Authors' objectives:

The objective of the report was to systematically review the available evidence regarding the clinical effectiveness and/or diagnostic test accuracy of provocation-neutralisation testing or treatment for food allergy.

Authors' results and conclusions: Five studies (n=365) showed no difference in symptom provocation between active extract and placebo. Two studies (n=60) found that more symptoms were provoked and one (n=132) found that more skin wheals were provoked. One study (n=37) was uninterpretable, as results for placebo were not stated. Three studies (n=61) showed a benefit from neutralisation therapy, one (n=11) showed no difference and one (n=15) showed either a benefit or no difference depending on outcome assessment. Most studies had methodological flaws, which made the interpretation of results difficult. These related, amongst others, to verification of allergy status, outcome assessment and presentation of results, randomisation and ability to identify the placebo. Two studies calculated sensitivities and specificities for small patient numbers, but design of the studies was poor and did not allow conclusions to be drawn.

Authors' recommendations: There was no convincing evidence to suggest that more symptoms or wheals can be provoked with active extract compared to placebo by provocation-neutralisation. No evidence was identified to suggest that provocation-neutralisation is useful for the diagnosis of food allergy. There was some evidence, based on small patient numbers, to suggest that neutralisation may be effective in the treatment of food allergies, although uncertainty remains around the outcome assessment and the initial diagnosis of food allergy in some of these studies. It should be noted that the absence of good evidence is not proof of ineffectiveness, and further well-designed studies are recommended for the assessment of the treatment aspect of this technique.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/2004/food_allergy.pdf

Year Published: 2004

URL for published report: http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/WMHTAC/REP/reports-list.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: West Midlands Health Technology Assessment Collaboration

Contact Address: Elaena Donald-Lopez, West Midlands Health Technology Assessment Collaboration, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT Tel: +44 121 414 7450; Fax: +44 121 414 7878

Contact Name: louise.a.taylor@bham.ac.uk

Contact Email: louise.a.taylor@bham.ac.uk

Copyright: University of Birmingham