Skip to main content

Advertisement

Log in

Biomarkers in Food Allergy

  • Food Allergy (T Green, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To familiarize the reader with the concept of precision medicine in food allergy by dealing with the current biomarkers for the diagnosis, prognosis, and management of the disease.

Recent Findings

Many efforts have been devoted in order to characterize reliable biomarkers able to identify specific phenotypes and endotypes in food allergy. Specific IgE (sIgE), sIgE/total IgE ratios, and T cell assays are just a few candidates that have been investigated over time. With the advent of omics sciences, a new era is commencing. A better understanding of pathogenesis of food allergy and mechanisms of action of the different therapeutic options will allow the accurate selection of the appropriate patient.

Summary

In the near future, advances in technologies and data interpretation will allow a better understanding of the pathogenesis of food allergy and the identification of proper biomarkers for a personalized treatment tailored on the specific patient’s profile.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BAT:

basophil activation test

CM:

cow’s milk

FA:

IgE-mediated food allergy

FEV1/FVC:

forced expiratory volume in one second/forced vital capacity

HE:

hen’s egg

IEC:

intestinal epithelial cell

LR:

likelihood ratio

LTP:

lipid transfer proteins

MAT:

mast cell activation test

MD:

molecular diagnostics

MS:

mass spectrometry

NPV:

negative predictive value

OFC:

oral food challenge

OIT:

oral immunotherapy

PA:

peanut allergy

PR-10:

pathogenesis-related protein-10

PPV:

positive predictive value

sIgE:

specific immunoglobulin E

SPT:

skin prick test

Treg:

regulatory T cell

References

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

  1. Arasi S, Mennini M, Valluzzi R, Riccardi C, Fiocchi A. Precision medicine in food allergy. Curr Opin Allergy Clin Immunol. 2018. https://doi.org/10.1097/ACI.0000000000000465.

  2. •• Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69:1008–25 The guidelines of the European Academy of Allergy and Clinical Immunology (EAACI) on the recognition, assessment, and management of food allergy and anaphylaxis.

    Article  CAS  Google Scholar 

  3. Punekar YS, Sheikh A. Establishing the sequential progression of multiple allergic diagnoses in a UK birth cohort using the General Practice Research Database. Clin Exp Allergy. 2009;39:1889–95.

    Article  CAS  Google Scholar 

  4. Nissen SP, Kjaer HF, Host A, Nielsen J, Halken S. The natural course of sensitization and allergic diseases from childhood to adulthood. Pediatr Allergy Immunol. 2013;24:549–55.

    Article  Google Scholar 

  5. Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, et al. Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow’s milk according to age: a systematic review. Ital J Pediatr. 2017;43:93.

    Article  Google Scholar 

  6. Calvani M, Arasi S, Bianchi A, Caimmi D, Cuomo B, Dondi A, et al. Is it possible to make a diagnosis of raw, heated, and baked egg allergy in children using cutoffs? A systematic review. Pediatr Allergy Immunol. 2015;26:509–21.

    Article  Google Scholar 

  7. Santos AF, Brough HA. Making the most of in vitro tests to diagnose food allergy. J Allergy Clin Immunol Pract. 2017;5:237–48.

    Article  Google Scholar 

  8. Grabenhenrich L, Lange L, Hartl M, Kalb B, Ziegert M, Finger A, et al. The component-specific to total IgE ratios do not improve peanut and hazelnut allergy diagnoses. J Allergy Clin Immunol. 2016;137:1751–60.

    Article  CAS  Google Scholar 

  9. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372:803–13.

    Article  Google Scholar 

  10. Caubet JC, Bencharitiwong R, Moshier E, Godbold JH, Sampson HA, Nowak-Wegrzyn A. Significance of ovomucoid- and ovalbumin-specific IgE/IgG(4)ratios in egg allergy. J Allergy Clin Immunol. 2012;129:739–47.

