In vitro diagnostics and molecular basis of IgE-mediated food allergies

Abstract

Detection of allergen-specific IgE represents the most important tool for in vitro diagnostic testing of food allergy. Applied methods vary in design (single allergen sources or mixtures, panel tests, single allergen components) and diagnostic efficacy. High specific IgE to liens egg, cows milk, peanut and fish is associated with an increased risk for clinical reactions, but rarely supersedes oral challenge tests. Cellular tests with basophil leukocytes, demonstrating IgE-mediated sensitizations indirectly, are useful only in selected cases. Particular protein families (i.e. Bet v 1 homologs, lipid transfer proteins and profilms) consist of allergenic molecules with similar sequence and structure. Their shared IgE binding sites form the basis of cross-reactivity. Cross-reactive carbohydrate determinants (CCD), frequently from plant origin, can also bind IgE being rarely clinically relevant. Allergy to plants (i.e. tree nuts, fruits, legumes) and animals (cows milk, liens egg, fish) is diagnosed with extracts, if their quality is sufficient. Detecting IgE to single allergenic components allows molecule-specific diagnoses, their value varies for each allergen source and single allergen component. Allergen-specific IgE detections are indicated in case of suspected food-allergic reactions despite uncertain history and skin tests, sensitizations to foods not applicable for skin testing, severe reactions to foods, conditions hampering skin testing or its interpretation, and in children. Interpreting should consider incorrect results due to inferior reagents or laboratory errors and clinically irrelevant results due to highly elevated total IgE, low assay thresholds or cross-reactive allergens (errors of interpretation). Positive test results indicate allergen-specific sensitizations, being clinically relevant only in case of corresponding symptoms. The following methods are not useful for diagnosing food allergy: bioresonance, electroacupuncture, kinesiology, cytotoxic food allergy test (methods without validity and/or evidence), lymphocyte stimulation test, food-specific IgG and IgG4 (methods with invalid interpretation).