This guideline is really quite complex. Unfortunately it basically says that if you or the parents suspect food allergy, test for that food. It gives IgE (immediate) and non IgE mediated (delayed) associated symptoms. For an IgE mediated reaction, a skin-prick test or IgE blood test should be used (aimed at the suspected target, rather than a panel). For non IgE mediated reactions, try eliminating the allergen for 2 to 4 weeks then reintroducing it. This should be done with the advice of a dietician. Unfortunately, I don’t think that current referral routes really support the numbers who would be referred under this guideline, though maybe this will change.
Refer any children where:
- Faltering growth + 1 or more GI symptoms
- 1 or more acute systemic reactions / severe delayed reactions
- Significant atopic eczema where parent suspects multiple or ‘cross-reactive’ food allergy
- Possible multiple food allergy
- Persistent suspicion of food allergy (especially if difficult / perplexing symptoms) despite a lack of supporting history.
- Symptoms don’t respond to single allergen elimination diet.
- Confirmed IgE mediated food allergy + concurrent asthma
- Negative tests, but strong suspicion of IgE mediated food allergy.
I have put together a ‘questionnaire’ based on the questions and symptoms that the NICE guideline suggests we elicit from the history. This could be given to parents if they raise the issue of a food allergy, to bring back at another consultation.
Lead Partner for Guidelines
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