    Article  CAS  Google Scholar 

  11. Mabelane T, Basera W, Botha M, Facey Thomas H, Ramjith J, Levin ME. Predictive values of alpha-gal IgE levels and alpha-gal IgE:total IgE ratio and oral food challenge proven meat allergy in a population with a high prevalence of reported red meat allergy. Pediatr Allergy Immunol. 2018. https://doi.org/10.1111/pai.12969.

  12. Glaumann S, Nopp A, Johansson SG, Rudengren M, Borres MP, Nilsson C. Basophil allergen threshold sensitivity, CD-sens, IgE-sensitization and DBPCFC in peanut-sensitized children. Allergy. 2012;67:242–7.

    Article  CAS  Google Scholar 

  13. Santos AF, Couto-Francisco N, Bécares N, Kwok M, Bahnson HT, Lack G. A novel human mast cell activation test for peanut allergy. J Allergy Clin Immunol. 2018. https://doi.org/10.1016/j.jaci.2018.03.011.

    Article  Google Scholar 

  14. Guerra ENS, Acevedo AC, Porto de Toledo I, Combes A, Chardin H. Do mucosal biomarkers reveal the immunological state associated with food allergy? Allergy. 2018. https://doi.org/10.1111/all.13571.

  15. Freeland DMH, Manohar M, Andorf S, Hobson BD, Zhang W, Nadeau KC. Oral immunotherapy for food allergy. Semin Immunol. 2017;30:36–44.

    Article  CAS  Google Scholar 

  16. Dhondalay GK, Rael E, Acharya S, Zhang W, Sampath V, Galli SJ, et al. Food allergy and omics. J Allergy Clin Immunol. 2018;141:20–9.

    Article  CAS  Google Scholar 

  17. • Syed A, Garcia MA, Lyu SC, et al. Peanut oral immunotherapy results in increased antigen-induced regulatory T-cell function and hypomethylation of forkhead box protein 3 (FOXP3). J Allergy Clin Immunol. 2014;133:500–10 Elegant study showing epigenetic changes in allergen specific T cell as reliable biomarker of clinical response to allergen specific immunotherapy in peanut allergic patients.

    Article  CAS  Google Scholar 

  18. Paparo L, Nocerino R, Cosenza L, Aitoro R, D’Argenio V, del Monaco V, et al. Epigenetic features of FoxP3 in children with cow’s milk allergy. Clin Epigenetics. 2016;8:86.

    Article  Google Scholar 

  19. Martino D, Neeland M, Dang T, Cobb J, Ellis J, Barnett A, et al. Epigenetic dysregulation of naive CD4+ T-cell activation genes in childhood food allergy. Nat Commun. 2018;9:3308.

    Article  Google Scholar 

  20. • Chinthrajah RS, Purington N, Andorf S, et al. Development of a tool predicting severity of allergic reaction during peanut challenge. Ann Allergy Asthma Immunol. 2018. https://doi.org/10.1016/j.anai.2018.04.020 This preliminary study proposes the first integrated approach combining different available diagnostic tools in order to identify subjects at higher risk for severe reactions to a standardized peanut oral food challenge.

    Google Scholar 

  21. Gupta M, Cox A, Nowak-Węgrzyn A, Wang J. Diagnosis of food allergy. Immunol Allergy Clin N Am. 2018;38:39–52.

    Article  Google Scholar 

  22. Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, et al. Food allergy: a practice parameter update—2014. J Allergy Clin Immunol. 2014;134:1016–25.

    Article  Google Scholar 

  23. Niggemann B. When is an oral food challenge positive? Allergy. 2010;65:2–6.

    Article  Google Scholar 

  24. Roberts G, Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol. 2005;115:1291–6.

    Article  CAS  Google Scholar 

  25. Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, et al. Adverse Reactions to Food Committee of American Academy of Allergy, Asthma & Immunology. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123(Suppl 6):S365–83.

