EAACI guidelines on the diagnosis of IgE-mediated food allergy

Alexandra F. Santos; Carmen Riggioni; Ioana Agache; Cezmi A. Akdis; Mubeccel Akdis; Alberto Alvarez-Perea; Montserrat Alvaro-Lozano; Barbara Ballmer-Weber; Simona Barni; Kirsten Beyer; Carsten Bindslev-Jensen; Helen A. Brough; Betul Buyuktiryaki; Derek Chu; Stefano Del Giacco; Audrey Dunn-Galvin; Bernadette Eberlein; Motohiro Ebisawa; Philippe Eigenmann; Thomas Eiwegger; Mary Feeney; Montserrat Fernandez-Rivas; Helen R. Fisher; David M. Fleischer; Mattia Giovannini; Claudia Gray; Karin Hoffmann-Sommergruber; Susanne Halken; Jonathan O.B. Hourihane; Christina J. Jones; Marek Jutel; Edward Knol; George N. Konstantinou; Gideon Lack; Susanne Lau; Andreina Marques Mejias; Mary Jane Marchisotto; Rosan Meyer; Charlotte G. Mortz; Beatriz Moya; Antonella Muraro; Caroline Nilsson; Lucila Camargo Lopes de Oliveira; Liam O’Mahony; Nikolaos G. Papadopoulos; Kirsten Perrett; Rachel L. Peters; Marcia Podesta; Lars K. Poulsen; Graham Roberts; Hugh A. Sampson; Jürgen Schwarze; Peter Smith; Elizabeth Huiwen Tham; Eva Untersmayr; Ronald Van Ree; Carina Venter; Brian P. Vickery; Berber Vlieg-Boerstra; Thomas Werfel; Margitta Worm; George Du Toit; Isabel Skypala

doi:10.1111/all.15902

EAACI guidelines on the diagnosis of IgE-mediated food allergy

Alexandra F. Santos^*, Carmen Riggioni, Ioana Agache, Cezmi A. Akdis, Mubeccel Akdis, Alberto Alvarez-Perea, Montserrat Alvaro-Lozano, Barbara Ballmer-Weber, Simona Barni, Kirsten Beyer, Carsten Bindslev-Jensen, Helen A. Brough, Betul Buyuktiryaki, Derek Chu, Stefano Del Giacco, Audrey Dunn-Galvin, Bernadette Eberlein, Motohiro Ebisawa, Philippe Eigenmann, Thomas EiweggerMary Feeney, Montserrat Fernandez-Rivas, Helen R. Fisher, David M. Fleischer, Mattia Giovannini, Claudia Gray, Karin Hoffmann-Sommergruber, Susanne Halken, Jonathan O.B. Hourihane, Christina J. Jones, Marek Jutel, Edward Knol, George N. Konstantinou, Gideon Lack, Susanne Lau, Andreina Marques Mejias, Mary Jane Marchisotto, Rosan Meyer, Charlotte G. Mortz, Beatriz Moya, Antonella Muraro, Caroline Nilsson, Lucila Camargo Lopes de Oliveira, Liam O’Mahony, Nikolaos G. Papadopoulos, Kirsten Perrett, Rachel L. Peters, Marcia Podesta, Lars K. Poulsen, Graham Roberts, Hugh A. Sampson, Jürgen Schwarze, Peter Smith, Elizabeth Huiwen Tham, Eva Untersmayr, Ronald Van Ree, Carina Venter, Brian P. Vickery, Berber Vlieg-Boerstra, Thomas Werfel, Margitta Worm, George Du Toit, Isabel Skypala

^*Corresponding author for this work

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Abstract

This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.

