IgE-mediated food allergy diagnosis: Current status and new perspectives.

In June 2005, the work of the EU Integrated Project EuroPrevall was started. EuroPrevall is the largest research project on food allergy ever performed in Europe. Major aims of the project are to generate for the first time reliable data on the prevalence of food allergies across Europe and on the natural course of food allergy development in infants. Improvement of in vitro diagnosis of food allergies is another important aim of the project. The present review summarizes current knowledge about the clinical presentation of food allergy and critically reviews available diagnostic tools at the beginning of the project period. A major problem in diagnosis is a relatively poor 'clinical specificity', i. e. both positive skin tests and in vitro tests for specific IgE are frequent in sensitized subjects without food allergy symptoms. So far, no in vitro test reliably predicts clinical food allergy. EuroPrevall aims at improving the predictive value of such tests by proceeding from diagnosis based on allergen extracts to purified allergen molecules, taking into account the affinity of the IgE-allergen interaction, and evaluating the potential of biological in vitro tests such as histamine release tests or basophil activation tests including assays performed with permanently growing cell lines.

[1]  A. Patrizi,et al.  The Natural History of Sensitizations to Food and Aeroallergens in Atopic Dermatitis: A 4‐Year Follow‐Up , 2000, Pediatric dermatology.

[2]  J. Bousquet,et al.  Comparison between RAST and Pharmacia CAP system: a new automated specific IgE assay. , 1990, The Journal of allergy and clinical immunology.

[3]  L. Shek,et al.  Determination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy. , 2003, The Journal of allergy and clinical immunology.

[4]  A. Heratizadeh,et al.  Late eczematous reactions to food in children with atopic dermatitis , 2004, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[5]  J. Díaz-Pena,et al.  Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy. , 2002, The Journal of allergy and clinical immunology.

[6]  J. Nordlee,et al.  Presentation of allergen in different food preparations affects the nature of the allergic reaction – a case series , 2003, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[7]  S. Vieths,et al.  N- and O-linked oligosaccharides of allergenic glycoproteins , 2001, Glycoconjugate Journal.

[8]  H. Sampson,et al.  Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. , 1997, The Journal of allergy and clinical immunology.

[9]  R. Asero.  Plant Food Allergies: A Suggested Approach to Allergen-Resolved Diagnosis in the Clinical Practice by Identifying Easily Available Sensitization Markers , 2005, International Archives of Allergy and Immunology.

[10]  H. Sampson,et al.  Adverse reactions to foods. , 2006, The Medical clinics of North America.

[11]  K. Nékám,et al.  Standardization of food challenges in patients with immediate reactions to foods – position paper from the European Academy of Allergology and Clinical Immunology , 2004, Allergy.

[12]  A. Dubois,et al.  Development and validation of challenge materials for double-blind, placebo-controlled food challenges in children. , 2004, The Journal of allergy and clinical immunology.

[13]  C. Bindslev‐Jensen,et al.  An evaluation of the diagnostic value of different skin tests with egg in clinically egg‐allergic children having atopic dermatitis , 2004, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[14]  H. Breiteneder,et al.  Molecular and biochemical classification of plant-derived food allergens. , 2000, The Journal of allergy and clinical immunology.

[15]  Thomas Bieber,et al.  Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. , 2004, The Journal of allergy and clinical immunology.

[16]  D. Hill,et al.  The diagnostic value of skin prick testing in children with food allergy , 2004, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[17]  D. Kemeny,et al.  Oral allergy syndrome (OAS): symptoms of IgE‐mediated hypersensitivity to foods , 1987, Clinical allergy.

[18]  S. Halken,et al.  Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood , 2002, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[19]  C. Bindslev‐Jensen,et al.  The diagnostic accuracy of the atopy patch test in diagnosing hypersensitivity to cow's milk and hen's egg in unselected children with and without atopic dermatitis. , 2004, Journal of the American Academy of Dermatology.

[20]  Bock Sa.  Prospective Appraisal of Complaints of Adverse Reactions to Foods in Children During the First 3 Years of Life , 1987 .

[21]  H. Sampson.  Utility of food-specific IgE concentrations in predicting symptomatic food allergy. , 2001, The Journal of allergy and clinical immunology.

[22]  H. Sampson,et al.  Measurement of peptide-specific IgE as an additional tool in identifying patients with clinical reactivity to peanuts. , 2003, The Journal of allergy and clinical immunology.

[23]  R. Asero,et al.  Detection of clinical markers of sensitization to profilin in patients allergic to plant-derived foods. , 2003, The Journal of allergy and clinical immunology.

[24]  M. Abramson,et al.  International prevalences of reported food allergies and intolerances. Comparisons arising from the European Community Respiratory Health Survey (ECRHS) 1991–1994 , 2001, European Journal of Clinical Nutrition.

[25]  H. Sampson,et al.  Allergenic cross-reactivity among legume foods. , 1988, The Journal of allergy and clinical immunology.

[26]  F. Brémont,et al.  Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges , 1997, Allergy.

[27]  S. Vieths,et al.  Double‐blind, placebo‐controlled food challenge with apple , 2001, Allergy.

[28]  S. Scheurer,et al.  Component-resolved diagnosis with recombinant allergens in patients with cherry allergy. , 2002, The Journal of allergy and clinical immunology.