    Article  Google Scholar 

  26. Wainstein BK, Studdert J, Ziegler M, Ziegler JB. Prediction of anaphylaxis during peanut food challenge: usefulness of the peanut skin prick test (SPT) and specific IgE level. Pediatr Allergy Immunol. 2010;21:603–11.

    Article  Google Scholar 

  27. Johannsen H, Nolan R, Pascoe EM, Cuthbert P, Noble V, Corderoy T, et al. Skin prick testing and peanut-specific IgE can predict peanut challenge outcomes in preschool children with peanut sensitization. Clin Exp Allergy. 2011;41:994–1000.

    Article  CAS  Google Scholar 

  28. DunnGalvin A, Daly D, Cullinane C, Stenke E, Keeton D, Erlewyn- Lajeunesse M, et al. Highly accurate prediction of food challenge outcome using routinely available clinical data. J Allergy Clin Immunol. 2011;127:633–9.

    Article  Google Scholar 

  29. Klemans RJ, van Os-Medendorp H, Blankestijn M, Bruijnzeel-Koomen CA, Knol EF, Knulst AC. Diagnostic accuracy of specific IgE to components in diagnosing peanut allergy: a systematic review. Clin Exp Allergy. 2015;45:720–30.

    Article  CAS  Google Scholar 

  30. Satagopan JM, Iasonos A, Zhou Q. Prognostic and predictive values and statistical interactions in the era of targeted treatment. Genet Epidemiol. 2015;39:509–17.

    Article  Google Scholar 

  31. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, et al. EAACI Molecular Allergology User’s Guide. Pediatr Allergy Immunol. 2016;27(Suppl 23):1–250.

    Article  Google Scholar 

  32. Heffler E, Puggioni F, Peveri S, Montagni M, Canonica GW, Melioli G. Extended IgE profile based on an allergen macroarray: a novel tool for precision medicine in allergy diagnosis. World Allergy Organ J. 2018;11:7.

    Article  Google Scholar 

  33. Sicherer SH, Wood RA, Vickery BP, Jones SM, Liu AH, Fleischer DM, et al. The natural history of egg allergy in an observational cohort. J Allergy Clin Immunol. 2014;133:492–9.

    Article  Google Scholar 

  34. Peters RL, Dharmage SC, Gurrin LC, Koplin JJ, Ponsonby AL, Lowe AJ, et al. HealthNuts study. The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study. J Allergy Clin Immunol. 2014;133:485–91.

    Article  CAS  Google Scholar 

  35. Dang R, Peters R, Allen K. Debates in allergy medicine: baked egg and milk do not accelerate tolerance to egg and milk. World Allergy Organ J. 2016;9:2.

    Article  Google Scholar 

  36. Dang TD, Peters RL, Koplin JJ, et al. HealthNuts study. Egg allergen specific IgE diversity predicts resolution of egg allergy in the population cohort HealthNuts. Allergy. 2018. https://doi.org/10.1111/all.13572.

  37. Beyer K, Ellman-Grunther L, Jarvinen KM, Wood RA, Hourihane J, Sampson HA. Measurement of peptide-specific IgE as an additional tool in identifying patients with clinical reactivity to peanuts. J Allergy Clin Immunol. 2003;112:202–7.

    Article  CAS  Google Scholar 

  38. Lin J, Bruni FM, Fu Z, Maloney J, Bardina L, Boner AL, et al. A bioinformatics approach to identify patients with symptomatic peanut allergy using peptide microarray immunoassay. J Allergy Clin Immunol. 2012;129:1321–8.

    Article  CAS  Google Scholar 

  39. Ayuso R, Sanchez-Garcia S, Pascal M, Lin J, Grishina G, Fu Z, et al. Is epitope recognition of shrimp allergens useful to predict clinical reactivity? Clin Exp Allergy. 2012;42:293–304.