Original language	English
Pages (from-to)	3057-3076
Number of pages	20
Journal	Allergy: European Journal of Allergy and Clinical Immunology
Volume	78
Issue number	12
Early online date	10 Oct 2023
DOIs	https://doi.org/10.1111/all.15902
Publication status	Published - Dec 2023

Keywords

basophil activation test
diagnosis
food allergy
oral food challenges
skin prick test
specific IgE

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Santos, A. F., Riggioni, C., Agache, I., Akdis, C. A., Akdis, M., Alvarez-Perea, A., Alvaro-Lozano, M., Ballmer-Weber, B., Barni, S., Beyer, K., Bindslev-Jensen, C., Brough, H. A., Buyuktiryaki, B., Chu, D., Del Giacco, S., Dunn-Galvin, A., Eberlein, B., Ebisawa, M., Eigenmann, P., ... Skypala, I. (2023). EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy: European Journal of Allergy and Clinical Immunology, 78(12), 3057-3076. https://doi.org/10.1111/all.15902

@article{dee9bb3e094a4cf0a004dde48aa61e7d,

title = "EAACI guidelines on the diagnosis of IgE-mediated food allergy",

abstract = "This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.",

keywords = "basophil activation test, diagnosis, food allergy, oral food challenges, skin prick test, specific IgE",

author = "Santos, {Alexandra F.} and Carmen Riggioni and Ioana Agache and Akdis, {Cezmi A.} and Mubeccel Akdis and Alberto Alvarez-Perea and Montserrat Alvaro-Lozano and Barbara Ballmer-Weber and Simona Barni and Kirsten Beyer and Carsten Bindslev-Jensen and Brough, {Helen A.} and Betul Buyuktiryaki and Derek Chu and Stefano Del Giacco and Audrey Dunn-Galvin and Bernadette Eberlein and Motohiro Ebisawa and Philippe Eigenmann and Thomas Eiwegger and Mary Feeney and Montserrat Fernandez-Rivas and Fisher, {Helen R.} and Fleischer, {David M.} and Mattia Giovannini and Claudia Gray and Karin Hoffmann-Sommergruber and Susanne Halken and Hourihane, {Jonathan O.B.} and Jones, {Christina J.} and Marek Jutel and Edward Knol and Konstantinou, {George N.} and Gideon Lack and Susanne Lau and Andreina Marques Mejias and Marchisotto, {Mary Jane} and Rosan Meyer and Mortz, {Charlotte G.} and Beatriz Moya and Antonella Muraro and Caroline Nilsson and Lopes de Oliveira, {Lucila Camargo} and Liam O{\textquoteright}Mahony and Papadopoulos, {Nikolaos G.} and Kirsten Perrett and Peters, {Rachel L.} and Marcia Podesta and Poulsen, {Lars K.} and Graham Roberts and Sampson, {Hugh A.} and J{\"u}rgen Schwarze and Peter Smith and Tham, {Elizabeth Huiwen} and Eva Untersmayr and Ronald Van Ree and Carina Venter and Vickery, {Brian P.} and Berber Vlieg-Boerstra and Thomas Werfel and Margitta Worm and George Du Toit and Isabel Skypala",

note = "Funding Information: We would like to thank Jeanette Kobler from the EAACI team for logistical and administrative support; and earlier members of the group of methodologists, including Jon Genuneit, Robert Boyle and Daniel Munblit, for the helpful discussions in an earlier stage of the project. Publisher Copyright: {\textcopyright} 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.",

year = "2023",

month = dec,

doi = "10.1111/all.15902",

language = "English",

volume = "78",

pages = "3057--3076",

journal = "Allergy: European Journal of Allergy and Clinical Immunology",

issn = "0105-4538",

publisher = "John Wiley and sons",

number = "12",

}

Santos, AF, Riggioni, C, Agache, I, Akdis, CA, Akdis, M, Alvarez-Perea, A, Alvaro-Lozano, M, Ballmer-Weber, B, Barni, S, Beyer, K, Bindslev-Jensen, C, Brough, HA, Buyuktiryaki, B, Chu, D, Del Giacco, S, Dunn-Galvin, A, Eberlein, B, Ebisawa, M, Eigenmann, P, Eiwegger, T, Feeney, M, Fernandez-Rivas, M, Fisher, HR, Fleischer, DM, Giovannini, M, Gray, C, Hoffmann-Sommergruber, K, Halken, S, Hourihane, JOB, Jones, CJ, Jutel, M, Knol, E, Konstantinou, GN, Lack, G, Lau, S, Marques Mejias, A, Marchisotto, MJ, Meyer, R, Mortz, CG, Moya, B, Muraro, A, Nilsson, C, Lopes de Oliveira, LC, O’Mahony, L, Papadopoulos, NG, Perrett, K, Peters, RL, Podesta, M, Poulsen, LK, Roberts, G, Sampson, HA, Schwarze, J, Smith, P, Tham, EH, Untersmayr, E, Van Ree, R, Venter, C, Vickery, BP, Vlieg-Boerstra, B, Werfel, T, Worm, M, Du Toit, G & Skypala, I 2023, 'EAACI guidelines on the diagnosis of IgE-mediated food allergy', Allergy: European Journal of Allergy and Clinical Immunology, vol. 78, no. 12, pp. 3057-3076. https://doi.org/10.1111/all.15902