[29]  M. García-Ara,et al.  Cow's milk‐specific immunoglobulin E levels as predictors of clinical reactivity in the follow‐up of the cow's milk allergy infants , 2004, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[30]  B. Niggemann,et al.  The predictive value of the skin prick test weal size for the outcome of oral food challenges , 2005, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[31]  H. Sampson,et al.  Food allergy – accurately identifying clinical reactivity , 2005, Allergy.

[32]  S. Scheurer,et al.  Novel isoforms of Pru av 1 with diverging immunoglobulin E binding properties identified by a synergistic combination of molecular biology and proteomics , 2005, Proteomics.

[33]  C. Bindslev‐Jensen,et al.  Adverse reactions to food * , 1995 .

[34]  H. Sampson,et al.  Fatal and near-fatal anaphylactic reactions to food in children and adolescents. , 1992, The New England journal of medicine.

[35]  D. Moneret-vautrin,et al.  Population study of food allergy in France. , 2001, The Journal of allergy and clinical immunology.

[36]  J. Lidholm,et al.  Different profiles in specific IgE to rBet v 1 and rBet v 2 in patients allergic to birch pollen from six countries. , 1997, International archives of allergy and immunology.

[37]  H. Sampson,et al.  Fatalities due to anaphylactic reactions to foods. , 2001, The Journal of allergy and clinical immunology.

[38]  M. Esteban,et al.  Validity of specific IgE antibodies in children with egg allergy , 2001, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[39]  S. Vieths,et al.  Improving diagnostic tests for food allergy with recombinant allergens. , 2004, Methods.

[40]  M. Fernández-Rivas,et al.  Clinically relevant peach allergy is related to peach lipid transfer protein, Pru p 3, in the Spanish population. , 2003, The Journal of allergy and clinical immunology.

[41]  A. Sloan,et al.  A perspective on popular perceptions of adverse reactions to foods. , 1986, The Journal of allergy and clinical immunology.

[42]  J. Ring,et al.  The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study , 2004, Allergy.

[43]  H. Sampson,et al.  Food allergy. Part 1: immunopathogenesis and clinical disorders. , 1999, The Journal of allergy and clinical immunology.

[44]  R. Van Ree,et al.  Pollen-related allergy to peach and apple: an important role for profilin. , 1995, The Journal of allergy and clinical immunology.

[45]  B. Niggemann.  Evolving role of the atopy patch test in the diagnosis of food allergy , 2002, Current opinion in allergy and clinical immunology.

[46]  Hugh A Sampson,et al.  Update on food allergy. , 2004, The Journal of allergy and clinical immunology.

[47]  R. Ree.  Clinical importance of cross-reactivity in food allergy. , 2004 .

[48]  Likelihood ratios and Fagan's nomogram: valuable but underrated tools for in vitro latex sensitization assessment. , 1999, Clinica chimica acta; international journal of clinical chemistry.

[49]  K. Grimshaw,et al.  Does severity of low‐dose, double‐blind, placebo‐controlled food challenges reflect severity of allergic reactions to peanut in the community? , 2005, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[50]  H. Sampson,et al.  Food allergy in infancy. , 1994, Pediatric clinics of North America.

[51]  R. Bush,et al.  Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual. , 1988, The Journal of allergy and clinical immunology.

[52]  S. Scheurer,et al.  Optimized allergen extracts and recombinant allergens in diagnostic applications , 2001, Allergy.

[53]  S. Vieths,et al.  Soybean allergy in patients allergic to birch pollen: clinical investigation and molecular characterization of allergens. , 2004, The Journal of allergy and clinical immunology.

[54]  R. Ree.  Carbohydrate Epitopes and Their Relevance for the Diagnosis and Treatment of Allergic Diseases , 2002 .

[55]  B. Niggemann,et al.  Unproven diagnostic procedures in IgE‐mediated allergic diseases , 2004, Allergy.

[56]  K. Beyer,et al.  Food allergy diagnostics: scientific and unproven procedures , 2005 .

[57]  R. Van Ree,et al.  Ara h 8, a Bet v 1-homologous allergen from peanut, is a major allergen in patients with combined birch pollen and peanut allergy. , 2004, The Journal of allergy and clinical immunology.

[58]  S. Vieths,et al.  The oral allergy syndrome: improved diagnostic and treatment methods , 2005, Current opinion in allergy and clinical immunology.

[59]  Wayne Thomas,et al.  Microarrayed allergen molecules: diagnostic gatekeepers for allergy treatment , 2002, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[60]  Bernstein Il,et al.  Practice parameters for allergy diagnostic testing. Joint Task Force on Practice Parameters for the Diagnosis and Treatment of Asthma. The American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. , 1995 .

[61]  A. Burks,et al.  Serological characteristics of peanut allergy in children , 2003, Allergy.

[62]  D. Moneret-vautrin,et al.  Epidemiology of life‐threatening and lethal anaphylaxis: a review , 2005, Allergy.

[63]  Massimo Natale,et al.  Cow's milk allergens identification by two-dimensional immunoblotting and mass spectrometry. , 2004, Molecular nutrition & food research.

[64]  J. Bousquet,et al.  A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. , 2001 .

[65]  Lerner Sa,et al.  Biphasic systemic anaphylactic reaction: three illustrative cases. , 1984 .

[66]  S. Vieths,et al.  Severe oral allergy syndrome and anaphylactic reactions caused by a Bet v 1- related PR-10 protein in soybean, SAM22. , 2002, The Journal of allergy and clinical immunology.