    Article  CAS  Google Scholar 

  40. Wang J, Lin J, Bardina L, Goldis M, Nowak-Wegrzyn A, Shreffler WG, et al. Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy. J Allergy Clin Immunol. 2010;125:695–702.

    Article  CAS  Google Scholar 

  41. Gupta RS, Lau CH, Hamilton RG, Donnell A, Newhall KK. Predicting outcomes of oral food challenges by using the allergen-specific IgE-total IgE ratio. J Allergy Clin Immunol Pract. 2014;2:300–5.

    Article  Google Scholar 

  42. Mehl A, Verstege A, Staden U, Kulig M, Nocon M, Beyer K, et al. Utility of the ratio of food-specific IgE/total IgE in predicting symptomatic food allergy in children. Allergy. 2005;60:1034–9.

    Article  CAS  Google Scholar 

  43. Fiocchi A, Wang J. omic sciences: new horizons in food allergy. Curr Opin Allergy Clin Immunol. 2015;15:234–6.

    Article  Google Scholar 

  44. Boyano-Martínez T, García-Ara C, Pedrosa M, Díaz-Pena JM, Quirce S. Accidental allergic reactions in children allergic to cow’s milk proteins. J Allergy Clin Immunol. 2009;123:883–8.

    Article  Google Scholar 

  45. Nurmatov U, Dhami S, Arasi S, Pajno GB, Fernandez-Rivas M, Muraro A, et al. Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis. Allergy. 2017;72:1133–47.

    Article  CAS  Google Scholar 

  46. Arasi S, Pajno G. Evidence gaps in Oral immunotherapy for food allergy. Curr Treat Options Allergy. 2017;4:458–67.

    Article  Google Scholar 

  47. •• Pajno GB, Fernandez-Rivas M, Arasi S, et al. EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy. Allergy. 2018;74:799–815 The up-to-date guidelines of the European Academy of Allergy and Clinical Immunology (EAACI) on the management of allergen immunotherapy in food allergy. Evidence-based recommendations are provided for clinical practice.

    Article  Google Scholar 

  48. Arasi S, Corsello G, Villani A, Pajno GB. The future outlook on allergen immunotherapy in children: 2018 and beyond. Ital J Pediatr. 2018.

  49. Turcanu V, Maleki SJ, Lack G. Characterization of lymphocyte responses to peanuts in normal children, peanut-allergic children, and allergic children who acquired tolerance to peanuts. J Clin Invest. 2003;111:1065–72.

    Article  CAS  Google Scholar 

  50. Flinterman AE, Pasmans SG, den Hartog Jager CF, Hoekstra MO, Bruijnzeel-Koomen CA, Knol EF, et al. T cell responses to major peanut allergens in children with and without peanut allergy. Clin Exp Allergy. 2010;40:590–7.

    CAS  PubMed  Google Scholar 

  51. Dang TD, Allen KJ, J Martino D, Koplin JJ, Licciardi PV, Tang ML. Foodallergic infants have impaired regulatory T-cell responses following in vivo allergen exposure. Pediatr Allergy Immunol. 2016;27:35–43.

    Article  Google Scholar 

  52. Bandyopadhyay S, Fisher DAC, Malkova O, Oh ST. Analysis of signaling networks at the single-cell level using mass cytometry. Methods Mol Biol. 2017;1636:371–92.

    Article  CAS  Google Scholar 

  53. Goswami R, Blazquez AB, Kosoy R, Rahman A, Nowak-Wegrzyn A, Berin MC. Systemic innate immune activation in food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 2017;139:1885–96.e9.

    Article  CAS  Google Scholar 

  54. Ryan JF, Hovde R, Glanville J, Lyu SC, Ji X, Gupta S, et al. Successful immunotherapy induces previously unidentified allergen-specific CD41 T-cell subsets. Proc Natl Acad Sci U S A. 2016;113:E1286–95.

