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Future diagnostic tools for food allergy

Doerthe A Andreae, MD
Wayne G Shreffler, MD, PhD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


The tools available for diagnosing food allergy include the clinical history, physical examination, trial elimination diets, diet diaries, skin prick testing (SPT), and allergen-specific serum immunoglobulin E (IgE) testing. Clinician-supervised oral food challenges remain the gold standard and are often required to confirm or rule out the diagnosis because of the limitations in the diagnostic accuracy of the other methods available.

Improved or new testing methodologies are needed for determining the presence and severity of a food allergy and the likelihood of resolution of an allergy. This topic reviews improvements in available diagnostic tools and new testing methods that are in development. Current diagnostic tools are discussed separately, as is the initial evaluation of a patient with suspected food allergy. (See "Diagnostic evaluation of food allergy" and "History and physical examination in the patient with possible food allergy".)


The role of medical testing for food allergy must be thought of in the context of the suspected mechanism of pathogenesis (ie, immunoglobulin E (IgE) or non-IgE mediated) and the limitations of available testing. IgE-mediated food allergy is more common, better understood, and more actively researched. There is also active research on testing for non-IgE-mediated and "IgE-associated" diseases that are believed to be driven, wholly or partly, by dietary proteins (eg, eosinophilic esophagitis [EoE], atopic dermatitis). (See "Diagnostic evaluation of food allergy" and "History and physical examination in the patient with possible food allergy".)

There is a persistent and wide gap between the number of individuals who believe they have food allergies and the true prevalence (approximately 30 and 5 percent, respectively) [1]. Part of this discrepancy stems from confusion regarding allergic (ie, immune-mediated) reactions versus other adverse reactions to foods. Diagnostic test limitations, including the low specificity of specific IgE for true allergy (particularly when used qualitatively), also contribute to overdiagnosis.

Research efforts are focused on improving diagnostic tests and on developing tests that have better prognostic performance. To address limitations, investigators are attempting to characterize the patient immune response in ever greater detail to find phenotypes that more closely correlate with the clinical disease aspect of interest.

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Literature review current through: Nov 2017. | This topic last updated: Jun 28, 2016.
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