Component-resolved diagnosis in adult patients with food-dependent anaphylaxis

Food anaphylaxis is a severe, potentially life-threatening, systemic hypersensitivity reaction. Within a retrospective study we applied ImmunoCAP-ISAC in a heterogenous cohort of 54 food anaphylactic patients and compared its performance to conventional in vitro (ELISA, ImmunoCAP) and in vivo (skin prick test, oral food challenge) diagnosis. Comparing clinical diagnosis with results obtained by ImmunoCAP-ISAC we obtained moderate agreement (kappa 0.524, p < 0.05). The comparison between SPT and ImmunoCAP vs ImmunoCAP-ISAC indicates a good sensitivity of microarray testing. Among the 54 tested sera, 36 and 41 were in substantial agreement with results obtained by SPT (69%, kappa 0.667, p < 0.05) and ImmunoCAP-ISAC (76%, kappa 0.759, p < 0.05), respectively. Within this adult anaphylaxis cohort, plant food allergens were identified as the predominant IgE-binding proteins, with PR10 proteins, ω-5-gliadin and nsLTPs as the most frequent ones. In summary, microarray based IgE testing may help to unravel the elicitating food in anaphylaxis in particular when the elicitor is so far unknown.