Component-resolved Diagnostics in Allergy Practice Focusing on Food Allergy: A Systematic Review

Abstract

In this systematic review, we have discussed the role of component-resolved diagnostics (CRD) in the diagnosis of immunoglobulin E (IgE)-mediated food allergies; IgE-mediated food allergies are adverse reactions to food caused by an immunologic mechanism involving specific IgE (sIgE) antibodies. While self-reported food adverse reactions are common, the prevalence of confirmed food allergies through oral food challenge (OFC) is estimated to be around 1%. The conventional diagnostic process for food allergies involves clinical history, in vivo and/or in vitro tests, and OFC. However, many components used in these tests are irrelevant to the diagnostic process. Component-resolved diagnostics is a diagnostic technique that uses purified allergens to detect sIgE antibody responses against individual allergenic molecules. It aims to enhance the specificity of IgE testing and differentiate between genuine sensitization and cross-reactivity-induced sensitization. Component-resolved diagnostics also helps in stratifying the clinical risk associated with sensitization patterns and predicting OFC outcomes. However, CRD cannot replace the OFC as the gold standard due to insufficient sensitivity and specificity levels. Proper interpretation is crucial to avoid unnecessary elimination diets and auto-injector prescriptions that may impact patients’ quality of life. Component-resolved diagnostics plays a significant role in the diagnostic work-up of food allergies by identifying and characterizing allergenic compounds causing allergic responses. It enables differentiation between primary and secondary sensitization, predicts disease progression and clinical risk, and aids in stratifying OFC results. However, there are gaps in research and clinical practice. Commercial diagnostic tests are only available for a limited number of allergens, CRD is costly compared to other tests, and it lacks sufficient sensitivity and specificity to replace the OFC. Further research and initiatives are necessary to address these gaps and improve the use of CRD in food allergy diagnosis.

Keywords

• component-resolved diagnostics; food allergy
• sensitization
• specific immunoglobulin e