RESUMO
The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta-analyses to assess the accuracy of diagnostic tests for IgE-mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta-analyses were undertaken for food-test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double-blind placebo-controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2-sIgE had 92%, Cor a 14-sIgE 95%, Ana o 3-sIgE 94%, casein-sIgE 93%, ovomucoid-sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies.
Assuntos
Hipersensibilidade a Ovo , Hipersensibilidade Alimentar , Feminino , Animais , Bovinos , Humanos , Criança , Pessoa de Meia-Idade , Hipersensibilidade a Ovo/diagnóstico , Hipersensibilidade Alimentar/diagnóstico , Testes Cutâneos/métodos , Imunoglobulina E , Alérgenos , Arachis , Testes Diagnósticos de Rotina , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
In medical education, case-based learning (CBL) is a fundamental method for training healthcare professionals across different levels of expertise. This approach hinges on using authentic or fabricated clinical cases to bridge the gap between theoretical knowledge and its practical application. It fosters active engagement and knowledge application among learners in healthcare domains. While creating effective cases demands substantial clinical understanding and time investment, the integration of Generative Artificial Intelligence (AI) presents a promising solution to this challenge. AI can efficiently analyze extensive medical data to generate diverse and realistic clinical scenarios, continuously updating case content based on emerging medical literature and guidelines. This study explores AI-generated cases' feasibility and educational value in continuing medical education, focusing on COVID-19 scenarios tailored for the MENA region. Results indicate the potential of AI-generated cases to foster engagement and critical thinking among learners, suggesting their suitability for different levels of education. This study highlights the advantages of integrating AI into CBL and emphasizes the need for future efforts to tackle obstacles and facilitate its successful adoption.
Assuntos
Inteligência Artificial , COVID-19 , Estudos de Viabilidade , Humanos , SARS-CoV-2 , Educação Médica ContinuadaRESUMO
BACKGROUND: Previous reports suggested that food proteins present in human milk (HM) may trigger symptoms in allergic children during breastfeeding, but existing evidence has never been reviewed systematically. OBJECTIVE: To assess the probability of food proteins in HM to trigger allergic reactions in infants with IgE-mediated food allergy. METHODS: Electronic bibliographic databases (MEDLINE, EMBASE) were systematically searched from inception to November 3, 2021. The data regarding the levels of food proteins detected in HM were extracted and compared with data from the Voluntary Incidental Trace Allergen Labelling (VITAL 3.0) guide to assess the probability of food-allergic individuals to experience immediate type allergic reactions on ingesting HM. RESULTS: A total of 32 studies were identified. Fourteen studies assessed excretion of cow's milk proteins into HM, 9 egg, 4 peanut, and 2 wheat; 3 measured levels of cow's milk and egg proteins simultaneously. We found that levels of all food proteins across the studies were much lower than the eliciting dose for 1% of allergic individuals (ED01) in most of the samples. The probability of an IgE-mediated allergic reaction in a food-allergic infant breastfed by a woman consuming the relevant food can be estimated as ≤1:1000 for cow's milk, egg, peanut, and wheat. CONCLUSIONS: To our knowledge, this is the first systematic review that assesses and summarizes evidence on food proteins in HM and potential for IgE-mediated allergic reactions. Our data suggest that the probability of IgE-mediated allergic reactions to food proteins in HM is low.