Implications for practice, policy, and future research
In clinical practice, validated allergy tests can guide diagnosis and
reduce the need for prolonged restrictive diets and high-risk OFC. To
assist clinicians in decision-making, further research is necessary to
determine the clinical impact and cost-effectiveness of allergy tests,
including SPT, sIgE, CRD and BAT, and their use in various combinations
to provide optimal diagnostic pathway for individual foods that is
guided by patient outcomes and health economics.
The utility of diagnostic tests differs between geographical regions;
stakeholders should promote studies that can correctly identify cut-offs
for their specific populations considering ethnicity and age to improve
the accurate diagnosis of IgE-mediated FA on a global scale. Ultimately,
the goal of evaluating diagnostic strategies is to improve patient
outcomes and inform clinical decision-making. The most appropriate study
design should be chosen to achieve this goal, considering logistics and
health economics in each geographical area.
Studies validating age-appropriate cut-offs are needed. There is lack of
evidence in adult FA regarding of allergen exposure due to dietary
habits and comorbidities, including cross-sensitization to
aeroallergens. More evidence is needed to assess food allergies in
toddlers specifically for CM, HE and peanut. Future research should
consider specific cut-offs which guide diagnosis of tolerance to baked
goods (foods containing baked egg or baked milk specifically) and safety
of introduction to sensitized patients with no history of prior food
ingestion. Establishing these parameters for clinical practice can
prevent prolonged unnecessary restrictive diets and improve quality of
life for patients.
There is limited evidence on diagnostic tests for less common allergens
such as fish, a wide variety of shellfish, fruits, vegetables, and
legumes. Properly designed studies addressing allergy to these foods is
needed.
To minimize bias and confounding, RCTs with DBPCFCs are required to
evaluate accuracy of novel diagnostic strategies and their impact in
patient outcomes and health economics. Such studies could provide
high-quality evidence on the sensitivity, specificity and cost
effectiveness of these tools compared to current tests.