Population Allergy Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, VIC, Australia.
Population Allergy Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
J Allergy Clin Immunol Pract. 2021 May;9(5):2028-2049.e2. doi: 10.1016/j.jaip.2020.12.048. Epub 2021 Jan 9.
Food allergy is most accurately diagnosed by a formal oral food challenge (OFC); however, it is time and labor intensive, risks the individual to severe reaction, and access is often a limiting step in the diagnostic process. This is compounded for tree nut allergy diagnosis as several OFCs may be required to determine allergy status to each individual tree nut. Accurate diagnosis using minimally invasive diagnostic tests in predicting clinical tree nut allergy is important to correctly identify those with potentially life-threatening reactions and to efficiently and safely tailor nut avoidance to only those nuts deemed allergic to enable less restricted diets and increased food choices for food allergic individuals.
To conduct a systematic review on the diagnostic capacity of clinical tests (skin prick test, specific IgE, component-resolved diagnostics, and basophil activation test) to determine OFC-proven or clinical tree nut allergy.
We searched 4 electronic databases (OVID Medline, Embase, Cochrane library, and PubMed) until May 2020. Eligible studies were categorized by type of tree nut and diagnostic test.
A total of 27 studies assessed diagnostic accuracy to a specific tree nut. Overall, the accuracy of diagnostic testing was only reasonable, with 95% positive predictive values established in a small number of tree nuts. Cashew has best diagnostic accuracy, with the cashew component Ana o 3 being most predictive. At the other end of the spectrum, diagnostic testing of almond is poor and of limited clinical use.
The systematic review highlights the limitations of our current diagnostic tools for tree nut allergy and highlights further areas for research. The unidirectionality of cross-reactivity between cashew/pistachio and walnut/pecan is described and can aid diagnosis. Using diagnostic algorithms such as those demonstrated for walnut/pecan and cashew/pistachio allergy, greater diagnostic accuracy and reduced number of OFCs may be achieved.
食物过敏最准确的诊断方法是进行正式的口服食物挑战（OFC）；然而，这种方法既费时又费力，存在个体发生严重过敏反应的风险，并且通常是诊断过程中的一个限制步骤。对于树坚果过敏的诊断情况更为复杂，因为可能需要多次 OFC 才能确定个体对每种树坚果的过敏状态。使用微创诊断测试准确诊断临床树坚果过敏对于正确识别那些有潜在生命威胁的反应者以及高效和安全地避免食用被认为过敏的坚果至关重要，这有助于避免限制饮食并增加食物过敏者的食物选择。
对临床测试（皮肤点刺试验、特异性 IgE、成分分辨诊断和嗜碱性粒细胞活化试验）的诊断能力进行系统评价，以确定 OFC 证实或临床树坚果过敏。
我们在 4 个电子数据库（OVID Medline、Embase、Cochrane 图书馆和 PubMed）中进行了搜索，截至 2020 年 5 月。根据特定的坚果种类和诊断测试对合格的研究进行分类。
共有 27 项研究评估了特定坚果的诊断准确性。总体而言，诊断测试的准确性仅为合理，只有少数几种坚果确定了 95%的阳性预测值。腰果的诊断准确性最高，腰果成分 Ana o 3 最具预测性。另一方面，杏仁的诊断测试效果不佳，临床应用有限。
系统评价强调了我们目前用于树坚果过敏的诊断工具的局限性，并强调了进一步研究的领域。描述了腰果/开心果和核桃/山核桃与核桃/山核桃之间交叉反应的单向性，这有助于诊断。使用诊断算法，如已经证明用于核桃/山核桃和腰果/开心果过敏的算法，可以提高诊断准确性并减少 OFC 的数量。
