC) are the gold-standard to diagnose food allergy. However, they can cause allergic reactions of unpredictable severity. We assessed accuracy of current and new diagnostic tests compared to DBPCFC to baked egg (BE) and to lightly cooked egg (LCE).
METHODS
Children aged 6 months to 15 years were assessed for possible egg allergy as part of the BAT2 study (NCT03309488). They underwent clinical assessment, skin prick test (SPT), specific IgE (sIgE) and basophil activation test (BAT). The results of the tests were compared with DBPCFC outcomes to both BE and LCE.
RESULTS
A total of 150 children underwent DBPCFC to BE, 60 (40%) reacted to and 85 (57%) tolerated BE and 5 (3%) had inconclusive oral food challenges (OFC). Seventy-seven children tolerant to BE had DBPCFC to LCE and 16 reacted. The test within each modality with the best diagnostic performance for BE allergy was as follows: SPT to egg white (EW) (AUC = 0.726), sIgE to EW (AUC = 0.776) and BAT to egg (AUC = 0.783). BAT (AUC = 0.867) was the best test in the younger than 2 years age group. Applying 100% sensitivity and 100% specificity cut-offs, followed by OFC, resulted in 100% diagnostic accuracy. BAT enabled the greatest reduction in OFC (41%). Using sIgE followed by BAT allowed to reduce the number of BATs performed by about 30% without significantly increasing the number of OFC.
CONCLUSIONS
The best diagnostic test was BAT to egg in terms of diagnostic accuracy and reduction in number of OFC. Using sIgE to EW followed by BAT required fewer BATs with sustained OFC reduction and diagnostic accuracy.
Identifiants
pubmed: 37417650
doi: 10.1111/all.15797
pmc: PMC10790315
doi:
Substances chimiques
Allergens
0
Immunoglobulin E
37341-29-0
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2510-2522Subventions
Organisme : Medical Research Council
ID : G0902018
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_18052
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/M008517/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/T032081/1
Pays : United Kingdom
Informations de copyright
© 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Références
J Allergy Clin Immunol. 2012 Aug;130(2):473-80.e1
pubmed: 22846751
N Engl J Med. 2016 May 5;374(18):1733-43
pubmed: 26943128
J Allergy Clin Immunol. 2021 Aug;148(2):495-505.e14
pubmed: 33675817
J Allergy Clin Immunol Pract. 2013 Jul-Aug;1(4):354-60
pubmed: 24013255
J Allergy Clin Immunol. 2011 Mar;127(3):668-76.e1-2
pubmed: 21377036
Nutrients. 2022 Aug 18;14(16):
pubmed: 36014905
Allergy. 2023 Sep;78(9):2510-2522
pubmed: 37417650
J Allergy Clin Immunol Pract. 2023 Dec 27;:
pubmed: 38157981
BMJ. 2015 Oct 28;351:h5527
pubmed: 26511519
J Allergy Clin Immunol. 2013 Oct;132(4):975-6.e1-5
pubmed: 24001803
Pediatr Allergy Immunol. 2021 Oct;32(7):1482-1489
pubmed: 33955090
J Allergy Clin Immunol. 2022 Sep;150(3):657-665.e13
pubmed: 35597613
J Allergy Clin Immunol. 2014 Feb;133(2):492-9
pubmed: 24636473
J Allergy Clin Immunol. 2016 May;137(5):1477-1486.e8
pubmed: 26896232
J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):13-23; quiz 24
pubmed: 25577613
J Allergy Clin Immunol Pract. 2022 Jan;10(1):1-9
pubmed: 34530176
Ann Allergy Asthma Immunol. 2016 May;116(5):415-9
pubmed: 26809899
Clin Exp Allergy. 2012 Aug;42(8):1197-205
pubmed: 22805467
Br J Nutr. 2022 Dec 28;128(12):2453-2463
pubmed: 35109944
Clin Exp Allergy. 2013 Oct;43(10):1189-95
pubmed: 24074337
Pediatr Allergy Immunol. 2013 Aug;24(5):450-5
pubmed: 23773122
Int Arch Allergy Immunol. 2022;183(3):249-261
pubmed: 34818647
J Allergy Clin Immunol. 2014 Sep;134(3):645-52
pubmed: 25065721
N Engl J Med. 2015 Feb 26;372(9):803-13
pubmed: 25705822
J Allergy Clin Immunol. 2012 Mar;129(3):739-47
pubmed: 22277199
Food Chem. 2021 Nov 15;362:129879
pubmed: 34118511
Pediatr Allergy Immunol. 2014 Dec;25(8):740-6
pubmed: 25251921
Allergy. 2019 Feb;74(2):318-326
pubmed: 30035811
J Allergy Clin Immunol. 2020 Aug;146(2):344-355
pubmed: 32311390
Pediatr Allergy Immunol. 2014 Nov;25(7):657-61
pubmed: 25298203
Pediatr Allergy Immunol. 2022 Feb;33(2):e13739
pubmed: 35212037
Allergy. 2023 Nov 27;:
pubmed: 38009299