Novel diagnostics in food allergy

Food allergy is increasing in prevalence, posing significant challenges for individuals and their families and adversely affecting their quality of life. Misdiagnosis can lead to unnecessary dietary and social limitations and increased food allergy risk, whereas failure to diagnose may result in life-threatening anaphylaxis. Therefore, a precise diagnosis is of the utmost importance; however, barriers exist at every stage of the diagnostic process. Diagnosis of food allergy relies on clinical history, IgE sensitization tests, and oral food challenge. Component testing and identification of optimal cutoffs have improved diagnostic accuracy. Nevertheless, many patients still require an oral food challenge, and better tests are needed to reduce this need. Novel ways of detecting biomarkers, such as the basophil activation test and peptide-specific IgE level, are transitioning into clinical practice. Future approaches may include the use of alternative biologic samples, novel laboratory technologies, and analytic tools (including artificial intelligence) to integrate test results and clinical information. Conscientious use of existing tests, access to tests with superior diagnostic accuracy, and combination of tests, can lead to improved precision of diagnosis of food allergy and timely introduction of tolerated foods into the diet. This review summarizes recent advances in novel approaches to food allergy diagnosis that can enhance clinical decision making both now and in the future.