TY - JOUR

T1 - EAACI guidelines on the diagnosis of IgE-mediated food allergy

AU - Santos, Alexandra F.

AU - Riggioni, Carmen

AU - Agache, Ioana

AU - Akdis, Cezmi A.

AU - Akdis, Mubeccel

AU - Alvarez-Perea, Alberto

AU - Alvaro-Lozano, Montserrat

AU - Ballmer-Weber, Barbara

AU - Barni, Simona

AU - Beyer, Kirsten

AU - Bindslev-Jensen, Carsten

AU - Brough, Helen A.

AU - Buyuktiryaki, Betul

AU - Chu, Derek

AU - Del Giacco, Stefano

AU - Dunn-Galvin, Audrey

AU - Eberlein, Bernadette

AU - Ebisawa, Motohiro

AU - Eigenmann, Philippe

AU - Eiwegger, Thomas

AU - Feeney, Mary

AU - Fernandez-Rivas, Montserrat

AU - Fisher, Helen R.

AU - Fleischer, David M.

AU - Giovannini, Mattia

AU - Gray, Claudia

AU - Hoffmann-Sommergruber, Karin

AU - Halken, Susanne

AU - Hourihane, Jonathan O.B.

AU - Jones, Christina J.

AU - Jutel, Marek

AU - Knol, Edward

AU - Konstantinou, George N.

AU - Lack, Gideon

AU - Lau, Susanne

AU - Marques Mejias, Andreina

AU - Marchisotto, Mary Jane

AU - Meyer, Rosan

AU - Mortz, Charlotte G.

AU - Moya, Beatriz

AU - Muraro, Antonella

AU - Nilsson, Caroline

AU - Lopes de Oliveira, Lucila Camargo

AU - O’Mahony, Liam

AU - Papadopoulos, Nikolaos G.

AU - Perrett, Kirsten

AU - Peters, Rachel L.

AU - Podesta, Marcia

AU - Poulsen, Lars K.

AU - Roberts, Graham

AU - Sampson, Hugh A.

AU - Schwarze, Jürgen

AU - Smith, Peter

AU - Tham, Elizabeth Huiwen

AU - Untersmayr, Eva

AU - Van Ree, Ronald

AU - Venter, Carina

AU - Vickery, Brian P.

AU - Vlieg-Boerstra, Berber

AU - Werfel, Thomas

AU - Worm, Margitta

AU - Du Toit, George

AU - Skypala, Isabel

N1 - Funding Information: We would like to thank Jeanette Kobler from the EAACI team for logistical and administrative support; and earlier members of the group of methodologists, including Jon Genuneit, Robert Boyle and Daniel Munblit, for the helpful discussions in an earlier stage of the project. Publisher Copyright: © 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

PY - 2023/12

Y1 - 2023/12

N2 - This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.

AB - This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.

KW - basophil activation test

KW - diagnosis

KW - food allergy

KW - oral food challenges

KW - skin prick test

KW - specific IgE

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U2 - 10.1111/all.15902

DO - 10.1111/all.15902

M3 - Article

C2 - 37815205

AN - SCOPUS:85173780179

SN - 0105-4538

VL - 78

SP - 3057

EP - 3076

JO - Allergy: European Journal of Allergy and Clinical Immunology

JF - Allergy: European Journal of Allergy and Clinical Immunology

IS - 12

ER -

EAACI guidelines on the diagnosis of IgE-mediated food allergy

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