Allergy, Asthma and Immunology: The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy?

Int. J. Environ. Res. Public Health 2013, 10(10), 5039-5061; doi:10.3390/ijerph10105039

Review

Rachel L. Peters^1,2, Lyle C. Gurrin^1,3, Shyamali C. Dharmage^1,3, Jennifer J. Koplin^1,3 and Katrina J. Allen^1,2,4,*

¹ Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia² Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia³ Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, VIC 3010, Australia⁴ Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC 3052, Australia

* Author to whom correspondence should be addressed.

Received: 2 August 2013; in revised form: 16 September 2013 / Accepted: 8 October 2013 / Published: 15 October 2013

(This article belongs to the Special Issue Food Allergy, Genes and Environment)

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Abstract: IgE-mediated food allergy is a transient condition for some children, however there are few indices to predict when and in whom food allergy will resolve. Skin prick test (SPT) and serum-specific IgE levels (sIgE) are usually monitored in the management of food allergy and are used to predict the development of tolerance or persistence of food allergy. The aim of this article is to review the published literature that investigated the predictive value of SPT and sIgE in development of tolerance in children with a previous diagnosis of peanut, egg and milk allergy. A systematic search identified twenty-six studies, of which most reported SPT or sIgE thresholds which predicted persistent or resolved allergy. However, results were inconsistent between studies. Previous research was hampered by several limitations including the absence of gold standard test to diagnose food allergy or tolerance, biased samples in retrospective audits and lack of systematic protocols for triggering re-challenges. There is a need for population-based, prospective studies that use the gold standard oral food challenge (OFC) to diagnose food allergy at baseline and follow-up to develop SPT and sIgE thresholds that predict the course of food allergy.

Keywords: food allergy; natural history; tolerance; skin prick test; serum-specific immunoglobulin E; hen’s egg; peanut; cow’s milk