D2.341 - Comparative Evaluation of Diagnostic Criteria for Food Allergy–Induced Anaphylaxis: Accuracy, Clinical Applicability, and Validation

Food allergy frequently triggers anaphylaxis, but its diverse symptoms can make recognition difficult and sometimes inaccurate. Although multiple diagnostic frameworks have been proposed, their variations leave uncertainty about which should be used in different clinical situations.

We conducted a systematic comparison of the following assessment criteria: NIAID/FAAN (National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network, 2006/2010), WAO (World Allergy Organization, 2020), EAACI (European Academy of Allergy and Clinical Immunology, 2014/2022), FARE (Food Allergy Research & Education, 2023/2025), and OFASS (Ordinal Food Allergy Severity Score, 2018). We compared diagnostic accuracy, clinical applicability, and validation using data from published cohort studies on food allergy and from oral food challenge (OFC) studies.

All criteria demonstrated high sensitivity for food-allergy anaphylaxis (93–98%). The NIAID/FAAN and WAO criteria showed the highest sensitivity (95–98%) but lower specificity (68–82%). The EAACI criteria demonstrated the greatest specificity (75–85%) for general food-allergy diagnosis. Positive predictive values (PPV) ranged from 91–98% across all criteria. OFASS achieved the highest specificity (82–89%) and inter-observer agreement (κ = 0.88 vs. 0.70–0.75) in OFCs. It was the only criterion with a quantitative scoring system (0–27 points, ≥3 = positive) and a positive predictive value of 95–98%. Key differences among criteria involved the weighting of gastrointestinal symptoms (higher in WAO/OFASS), recognition of cofactors (WAO/EAACI), and ease of application by non-medical personnel (FARE).

No single criterion is superior across all parameters. NIAID/FAAN and WAO are preferred for clinical use, OFASS for research and oral food challenges, EAACI for general diagnosis, and FARE for education. Selection should be guided by the clinical context.