title: The diagnosis of food allergy: a systematic review and meta-analysis.
abstract: BACKGROUND
  We investigated the accuracy of tests used to diagnose food allergy.
  
  
  METHODS
  Skin prick tests (SPT), specific-IgE (sIgE), component-resolved diagnosis and the atopy patch test (APT) were compared with the reference standard of double-blind placebo-controlled food challenge. Seven databases were searched and international experts were contacted. Two reviewers independently identified studies, extracted data, and used QUADAS-2 to assess risk of bias. Where possible, meta-analysis was undertaken.
  
  
  RESULTS
  Twenty-four (2831 participants) studies were included. For cows' milk allergy, the pooled sensitivities were 53% (95% CI 33-72), 88% (95 % CI 76-94), and 87% (95% CI 75-94), and specificities were 88% (95% CI 76-95), 68% (95% CI 56-77), and 48% (95% CI 36-59) for APT, SPT, and sIgE, respectively. For egg, pooled sensitivities were 92% (95% CI 80-97) and 93% (95% CI 82-98), and specificities were 58% (95% CI 49-67) and 49% (40-58%) for skin prick tests and specific-IgE. For wheat, pooled sensitivities were 73% (95% CI 56-85) and 83% (95% CI 69-92), and specificities were 73% (95% CI 48-89) and 43% (95% CI 20-69%) for SPT and sIgE. For soy, pooled sensitivities were 55% (95% CI 33-75) and 83% (95% CI 64-93), and specificities were 68% (95% CI 52-80) and 38% (95% CI 24-54) for SPT and sIgE. For peanut, pooled sensitivities were 95% (95% CI 88-98) and 96% (95% CI 92-98), and specificities were 61% (95% CI 47-74), and 59% (95% CI 45-72) for SPT and sIgE.
  
  
  CONCLUSIONS
  The evidence base is limited and weak and is therefore difficult to interpret. Overall, SPT and sIgE appear sensitive although not specific for diagnosing IgE-mediated food allergy.
authors: Enhance Reviews Ltd, Wantage, UK.
authors: K
authors: K
authors: Soares-Weiser
authors: Y
authors: Y
authors: Takwoingi
authors: S S
authors: SS
authors: Panesar
authors: A
authors: A
authors: Muraro
authors: T
authors: T
authors: Werfel
authors: K
authors: K
authors: Hoffmann-Sommergruber
authors: G
authors: G
authors: Roberts
authors: S
authors: S
authors: Halken
authors: L
authors: L
authors: Poulsen
authors: R
authors: R
authors: van Ree
authors: B J
authors: BJ
authors: Vlieg-Boerstra
authors: A
authors: A
authors: Sheikh
mesh_terms: D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012882:Skin Tests
chemical_list: D007073:Immunoglobulin E
keywords: atopy patch test; component-specific-IgE; food allergy; skin prick test; specific-IgE