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. 2021 May;76(5):1454-1462.
doi: 10.1111/all.14583. Epub 2020 Sep 24.

Predicting food allergy: The value of patient history reinforced

Sarah A Lyons  1 , André C Knulst  1 , Peter G J Burney  2 , Montserrat Fernandez-Rivas  3 , Barbara K Ballmer-Weber  4   5   6 , Laura Barreales  7 , Christian Bieli  8 , Michael Clausen  9 , Ruta Dubakiene  10 , Cristina Fernandez-Perez  7 , Monika Jedrzejczak-Czechowicz  11 , Marek L Kowalski  11 , Ischa Kummeling  2 , Tanya Kralimarkova  12 , Tihomir B Mustakov  12 , Harmieke van Os-Medendorp  1   13 , Nikolaos G Papadopoulos  14   15 , Todor A Popov  16 , James Potts  2 , Serge A Versteeg  17 , Paraskevi Xepapadaki  14 , Paco M J Welsing  18 , Clare Mills  19 , Ronald van Ree  17   20 , Thuy-My Le  1
Affiliations

Predicting food allergy: The value of patient history reinforced

Sarah A Lyons et al. Allergy. 2021 May.

Abstract

Background: EAACI guidelines emphasize the importance of patient history in diagnosing food allergy (FA) and the need for studies investigating its value using standardized allergy-focused questionnaires.

Objective: To determine the contribution of reaction characteristics, allergic comorbidities and demographics to prediction of FA in individuals experiencing food-related adverse reactions.

Methods: Adult and school-age participants in the standardized EuroPrevall population surveys, with self-reported FA, were included. Penalized multivariable regression was used to assess the association of patient history determinants with "probable" FA, defined as a food-specific case history supported by relevant IgE sensitization.

Results: In adults (N = 844), reproducibility of reaction (OR 1.35 [95% CI 1.29-1.41]), oral allergy symptoms (OAS) (4.46 [4.19-4.75]), allergic rhinitis (AR) comorbidity (2.82 [2.68-2.95]), asthma comorbidity (1.38 [1.30-1.46]) and male sex (1.50 [1.41-1.59]) were positively associated with probable FA. Gastrointestinal symptoms (0.88 [0.85-0.91]) made probable FA less likely. The AUC of a model combining all selected predictors was 0.85 after cross-validation. In children (N = 670), OAS (2.26 [2.09-2.44]) and AR comorbidity (1.47 [CI 1.39-1.55]) contributed most to prediction of probable FA, with a combined cross-validation-based AUC of 0.73. When focusing on plant foods, the dominant source of FA in adults, the pediatric model also included gastrointestinal symptoms (inverse association), and the AUC increased to 0.81.

Conclusions: In both adults and school-age children from the general population, reporting of OAS and of AR comorbidity appear to be the strongest predictors of probable FA. Patient history particularly allows for good discrimination between presence and absence of probable plant FA.

Keywords: Europe; food allergy; food sensitization; patient history; prediction.

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Conflict of interest statement

Outside of submitted work: Dr Papadopoulos reports personal fees from Novartis, Nutricia, HAL Allergy, Menarine/Faes Farma, Sanofi, Mylan/Meda, Biomay, AstraZeneca, GSK, MSD, ASIT Biotech, Boehringer Ingelheim; and grants from Gerolymatos International SA, and Capricare. Dr Fernández‐Rivas reports grants from Aimmune and Diater, and personal fees from Aimmune, Diater, ALK, DBV, Allergy Therapeutics, GSK, HAL Allergy, Thermo Fisher Scientific and SPRIM. Dr Ballmer‐Weber reports personal fees from Thermo Fisher Scientific. Dr Xepapadaki reports personal fees from Uriach, Novartis, Nestle, and Nutricia. Dr Mills reports grants from Reacta Biotech; and is shareholder of Reacta Biotech Ltd. Dr Van Ree reports personal fees from HAL Allergy BV, Citeq BV, Angany Inc, and Thermo Fisher Scientific. The other authors declare that they have no relevant conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Independent predictors of probable FA in individuals reporting food‐related symptoms, results from Lasso regression analysis. 95% confidence intervals were calculated from standard errors obtained through 1000 bootstrap samples.GI, gastrointestinal; OA, oral allergy
See this image and copyright information in PMC

References

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