Component resolved diagnosis in real life: the risk assessment of food allergy using microarray-based immunoassay.
BACKGROUND
The development of component-resolved diagnostics constitutes a potential breakthrough in food allergy testing, as detection of specific IgE (sIgE) to individual allergens may make it possible to establish the risk of a mild versus severe reaction.


OBJECTIVE
To compare allergists' risk assessment based on the current decision making process with that of virtual allergen-oriented risk assessment through microarray-based immunoassay.


METHODS
An observational, real-life study was performed on 86 adults with food allergy. The prescription of epinephrine was the surrogate marker of a severe reaction. In the same patients, the prescription of epinephrine based on the current decision making of the allergist and the independently established allergen-oriented risk assessment determined by microarray-based immunoassay were compared.


RESULTS
Fair degree of agreement between the specialists' risk assessment and that of the microarray-based immunoassay (k index 0.372 (95% CI: 0.185- 0.559) p < 0.001) was documented. Three causes of discrepancy emerged: the poor sensitivity of the allergen microarray-immunoassay (51.9%), the differences in risk assessment established by the specialist and the microarray-immunoassay (33.3%), the non-inclusion of the causative allergen in the microarray-immunoassay platform (14.8%).


CONCLUSIONS
Improvement of the diagnostic accuracy of microarray-immunoassay, combined with marrying its results to clinical information, could one day soon lead to changes in clinical practice in food allergy.
Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy. l.antonicelli@ospedaliriuniti.marche.it.
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Antonicelli
Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy.
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Massaccesi
Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy.
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Braschi
Laboratory of Clinical Pathology and Microbiology, General Service Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy.
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Cinti
Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy.
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Bilò
Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy.
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Bonifazi
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis*; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D008297:Male; D008875:Middle Aged; D040081:Protein Array Analysis / Q000379:methods*; D018570:Risk Assessment
Food allergy; component-resolved diagnostics; food allergenic molecules; risk-assessment