TY - JOUR
T1 - Predicting food allergy: The value of patient history reinforced
AU - Lyons, Sarah A.
AU - Knulst, André C.
AU - Burney, Peter G. J.
AU - Fernandez-Rivas, Montserrat
AU - Ballmer-Weber, Barbara K.
AU - Barreales, Laura
AU - Bieli, Christian
AU - Clausen, Michael
AU - Dubakiene, Ruta
AU - Fernandez-Perez, Cristina
AU - Jedrzejczak-Czechowicz, Monika
AU - Kowalski, Marek L.
AU - Kummeling, Ischa
AU - Kralimarkova, Tanya
AU - Mustakov, Tihomir B.
AU - van Os-Medendorp, Harmieke
AU - Papadopoulos, Nikolaos G.
AU - Popov, Todor A.
AU - Potts, James
AU - Versteeg, Serge A.
AU - Xepapadaki, Paraskevi
AU - Welsing, Paco M. J.
AU - Mills, Clare
AU - van Ree, Ronald
AU - le, Thuy-My
N1 - Funding Information: 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. Funding Information: We would like to thank all the patients for their participation in the study. We acknowledge the support of the EuroPrevall project by the EU (grant FP6‐FOOD‐CT‐2005‐514000). Publisher Copyright: © 2020 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - Europe
KW - food allergy
KW - food sensitization
KW - patient history
KW - prediction
UR - http://www.scopus.com/inward/record.url?scp=85091388518&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/all.14583
DO - https://doi.org/10.1111/all.14583
M3 - Article
C2 - 32894581
SN - 0105-4538
VL - 76
SP - 1454
EP - 1462
JO - Allergy: European Journal of Allergy and Clinical Immunology
JF - Allergy: European Journal of Allergy and Clinical Immunology
IS - 5
ER -