Evaluation of IgE-mediated food hypersensitivities

During the past 25 years the diagnostic assessment of IgE-associated food h ypersensitivity has improved substantially. The double-blind placebo-contro lled food challenge has become the "gold-standard" against which all other diagnostic approaches can be measured. Having a standard which gives a corr ect answer almost ail of the time, has enabled us to move to more accurate diagnoses in both the clinic and the laboratory. Food allergy has gone from being a medical mystery to being a clear component of allergy evaluation. Histories are obtained from patients which may be used to design food chall enges. The role of skin testing and its interpretation has moved from the f ringe to having a central role in eliminating foods incriminated as causes of immediate-onset allergic reactions. The material used for skin testing f or foods has improved and we have learned when we must use fresh substances to supplement the commercial extracts. Recently the CAP radioallergosorben t test has shown promise in raising the probability of food reactions to th e point that for a few foods in specific individuals, challenges may not be needed, progress in this area will continue. We have been able to clarify which foods have a high probability of producing symptoms and which foods a nd which constellation of complaints are unlikely to be confirmed. These pa tterns of food allergic reactions have now been reproduced in many research centers throughout the world giving us confidence in their validity. (C) 2 000 Lippincott Williams & Wilkins, Inc.