Peanut allergy diagnosis: A 2020 practice parameter update, systematic review, and GRADE analysis

Abstract

Given the burden of disease and the consequences of a diagnosis of peanut allergy, it is important that peanut allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is peanut sensitization present (eg, a "positive" test) is not always associated with clinical reactivity. This practice parameter addresses the diagnosis of IgE-mediated peanut allergy, both in children and adults, as pertaining to 3 fundamental questions, and based on the systematic reviews and meta-analyses, makes recommendations for the clinician who is evaluating a patient for peanut allergy. These questions relate to when diagnostic tests should be completed, which diagnostic tests to utilize, and the utility (or lack thereof) of diagnostic testing to predict the severity of a future allergic reaction to peanut.

Keywords: Ara h 2; GRADE analysis; Peanut allergy; cost-effectiveness analysis; diagnosis; evidence to recommendation; likelihood ratio; meta-analysis; peanut components; practice parameter update; serologic IgE testing; skin prick testing; systematic review.