Comparison with previous research
The previous SR on diagnostic test accuracy [8] included only
studies where at least 50% of subjects had a DBPCFC as reference
standard. While this approach may potentially increase the rigor of the
studies included, it may also exclude evidence from various geographical
regions and clinical settings where the logistics of a DBPCFC are not
feasible or practical and may exclude a subset of patients seen in
allergy clinic who do not have an indication or do not accept to undergo
an OFC (e.g. highly sensitized subjects or patients with a recent
history of reaction to the culprit food). As the objective of the
current systematic review is to inform clinical recommendations, we
chose to include index tests validated with other OFC techniques, namely
open OFCs which are widely used in clinical practice and reliable in
most clinical cases. We considered merging the studies included in the
previous SR in this SR as an update and a way to increase the number of
studies; however, we decided not to include older studies as
methodologies have changed and available diagnostic tools have higher
quality and diversity compared to those used prior to 2012.