Reply to “Developing practice parameters that improve health of patients and populations”

• Published in: The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 9; no. 2; pp. 1047 - 1048
• Main Authors: Hamilton, Robert G., Hemmer, Wolfgang, Nopp, Anna, Kleine-Tebbe, Jorg
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2021; Elsevier Limited
• Subjects: Albumin; Allergens; Bet v 1 antigen; Cross-reactivity; Food allergies; Food sources; Globulins; Immunoglobulin E; Medicin och hälsovetenskap; Meta-analysis; Pollen
• ISSN: 2213-2198; 2213-2201; 2213-2201
• DOI: 10.1016/j.jaip.2020.12.017

To the Editor: The authors thank Golden and Shaker1 for their update regarding the development of allergy specialty–related practice parameters and comments as they relate to utility of diagnostic method delimited practice parameters such as the classic Bernstein et al report2 that we discussed in our review on diagnostic allergy methods.3 We appreciate their work on the Joint Task Force on Practice Parameters, which has been involved in preparing evidence-based guidelines for the allergy community using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method that considers the type and certainty of evidence.4 It is true that the requirement of a systematic meta-analysis, which provides a rigorous review of published data on diagnostic assay performance, essentially precludes any possibility of a future updated global guideline on diagnostic methods such as the Bernstein et al practice parameter. Possibly, the next allergen specificity to be targeted for a focused practice parameter in the area of food allergy will be hazelnut where a current meta-analysis has been performed.9 Assessment of IgE antibody responses to the hazelnut 11S-globulin Cor a 9 and particularly the hazelnut 2S-albumin Cor a 14 increases the diagnostic specificity by separating the response of common, predominantly oral symptoms induced by birch pollen–associated Bet v 1 (PR10 family) cross-reactivity (due to Cor a 1) and non-specific lipid transfer protein sensitizations (due to Cor a 8) from primary hazelnut sensitizations to stable and highly abundant hazelnut storage protein.9 Finally, some of us are concerned that waiting for sufficient peer-reviewed reports to permit the rigorous evidence-based meta-analyses required by the GRADE program for new practice parameter development will seriously hinder the introduction of new molecules into clinical practice. More specifically, it has become clear that IgE antibody responses to 2S-albumins from other food sources such as walnuts (Jug r 1), cashew (Ana o 3), sesame (Ses i 1 and Ses i 2), and soy (Gly m 8) are clear drivers of primary food allergies starting in infancy.10 Their measurements allow the discrimination of true food sensitization from pollen-associated cross-reactivities.