Implications for practice, policy, and future research
In clinical practice, validated allergy tests can guide diagnosis and reduce the need for prolonged restrictive diets and high-risk OFC. To assist clinicians in decision-making, further research is necessary to determine the clinical impact and cost-effectiveness of allergy tests, including SPT, sIgE, CRD and BAT, and their use in various combinations to provide optimal diagnostic pathway for individual foods that is guided by patient outcomes and health economics.
The utility of diagnostic tests differs between geographical regions; stakeholders should promote studies that can correctly identify cut-offs for their specific populations considering ethnicity and age to improve the accurate diagnosis of IgE-mediated FA on a global scale. Ultimately, the goal of evaluating diagnostic strategies is to improve patient outcomes and inform clinical decision-making. The most appropriate study design should be chosen to achieve this goal, considering logistics and health economics in each geographical area.
Studies validating age-appropriate cut-offs are needed. There is lack of evidence in adult FA regarding of allergen exposure due to dietary habits and comorbidities, including cross-sensitization to aeroallergens. More evidence is needed to assess food allergies in toddlers specifically for CM, HE and peanut. Future research should consider specific cut-offs which guide diagnosis of tolerance to baked goods (foods containing baked egg or baked milk specifically) and safety of introduction to sensitized patients with no history of prior food ingestion. Establishing these parameters for clinical practice can prevent prolonged unnecessary restrictive diets and improve quality of life for patients.
There is limited evidence on diagnostic tests for less common allergens such as fish, a wide variety of shellfish, fruits, vegetables, and legumes. Properly designed studies addressing allergy to these foods is needed.
To minimize bias and confounding, RCTs with DBPCFCs are required to evaluate accuracy of novel diagnostic strategies and their impact in patient outcomes and health economics. Such studies could provide high-quality evidence on the sensitivity, specificity and cost effectiveness of these tools compared to current tests.