    Article  CAS  Google Scholar 

  55. Wood RA, Sampson HA. Oral immunotherapy for the treatment of peanut allergy: is it ready for prime time? J Allergy Clin Immunol Pract. 2014;2:97–8 30.

    Article  Google Scholar 

  56. Lucendo AJ, Arias A, Tenias JM. Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with metaanalysis. Ann Allergy Asthma Immunol. 2014;113:624–9.

    Article  Google Scholar 

  57. Pillon R, Ziberna F, Badina L, Ventura A, Longo G, Quaglia S, et al. Prevalence of celiac disease in patients with severe food allergy. Allergy. 2015;70:1346–9.

    Article  CAS  Google Scholar 

  58. Breiteneder H. Mapping of conformational IgE epitopes of food allergens. Allergy. 2018. https://doi.org/10.1111/all.13592.

  59. Kim E, Lembert M, Fallata GM, et al. Intestinal epithelial cells regulate gut eotaxin responses and severity of allergy. Front Immunol. 2018;9:1692.

    Article  Google Scholar 

  60. Tripodi S, Comberiati P, Di Rienzo Businco A, et al. Severe anaphylaxis to sheep’s milk cheese in a child desensitized to cow’s milk through specific oral tolerance induction. Eur Ann Allergy Clin Immunol. 2013;45:56–60.

    CAS  PubMed  Google Scholar 

  61. Bégin P, Dominguez T, Wilson SP, Bacal L, Mehrotra A, Kausch B, et al. Phase 1 results of safety and tolerability in a rush oral immunotherapy protocol to multiple foods using omalizumab. Allergy Asthma Clin Immunol. 2014;10:7.

    Article  Google Scholar 

  62. Wood RA, Kim JS, Lindblad R, Nadeau K, Henning AK, Dawson P, et al. A randomized, double-blind, placebo-controlled study of omalizumab combined with oral immunotherapy for the treatment of cow’s milk allergy. J Allergy Clin Immunol. 2016;137:1103–10.

    Article  CAS  Google Scholar 

  63. Sampath V, Sindher SB, Zhang W, Nadeau KC. New treatment directions in food allergy. Ann Allergy Asthma Immunol. 2018;120:254–62.

    Article  Google Scholar 

  64. Wichers H. Immunomodulation by food: promising concept for mitigating allergic disease? Anal Bioanal Chem. 2009;395:37–45.

    Article  CAS  Google Scholar 

  65. Piras C, Guo Y, Soggiu A, et al. Changes in protein expression profiles in bovine endometrial epithelial cells exposed to E. coli LPS challenge. Mol Biosyst. 2017;13:392–405.

    Article  CAS  Google Scholar 

  66. Macpherson AJ, Harris NL. Interactions between commensal intestinal bacteria and the immune system. Nat Rev Immunol. 2004;4:478–85.

    Article  CAS  Google Scholar 

  67. Kolmeder CA, Ritari J, Verdam FJ, Muth T, Keskitalo S, Varjosalo M, et al. Colonic metaproteomic signatures of active bacteria and the host in obesity. Proteomics. 2015;15:3544–52.

    Article  CAS  Google Scholar 

  68. Koeberl M, Clarke D, Lopata AL. Next generation of food allergen quantification using mass spectrometric systems. J Proteome Res. 2014;13:3499–509.

    Article  CAS  Google Scholar 

  69. Bräcker J, Brockmeyer J. Characterization and detection of food allergens using high-resolution mass spectrometry: current status and future perspective. J Agric Food Chem. 2018;66:8935–40. https://doi.org/10.1021/acs.jafc.8b02265.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antonella Muraro.

Ethics declarations

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Food Allergy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Muraro, A., Arasi, S. Biomarkers in Food Allergy. Curr Allergy Asthma Rep 18, 64 (2018). https://doi.org/10.1007/s11882-018-0816-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-018-0816-4

Keywords

Navigation