Gomes-Belo Joana, Hannachi Farah, Swan Kate, Santos Alexandra F
Children's Allergy Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom.
Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon, Portugal.
Curr Pediatr Rev. 2018;14(3):139-149. doi: 10.2174/1573396314666180423105842.
An accurate diagnosis of food allergy is extremely important to guide safe and yet not overly restrictive dietary management. The cornerstone of the diagnosis of food allergy is the clinical history; it allows appropriate selection of the allergens to be tested and interpretation of the results of allergy tests, namely Skin Prick Test (SPT), Specific IgE (sIgE) to allergen extracts and, more recently, specific IgE to allergen components and the Basophil Activation Test (BAT). SPT and sIgE to allergen extracts are very sensitive methods to detect IgE sensitization to a specific food and assess the possibility of spontaneous resolution. Cut-offs have been generated based on the probability of clinical reactivity during oral food challenges and can improve the specificity of SPT and sIgE, helping to confirm the diagnosis of food allergy. Specific IgE to allergen components refines food allergy diagnosis as it allows differentiating species-specific from cross-reactive allergens, aiding the differential diagnosis between a true and potentially severe food allergy from pollen-food syndrome or clinically irrelevant sensitization. The BAT is a new diagnostic test which has high specificity and sensitivity and can complement specific IgE, allowing the deferral of OFC in patients with a positive BAT. Depending on the likelihood of clinical allergy determined based on the combination of the history and the results of allergy tests, an oral food challenge may be indicated to confirm or exclude the diagnosis. Oral food challenge is the gold standard for the diagnosis of food allergy, but is a resource-intensive procedure with some level of risk involved; thus they are reserved for the equivocal cases. This review article discusses the above diagnostic techniques detailing the methods, utility, advantages and disadvantages.
准确诊断食物过敏对于指导安全且不过度限制的饮食管理极为重要。食物过敏诊断的基石是临床病史；它有助于适当选择要检测的过敏原，并解读过敏测试结果，即皮肤点刺试验（SPT）、针对过敏原提取物的特异性IgE（sIgE），以及最近针对过敏原成分的特异性IgE和嗜碱性粒细胞活化试验（BAT）。SPT和针对过敏原提取物的sIgE是检测对特定食物的IgE致敏和评估自然缓解可能性的非常敏感的方法。基于口服食物激发试验期间临床反应的可能性已制定了临界值，可提高SPT和sIgE的特异性，有助于确诊食物过敏。针对过敏原成分的特异性IgE可优化食物过敏诊断，因为它能够区分物种特异性过敏原和交叉反应性过敏原，有助于鉴别真正的、可能严重的食物过敏与花粉-食物综合征或临床无关的致敏。BAT是一种新的诊断试验，具有高特异性和敏感性，可补充特异性IgE，使BAT阳性的患者无需进行口服食物激发试验。根据基于病史和过敏测试结果综合判断的临床过敏可能性，可能需要进行口服食物激发试验以确诊或排除诊断。口服食物激发试验是食物过敏诊断的金标准，但它是一种资源密集型程序，存在一定风险；因此仅用于疑难病例。这篇综述文章详细讨论了上述诊断技术，包括方法、用途、优缺点。
