Chapter 2 : Exploring Current and Novel Methods for the Detection and Diagnosis of Food Allergy: the Clinical Approach

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The recently revised nomenclature for allergic diseases includes several manifestations of food allergy such as asthma, urticaria and/or angioedema, anaphylaxis, eczema, and rhinitis. The aim of a correct diagnosis of food allergy is to establish a causal relationship between food ingestion and the clinical symptoms reported by the patient and to identify the triggering allergen and the immune mechanism determining the reaction. The current approach to food allergy diagnosis using well-established tools including medical history, skin test (ST), immunoglobulin E (IgE) detection, and oral challenge, sich as double-blind placebocontrolled food challenge (DBPCFC) is depicted. The use of flow cytometry has increased the use of basophil activation testing to confirm the diagnosis of food allergy. Allergenic molecules can be used as the most objective tool for the best diagnosis and unequivocal identification of affected subjects molecules can be used as the most objective tool for the best diagnosis and unequivocal identification of affected subjects. A combination of in vivo and in vitro tools are needed to reach a good level of diagnostic reliability in food allergy diseases. Great expectations arise from the combined use of allergens obtained by molecular biology techniques, exactly as they are seen and processed by the immune system, sophisticated assays that allow suitable multiple-IgE detection of hundreds of allergenic molecules and global sharing of a huge mass of data. This novel approach will represent developments that are not too far in the future for food allergy diseases.

Citation: Mari A, Scala E. 2006. Exploring Current and Novel Methods for the Detection and Diagnosis of Food Allergy: the Clinical Approach, p 19-47. In Maleki S, Burks A, Helm R (ed), Food Allergy. ASM Press, Washington, DC. doi: 10.1128/9781555815721.ch2
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Image of Figure 1.
Figure 1.

General flow chart for a possible food allergy mechanism: from suspicion to immune mechanism (adapted from ).

Citation: Mari A, Scala E. 2006. Exploring Current and Novel Methods for the Detection and Diagnosis of Food Allergy: the Clinical Approach, p 19-47. In Maleki S, Burks A, Helm R (ed), Food Allergy. ASM Press, Washington, DC. doi: 10.1128/9781555815721.ch2
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Image of Figure 2.
Figure 2.

Flow chart for a diagnostic approach to food allergy diagnosis.

Citation: Mari A, Scala E. 2006. Exploring Current and Novel Methods for the Detection and Diagnosis of Food Allergy: the Clinical Approach, p 19-47. In Maleki S, Burks A, Helm R (ed), Food Allergy. ASM Press, Washington, DC. doi: 10.1128/9781555815721.ch2
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Image of Figure 3.
Figure 3.

Scientific publications related to allergenic molecules. (A) Overall number of papers, dedicated to native or to recombinant molecules, are indicated on the left. (Right) Three-group distribution during the last 40 years. (B) Papers dedicated to basic research (benchside, biochemistry, molecular biology, immunochemistry, immune mechanisms, and genetics) or to clinical research (environmental detection, diagnosis, epidemiology, and immunotherapy) are reported as either overall numbers or distribution during the last 40 years.

Citation: Mari A, Scala E. 2006. Exploring Current and Novel Methods for the Detection and Diagnosis of Food Allergy: the Clinical Approach, p 19-47. In Maleki S, Burks A, Helm R (ed), Food Allergy. ASM Press, Washington, DC. doi: 10.1128/9781555815721.ch2
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Table 1.

Features of in vivo and in vitro tests for food allergy diagnosis

Citation: Mari A, Scala E. 2006. Exploring Current and Novel Methods for the Detection and Diagnosis of Food Allergy: the Clinical Approach, p 19-47. In Maleki S, Burks A, Helm R (ed), Food Allergy. ASM Press, Washington, DC. doi: 10.1128/9781555815721.ch2
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Table 2.

Features of allergenic molecule databases on the Web

Citation: Mari A, Scala E. 2006. Exploring Current and Novel Methods for the Detection and Diagnosis of Food Allergy: the Clinical Approach, p 19-47. In Maleki S, Burks A, Helm R (ed), Food Allergy. ASM Press, Washington, DC. doi: 10.1128/9781555815721.ch2

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