Date and Time
May 19, 2010
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Jennifer Schneider

Context: There is heightened interest in food allergies but no clear consensus regarding the most effective diagnostic and management approaches.

Evidence Acquisition: PubMed, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects (DARE), and Cochrane Central Register of Controlled Trials (Central). Searches were limited to English-language articles indexed 1/1988-9/2009. We included studies of diagnostic tests if they had a prospective, defined study population, used food challenge as a criterion standard, and reported sufficient data to calculate sensitivity and specificity. We included systematic reviews, and controlled trials for management and prevention outcomes. For foods where anaphylaxis is common we included cohort studies with a sample size greater than 100.

Results: We identified 12,378 citations and included 72. Food allergy affects more than 1-2% but less than 10% of the population. It is unclear if the prevalence of food allergies is increasing. Summary receiver operating characteristic curves comparing skin prick tests (area under the curve 0.87 (0.81, 0.93) and serum food-specific IgE (area under the curve 0.84 (0.78, 0.91) to food challenge showed no statistical superiority in either test. Elimination diets are the mainstay of therapy but have been rarely studied. Immunotherapy is promising but data are insufficient to recommend use. In high-risk infants, hydrolyzed formulas may prevent cow's milk allergy but standardized definitions of "high-risk" and "hydrolyzed formula" do not exist.

Conclusions: The evidence about the prevalence and treatment of food allergy is greatly limited by a lack of uniformity for criteria for making a diagnosis.