Component testing for animal-derived food allergies
- Julie Wang, MD
Julie Wang, MD
- Associate Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
Advances in the identification of clinically relevant allergens and the development of recombinant proteins allow for assessment of immunoglobulin E (IgE) binding to individual proteins within an allergenic food. This type of testing is known as component-resolved diagnosis (CRD). Increased sensitivity and specificity can be achieved by assessing IgE binding to separate proteins, either purified native or recombinant, thereby providing improved diagnostic accuracy in terms of predicting clinical reactivity. CRD may also provide additional prognostic information regarding the severity or persistence of food allergies.
CRD is available for plant-derived and animal-derived foods. While CRD has shown to be informative for pollen-related food allergies, the usefulness of CRD for animal-derived food allergens is not as well defined.
CRD testing for animal-derived food allergies is reviewed here. Component testing for pollen-related, plant-derived food allergies is discussed separately, including an overview of CRD and the types of assays available. An overview of testing for food allergies is also presented separately. (See "Component testing for pollen-related, plant-derived food allergies" and "Diagnostic evaluation of food allergy".)
For milk and egg allergies, component-resolved diagnosis (CRD) allows identification of immunoglobulin E (IgE) binding to specific proteins, which may be informative to distinguish between different phenotypes of milk and egg allergy. For shrimp allergy, cross-reactive proteins with other arthropods (dust mite and cockroach) can result in positive tests that may not be clinically relevant, similar to what is seen in pollen-related, plant-derived food allergies. However, no single test result taken in isolation is reliable enough to negate the need for oral food challenges. Further studies are needed to determine the utility of IgE testing to individual proteins for these foods. (See "Component testing for pollen-related, plant-derived food allergies".)
Milk — Casein (Bos domesticus [Bos d] 8) is the major allergen present in milk, accounting for 75 to 80 percent of all cow's milk proteins . Beta-lactoglobulin (Bos d 5) forms a large portion of whey, accounting for approximately 10 percent of proteins in milk. Alpha-lactalbumin (Bos d 4) represents 25 percent of the whey fraction and comprises 5 percent of cow's milk proteins. Sensitization to other minor components that can be measured include serum albumin (Bos d 6) and transferrin (Bos d lactoferrin).
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