title: Diagnosing and managing common food allergies: a systematic review.
abstract: BACKGROUND
  There is heightened interest in food allergies but no clear consensus exists regarding the prevalence or most effective diagnostic and management approaches to food allergies.
  
  
  OBJECTIVE
  To perform a systematic review of the available evidence on the prevalence, diagnosis, management, and prevention of food allergies.
  
  
  METHODS
  Electronic searches of PubMed, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials. Searches were limited to English-language articles indexed between January 1988 and September 2009.
  
  
  METHODS
  Diagnostic tests were included if they had a prospective, defined study population, used food challenge as a criterion standard, and reported sufficient data to calculate sensitivity and specificity. Systematic reviews and randomized controlled trials (RCTs) for management and prevention outcomes were also used. For foods where anaphylaxis is common, cohort studies with a sample size of more than 100 participants were included.
  
  
  METHODS
  Two investigators independently reviewed all titles and abstracts to identify potentially relevant articles and resolved discrepancies by repeated review and discussion. Quality of systematic reviews and meta-analyses was assessed using the AMSTAR criteria, the quality of diagnostic studies using the QUADAS criteria most relevant to food allergy, and the quality of RCTs using the Jadad criteria.
  
  
  RESULTS
  A total of 12,378 citations were identified and 72 citations were included. Food allergy affects more than 1% to 2% but less than 10% of the population. It is unclear if the prevalence of food allergies is increasing. Summary receiver operating characteristic curves comparing skin prick tests (area under the curve [AUC], 0.87; 95% confidence interval [CI], 0.81-0.93) and serum food-specific IgE (AUC, 0.84; 95% CI, 0.78-0.91) to food challenge showed no statistical superiority for either test. Elimination diets are the mainstay of therapy but have been rarely studied. Immunotherapy is promising but data are insufficient to recommend use. In high-risk infants, hydrolyzed formulas may prevent cow's milk allergy but standardized definitions of high risk and hydrolyzed formula do not exist.
  
  
  CONCLUSIONS
  The evidence for the prevalence and management of food allergy is greatly limited by a lack of uniformity for criteria for making a diagnosis.
authors.affiliation: VA Palo Alto Healthcare System, Palo Alto, California, USA. jjschnei@stanford.edu
authors.forename: Jennifer J Schneider
authors.initials: JJ
authors.lastname: Chafen
authors.forename: Sydne J
authors.initials: SJ
authors.lastname: Newberry
authors.forename: Marc A
authors.initials: MA
authors.lastname: Riedl
authors.forename: Dena M
authors.initials: DM
authors.lastname: Bravata
authors.forename: Margaret
authors.initials: M
authors.lastname: Maglione
authors.forename: Marika J
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Vandana
authors.initials: V
authors.lastname: Sundaram
authors.forename: Neil M
authors.initials: NM
authors.lastname: Paige
authors.forename: Ali
authors.initials: A
authors.lastname: Towfigh
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Hulley
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
mesh_terms: D002648:Child; D004035:Diet Therapy / Q000379:methods; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D007167:Immunotherapy; D007223:Infant; D041943:Infant Formula; D015995:Prevalence