Background:
Plant food allergy (FA) is a major global health
problem, being peanut one of the most studied allergenic foods
worldwide. Biomarkers (Bms) are essential tools for precision medicine,
guiding diagnosis, risk stratification, and treatment. However, evidence
on their clinical applicability in plant FA remains limited and
fragmented. Therefore, we aim to systematically review the Bms
identified in plant FA related to several aspects of the pathology.
Methods:
This systematic review was performed in accordance
with the PRISMA guidelines. A comprehensive search was conducted in
three databases (
PubMed
,
Web of Sciences
and
Cochrane Library
) between July 2019 and July 2024. Articles were
screened using predefined inclusion and exclusion criteria, and
categorized into five thematic sections: sensitization, tolerance,
threshold, severity and follow-up treatment. Risk-of-bias and certainty
of evidence were assessed using validated tools and the GRADE approach.
Results:
From the 733 articles found, 71 studies met inclusion
criteria and were selected for data extraction. A majority of them were
high-quality publications and predominantly involved pediatric cohorts
from Europe and North America. Peanut was the most studied food,
followed by nuts and wheat, while fruits and seeds were rarely
represented. Across all sections, most of the studies were related to
severity and tolerance. Specific IgE to whole extracts or molecular
components were the most frequent Bms, followed by skin prick test.
Emerging Bms were identified, although they remain in early validation
stages. Risk-of-bias and certainty of evidence were primarily moderate,
reflecting the exploratory nature of most of the included studies.
Conclusions:
This review highlights the predominance of
classical Bms and the promise of novel candidates for future clinical
integration. However, research remains allergen-, age- and
region-restricted, underscoring the need for multicenter studies,
representative patient samples, and validation of emerging Bms to
achieve globally applicable precision medicine in plant FA.
