Accurate 2-Step Algorithm for Cashew Allergy Diagnosis Reduces Health Costs

Jennifer Koplin, PhD

An investigation presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022 determined that a 2-step algorithm for cashew allergy diagnosis in children was accurate and resulted in a large reduction in both oral food challenges and health system costs.

Investigators noted that in the absence of clear clinical history, the diagnosis of cashew allergy using cashew-specific IgE or skin prick tests (SPT) requires a large number of oral food challenges.

However, an allergen component of cashews, Ana 0 3 sIgE, may improve diagnosis.

As such, investigators led by Jennifer Koplin, PhD, . Department of Pediatrics at the University of Melbourne, Australia, aimed to determine if a 2-step diagnostic algorithm could reduce oral food challenges and health system costs compared to cashew SPT alone.

The Methods

Koplin and colleagues pooled individual level data from 6 studies that were used to determine diagnostic accuracy and oral food challenge rates. Additionally, 2 studies used cashew SPT (n5567, 198 allergic), with 95% positive and negative predictive values of >_12mm and <3mm.

A total of 4 studies were included in the cashew sIgE/Ana o 3 sIgE algorithm (n5271, 156 allergic) and used cut-offs of >_8.5kUA/L and <_0.1kUA/L for cashew sIgE and >_0.35kUA/L and<_0.1kUA/L for Ana o 3 sIgE.>≤1kUA/L for Ana o 3 sIgE.

From there, costs were determined based oin unit pricing from hospital patient costs, expenses incurred by families, individual patient data on allergic reaction types and rates and adrenaline autoinjector carriage.

The Findings

Koplin and investigators observed that the cashew sIgE/Ana o 3 sIgE algorithm resulted in an 80.5% reduction in oral food challenges compared to SPT alone (58.4% to 11.4%).

Additionally, the diagnostic accuracy was similar (91.1% vs 97.2% accuracy, 1.1% vs 2.3% false negative rate), and the total cost of the 2-step algorithm was lower at $501,512 per 1000 patients compared to $910,880 to 1000 patients.

Investigators added that the 2-step algorithm for cashew allergy diagnosis in children was “accurate and results in a large reduction in both OFCs and health system costs compared to cashew SPT”.