Current Allergy and Asthma Reports

, Volume 13, Issue 1, pp 58–63 | Cite as

Allergen Component Testing for Food Allergy: Ready for Prime Time?



Food allergies can cause life-threatening reactions and greatly influence quality of life. Accurate diagnosis of food allergies is important to avoid serious allergic reactions and prevent unnecessary dietary restrictions, but can be difficult. Skin prick testing (SPT) and serum food-specific IgE (sIgE) levels are extremely sensitive testing options, but positive test results to tolerated foods are not uncommon. Allergen component-resolved diagnostics (CRD) have the potential to provide a more accurate assessment in diagnosing food allergies. Recently, a number of studies have demonstrated that CRD may improve the specificity of allergy testing to a variety of foods including peanut, milk, and egg. While it may be a helpful adjunct to current diagnostic testing, CRD is not ready to replace existing methods of allergy testing, as it not as sensitive, is not widely available, and evaluations of component testing for a number of major food allergens are lacking.


Food allergy Diagnosis Skin prick testing Food-specific IgE Sensitivity Specificity Oral food challenge Component-resolved diagnostics Microarray Milk allergy Hazelnut allergy Egg allergy Peanut allergy Shrimp allergy 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(suppl):S1–58. National Institute of Allergy and Infectious Diseases sponsored consensus guidelines for the diagnosis and management of food allergy.PubMedGoogle Scholar
  2. 2.
    Chafen JJ, Newberry SJ, Riedl MA, et al. Diagnosing and managing common food allergies: a systematic review. JAMA. 2010;303:1848–56.PubMedCrossRefGoogle Scholar
  3. 3.
    Rona RJ, Keil T, Summers C, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007;120:638–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124:1549–55.PubMedCrossRefGoogle Scholar
  5. 5.
    Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow up. J Allergy Clin Immunol. 2010;125:1322–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Lieberman JA, Cox AL, Vitale M, Sampson HA. Outcomes of office-based, open food challenges in the management of food allergy. J Allergy Clin Immunol. 2011;128:1120–2.PubMedCrossRefGoogle Scholar
  7. 7.
    Ott H, Baron JM, Heise R, et al. Clinical usefulness of microarray-based IgE detection in children with suspected food allergy. Allergy. 2008;63:1521–8.PubMedCrossRefGoogle Scholar
  8. 8.
    D’Urbano LE, Pellegrino K, Artesani MC, et al. Performance of a component-based allergen-microarray in the diagnosis of cow’s milk and hen’s egg allergy. Clin Exp Allergy. 2010;40:1561–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Alessandri C, Zennaro D, Scala E, et al. Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen’s egg and an increased risk to progress to multiple environmental allergen sensitisation. Clin Exp Allergy. 2012;42:441–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Caubet JC, Bencharitiwong R, Moshier E, et al. Significance of ovomucoid- and ovalbumin-specific IgE/IgG(4) ratios in egg allergy. J Allergy Clin Immunol. 2012;129:739–47.PubMedCrossRefGoogle Scholar
  11. 11.
    Lemon-Mulé H, Sampson HA, Sicherer SH, et al. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. 2008;122:977–83.PubMedCrossRefGoogle Scholar
  12. 12.
    • Nicolaou N, Poorafshar M, Murray C, et al. Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol. 2010;125:191–7. Excellent study demonstrating the lack of specificity of SPT and peanut sIgE in the diagnosis of peanut allergy, and identifying Ara h 2 as a key predictor of reactivity to peanut.PubMedCrossRefGoogle Scholar
  13. 13.
    Koppelman SJ, Wensing M, Ertmann M, et al. Relevance of Ara h1, Ara h2 and Ara h3 in peanut-allergic patients, as determined by immunoglobulin E Western blotting, basophil-histamine release and intracutaneous testing: Ara h2 is the most important peanut allergen. Clin Exp Allergy. 2004;34:583–90.PubMedCrossRefGoogle Scholar
  14. 14.
    Dang TD, Tang M, Choo S, et al. Increasing the accuracy of peanut allergy diagnosis by using Ara h 2. J Allergy Clin Immunol. 2012;129:1056–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Osborne NJ, Koplin JJ, Martin PE, et al. The HealthNuts population-based study of paediatric food allergy: validity, safety and acceptability. Clin Exp Allergy. 2010;40:1516–22.PubMedCrossRefGoogle Scholar
  16. 16.
    Koppelman SJ, de Jong GA, Laaper-Ertmann M, et al. Purification and immunoglobulin E-binding properties of peanut allergen Ara h 6: evidence for cross-reactivity with Ara h 2. Clin Exp Allergy. 2005;35:490–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Asarnoj A, Glaumann S, Elfström L, et al. Anaphylaxis to peanut in a patient predominantly sensitized to Ara h 6. Int Arch Allergy Immunol. 2012;159:209–12.PubMedGoogle Scholar
  18. 18.
    Asarnoj A, Movérare R, Ostblom E, et al. IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization in 8-year-olds. Allergy. 2010;65:1189–95.PubMedCrossRefGoogle Scholar
  19. 19.
    Movérare R, Ahlstedt S, Bengtsson U, et al. Evaluation of IgE antibodies to recombinant peanut allergens in patients with reported reactions to peanut. Int Arch Allergy Immunol. 2011;156:282–90.PubMedCrossRefGoogle Scholar
  20. 20.
    • Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol. 2012;130:468–72. Large trial demonstrating that isolated sensitization to the peanut component Ara h 8 almost always indicates tolerance to peanuts.PubMedCrossRefGoogle Scholar
  21. 21.
    Vetander M, Helander D, Lindquist C, et al. Classification of anaphylaxis and utility of the EAACI Taskforce position paper on anaphylaxis in children. Pediatr Allergy Immunol. 2011;22:369–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Gámez C, Sánchez-García S, Ibáñez MD, et al. Tropomyosin IgE-positive results are a good predictor of shrimp allergy. Allergy. 2011;66:1375–83.PubMedCrossRefGoogle Scholar
  23. 23.
    Ortolani C, Ballmer-Weber BK, Hansen KS, et al. Hazelnut allergy; a double-blind, placebo-controlled food challenge multicenter study. J Allergy Clin Immunol. 2000;105:577–81.PubMedCrossRefGoogle Scholar
  24. 24.
    Flinterman AE, Hoekstra MO, Meijer Y, et al. Clinical reactivity to hazelnut in children: association with sensitization to birch pollen or nuts? J Allergy Clin Immunol. 2006;118:1186–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Flinterman AE, Akkerdaas JH. den Hartog Jager CF, et al. Lipid transfer protein-linked hazelnut allergy in children from a non-Mediterranean birch-endemic area. J Allergy Clin Immunol. 2008;121:423–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Sicherer SH, Dhillon G, Laughery KA, et al. Caution: the Phadia hazelnut ImmunoCAP (f17) has been supplemented with recombinant Cor a 1 and now detects Bet v 1-specific IgE, which leads to elevated values for persons with birch pollen allergy. J Allergy Clin Immunol. 2008;122:413–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Phadia Immunology Reference Laboratory. Available at: Accessed August 19, 2012.

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Division of Pediatric Allergy & Immunology and Jaffe Institute for Food AllergyThe Mount Sinai School of MedicineNew YorkUSA
  2. 2.Department of Pediatrics, Box 1198The Mount Sinai School of MedicineNew YorkUSA

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