食物过敏最准确的诊断是通过正式的口服食物挑战(OFC);然而,这是时间和劳动力密集型的,个人有严重反应的风险,并且访问通常是诊断过程中的限制步骤。这对于树坚果过敏诊断是复杂的,因为可能需要几个OFC来确定每个单独的树坚果的过敏状态。使用微创诊断测试来预测临床树坚果过敏的准确诊断对于正确识别具有潜在威胁生命的反应的人以及有效且安全地针对仅那些被认为过敏的坚果来减少限制饮食和增加食物选择是重要的食物过敏个体。
对临床试验的诊断能力进行系统评价(皮肤点刺试验,特异性IgE,组件解析诊断,和嗜碱性粒细胞活化试验)以确定OFC证明或临床树坚果过敏。
我们搜索了4个电子数据库(OVIDMedline,Embase,科克伦图书馆,和PubMed)直到2020年5月。符合条件的研究按树坚果的类型和诊断测试进行分类。
共有27项研究评估了对特定树坚果的诊断准确性。总的来说,诊断测试的准确性是合理的,在少数树坚果中建立了95%的阳性预测值。腰果有最好的诊断准确性,腰果成分Anao3最具预测性。在光谱的另一端,杏仁的诊断测试很差,临床使用有限。
系统综述强调了我们目前对树坚果过敏的诊断工具的局限性,并强调了进一步的研究领域。描述了腰果/开心果和核桃/山核桃之间交叉反应的单向性,可以帮助诊断。使用诊断算法,如核桃/山核桃和腰果/开心果过敏,可以实现更高的诊断准确性和减少的OFC数量。
Food allergy is most accurately diagnosed by a formal oral food challenge (OFC); however, it is time and labor intensive, risks the individual to severe reaction, and access is often a limiting step in the diagnostic process. This is compounded for tree nut allergy diagnosis as several OFCs may be required to determine allergy status to each individual tree nut. Accurate diagnosis using minimally invasive diagnostic tests in predicting clinical tree nut allergy is important to correctly identify those with potentially life-threatening reactions and to efficiently and safely tailor nut avoidance to only those nuts deemed allergic to enable less restricted diets and increased food choices for food allergic individuals.
To conduct a systematic
review on the diagnostic capacity of clinical tests (skin prick test, specific IgE, component-resolved diagnostics, and basophil activation test) to determine OFC-proven or clinical tree nut allergy.
We searched 4 electronic databases (OVID Medline, Embase, Cochrane library, and PubMed) until May 2020. Eligible studies were categorized by type of tree nut and diagnostic test.
A total of 27 studies assessed diagnostic accuracy to a specific tree nut. Overall, the accuracy of diagnostic testing was only reasonable, with 95% positive predictive values established in a small number of tree nuts. Cashew has best diagnostic accuracy, with the cashew component Ana o 3 being most predictive. At the other end of the spectrum, diagnostic testing of almond is poor and of limited clinical use.
The systematic
review highlights the limitations of our current diagnostic tools for tree nut allergy and highlights further areas for research. The unidirectionality of cross-reactivity between cashew/pistachio and walnut/pecan is described and can aid diagnosis. Using diagnostic algorithms such as those demonstrated for walnut/pecan and cashew/pistachio allergy, greater diagnostic accuracy and reduced number of OFCs may be achieved.