Related Experiment Video
Updated: Jun 11, 2025
Basophil Activation Test for Allergy Diagnosis
Published on: May 31, 2021
Oral Food Challenge in Children with Tree Nut and Peanut Allergy: The Predictive Value of Diagnostic Tests
Ludovica Cela1, Alessandro Gravina1, Antonio Semeraro1
1Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy.
Insights
Food allergy diagnosis in children relies on oral food challenges (OFCs). While skin prick tests (SPTs) and serum specific IgE (sIgE) show variable predictive value, OFCs remain the definitive diagnostic standard.
Area of Science:
- Allergy and Immunology
- Pediatrics
- Diagnostic Medicine
Background:
- Food allergy (FA) affects 6-8% of young children, with tree nut and peanut allergies being common causes of anaphylaxis.
- The oral food challenge (OFC) is the gold standard for diagnosing food allergies.
- Skin prick tests (SPTs) and serum specific IgE (sIgE) tests are also used in clinical practice.
Purpose of the Study:
- To review current evidence on the predictive value (PV) of SPTs and sIgE for OFC outcomes in diagnosing food allergies.
- To synthesize conflicting literature data regarding the correlation between sIgE levels, SPT wheal size, and OFC results.
Main Methods:
- A narrative review of existing literature was conducted.
- Evidence regarding the predictive value of in vivo (SPTs) and in vitro (sIgE) tests for OFC outcomes was collected and analyzed.
Main Results:
- Data in the literature are conflicting regarding the correlation between increasing sIgE concentration and SPT wheal size with OFC outcomes.
- Most studies reviewed indicate that SPTs and sIgE tests may predict OFC outcomes, but with variable predictive value.
- The conclusive evidence for the predictive accuracy of these tests is not yet established.
Conclusions:
- While SPTs and sIgE tests show potential in predicting food allergy diagnosis, their predictive value is variable and not consistently conclusive.
- The oral food challenge (OFC) remains the current gold standard for the definitive diagnosis of food allergies due to limitations in other testing methods.
Abstract:
Food allergy (FA) affects approximately 6-8% of young children, with a peak prevalence at approximately one year of age. Tree nut and peanut allergies are among the main causes of anaphylaxis in the world. The gold standard for the diagnosis of FAs is the oral food challenge (OFC). Other diagnostic tests used in the clinical practice are skin prick tests (SPTs) and laboratory tests to measure out the presence of serum specific IgE (sIgE). In this narrative review, we collect the current evidence of the predictive value (PV) of SPTs and sIgE for the outcome of the OFCs. In literature, data are conflicting as to whether increasing sIgE concentration and wheal size in SPTs correlate with OFC outcomes. Most studies included in our review have shown that in vivo and in vitro tests may predict OFC outcomes with variable PV, but data are not conclusive; therefore, the OFC currently remains the gold standard for FA diagnosis.
