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The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta‐analyses to assess the accuracy of diagnostic tests for IgE‐mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta‐analyses were undertaken for food‐test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double‐blind placebo‐controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2‐sIgE had 92%, Cor a 14‐sIgE 95%, Ana o 3‐sIgE 94%, casein‐sIgE 93%, ovomucoid‐sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies. [ABSTRACT FROM AUTHOR]

Diagnostic allergens are defined as medicinal products in the EU. Marketing authorization by national authorities is necessary; however, diagnostic allergens are not homogeneously regulated in different EU member states. Allergen manufacturers argue with increasing costs forcing them to continuously reduce the diagnostic allergen portfolios offered to allergists. In contrast, EAACI and national European Allergy Societies see the need for the availability of a wide range of high‐quality diagnostic allergens for in vivo diagnosis of IgE‐mediated allergies not only covering predominant but also less frequent allergen sources. In a recent EAACI task force survey, the current practice of allergy diagnosis was shown to rely on skin tests as first option in almost 2/3 of all types of allergic diseases and in 90% regarding respiratory allergies. With the need to ensure the availability of high‐quality diagnostic allergens in the EU, an action plan has been set up by EAACI to analyse the current regulatory demands in EU member states and to define possible solutions stated in this document: (a) simplification of authorization for diagnostic allergens; (b) specific regulation of special types of diagnostic allergens; (c) new models beyond the current model of homologous groups; (d) simplification of pharmacovigilance reporting; (e) reduction of regulation fees for diagnostic allergens; (f) reimbursement for diagnostic allergens. Joining forces of allergists, manufacturers and authorities are of high importance to ensure remaining relevant allergens in the EU markets to facilitate a sustainable and comprehensive service for the diagnosis and treatment of allergic diseases. [ABSTRACT FROM AUTHOR]

Species of the Amaranthaceae family are abundant in the Southeast of Spain, one of the driest areas in Europe. The Amaranthaceae include species of interest from the point of view of allergic diseases. With the expansion of aridity, many species belonging to this family will be favoured. The objectives of this study were: first, to define the prevalence of sensitization to Amaranthaceae pollen in allergic patients in the Southeast of Spain; second, to present the aerobiological features of this taxon; and, finally, to demarcate those periods of increased risk of suffering allergic symptoms with the aim of improving the diagnosis and prevention of hay fever. Skin prick tests with extracts of pollen were performed on patients with symptoms of respiratory allergy referred for consultation for the first time in Almería and Murcia. Samples of the atmospheric bioaerosol were taken using a Lanzoni VPPS 2000 volumetric sampler, samples treatment and subsequent counts being carried out according to the methodology approved by the Spanish Aerobiological Network. The statistical significance of the correlation between aerobiological and meteorological data from this arid region in 2010–2014 was determined. The aerobiological study revealed the presence of two distinct peaks responsible for pollen symptoms. The flowering of this taxon is especially noteworthy in the city of Cartagena, where it supposes 94% of the total pollen collected in these periods. This situation converts Amaranthaceae pollen in the second leading cause of hay fever in the Southeast of Spain. With the expansion of aridity, an increase in the presence of these species is expected. Bearing in mind their prevalence in the spring and summer/autumn periods and their extensive presence in the bioaerosol, this makes data from Southeastern Spanish a benchmark with respect to the aerobiology of this type of pollen. [ABSTRACT FROM AUTHOR]

Background: Kiwifruit is a common cause of food allergy. Symptoms range from mild to anaphylactic reactions. Objective: We sought to elucidate geographic differences across Europe regarding clinical patterns and sensitization to kiwifruit allergens. Factors associated with the severity of kiwifruit allergy were identified, and the diagnostic performance of specific kiwifruit allergens was investigated. Methods: This study was part of EuroPrevall, a multicenter European study investigating several aspects of food allergy. Three hundred eleven patients with kiwifruit allergy from 12 countries representing 4 climatic regions were included. Specific IgE to 6 allergens (Act d 1, Act d 2, Act d 5, Act d 8, Act d 9, and Act d 10) and kiwifruit extract were tested by using ImmunoCAP. Results: Patients from Iceland were mainly sensitized to Act d 1 (32%), those from western/central and eastern Europe were mainly sensitized to Act d 8 (pathogenesis-related class 10 protein, 58% and 44%, respectively), and those from southern Europe were mainly sensitized to Act d 9 (profilin, 31%) and Act d 10 (nonspecific lipid transfer protein, 22%). Sensitization to Act d 1 and living in Iceland were independently and significantly associated with severe kiwifruit allergy (odds ratio, 3.98 [P = .003] and 5.60 [P < .001], respectively). Using a panel of 6 kiwifruit allergens in ImmunoCAP increased the diagnostic sensitivity to 65% compared with 20% for skin prick tests and 46% ImmunoCAP using kiwi extract. Conclusion: Kiwifruit allergen sensitization patterns differ across Europe. The use of specific kiwifruit allergens improved the diagnostic performance compared with kiwifruit extract. Sensitization to Act d 1 and living in Iceland are strong risk factors for severe kiwifruit allergy. [ABSTRACT FROM AUTHOR]

Objective: Atopy patch test (APT) is a consensus procedure for diagnosing food allergy, especially in children with atopic dermatitis. The prevalence of positive APT reactions which can be expected to be found in unselected populations of adults or children is largely unknown. Nor is it clear whether positive APT reactions are more frequent in atopic patients and whether APT results are influenced by factors such as sex, geographical settings and life-style. Study Design and Setting: In an unselected population of 335 schoolchildren aged 10 years from two European countries with some differences life style (Italy and Slovakia) we investigated the prevalence of positive ATP reactions after cow milk, hen egg, tomato and wheat flour. We also assessed a possible link between positive APT results and other laboratory characteristics of atopy (allergen skin prick tests, histamine skin reactivity and eosinophil cell counts). Results: Atopy patch tests for foods were each positive in 5-15 % of the tested subjects with about 21% having at least one positive APT result: in general, they were more frequently positive in Italian children. In both countries the prevalence of positive APT reactions was significantly higher in males than in females. No relationship was found between positive ATP results and histamine skin reactivity, skin prick tests for the tested food allergens or for inhalant allergens and eosinophil cell counts. Conclusion: The findings from this study in unselected children suggest that APTs frequently elicit positive responses in unselected children populations, especially in boys, with different frequencies for particular food allergen in different geographical settings independently from the presence of positive SPT reactions. [ABSTRACT FROM AUTHOR]

Background: Within a large prospective study, the Global Asthma and Allergy European Network (GA(2) LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings., Objective: To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points., Methods: The GA(2) LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated., Results: Depending on the allergen, from 40% (blatella) to 87-89% (grass, mites) of the positive SPT reactions (wheal size ≥ 3 mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10 mm depending on the allergen., Conclusion: These 'reading keys' for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use., (© 2013 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.)