Faculty of Life Sciences and Medicine, Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
J Allergy Clin Immunol Pract. 2021 Jan;9(1):71-80. doi: 10.1016/j.jaip.2020.09.037.
The diagnosis of food allergy can have a major impact on the lives of patients and families, imposing dietary restrictions and limitations on social activities. On the other hand, misdiagnosis can place the patient at risk of a potentially severe allergic reaction. Therefore, an accurate diagnosis of food allergy is of utmost importance. The diagnosis of food allergy is often established by the combination of the clinical history and allergen-specific IgE; however, without a clear history of an allergic reaction, the interpretation of IgE sensitization tests can be difficult. There are also rare cases of clinical food allergy in the absence of IgE sensitization. For that reason, testing for suspected food allergy ideally requires access to oral food challenges (OFCs), which are currently the gold standard tests to diagnose food allergy. As OFCs are time consuming and involve the risk of acute allergic reactions of unpredictable severity, the question remains: how can we improve the accuracy of diagnosis before referring the patient for an OFC? Herein, we review the predictive value of different tests used to support the diagnosis of food allergy, discuss implications for therapy and prognosis, and propose a diagnostic approach to be applied in clinical practice.
食物过敏的诊断可能对患者及其家庭的生活产生重大影响，导致饮食限制和社交活动受限。另一方面，误诊可能使患者面临潜在严重过敏反应的风险。因此，准确诊断食物过敏至关重要。食物过敏的诊断通常通过临床病史和过敏原特异性 IgE 相结合来确立；然而，如果没有明确的过敏反应史，IgE 致敏试验的解读可能会很困难。也有罕见的无 IgE 致敏的临床食物过敏病例。因此，疑似食物过敏的检测理想情况下需要进行口服食物挑战（OFC），这是目前诊断食物过敏的金标准测试。由于 OFC 耗时且涉及不可预测严重程度的急性过敏反应风险，问题仍然存在：在将患者转介进行 OFC 之前，我们如何提高诊断的准确性？在此，我们回顾了用于支持食物过敏诊断的不同检测的预测价值，讨论了对治疗和预后的影响，并提出了一种应用于临床实践的诊断方法。
