Innovative diagnostic techniques and their clinical implications in food allergy: current clinical practice and future perspectives.

Abstract

Food allergy (FA) is an immune-mediated adverse reaction to food components (mainly proteins) and represents an increasing global health problem, affecting millions of individuals and imposing substantial clinical, psychosocial, and economic burdens. Accurate diagnosis is essential to prevent life-threatening reactions while avoiding unnecessary dietary restrictions and impaired quality of life. Current diagnostic approaches rely on clinical history, skin prick tests (SPT), measurement of serum allergen-specific IgE (sIgE), and oral food challenges (OFC). However, SPT and sIgE are highly sensitive but lack specificity, frequently identifying clinically irrelevant sensitization, whereas OFC remains the diagnostic gold standard despite being resource-demanding and carrying a substantial risk of systemic reactions. In recent years, several innovative diagnostic approaches have emerged with the aim of improving diagnostic accuracy and reducing reliance on OFC. Component-resolved diagnostics (CRD) enable detailed characterization of molecular sensitization profiles, supporting improved risk stratification and identification of clinically relevant cross-reactivity patterns. Functional cellular assays, including the basophil activation test (BAT) and the mast cell activation test (MAT), offer direct assessment of IgE-mediated effector cell responses and have demonstrated higher diagnostic specificity compared with conventional testing. Epitope-specific IgE profiling and the allergen-specific IgG4/IgE ratio may additionally contribute to a better understanding of disease phenotype and evolution. Furthermore, advances in multi-omics technologies combined with artificial intelligence and machine learning are creating new opportunities for biomarker discovery and predictive modelling in FA. This narrative review summarizes current innovative diagnostic techniques in food allergy, discussing their clinical applications, limitations, and future directions toward more precise and personalized diagnostic approaches.