In December 2010, the National Institute of Allergy and Infectious Disease (NIAID) released an Expert Panel Report on the Guidelines for the Diagnosis and Management of Food Allergy in the United States. You are able to view the full report or the summary (I would suggest the summary as the full report is lengthy). I will mention a few of the guidelines to give you an understanding of the report, but feel free to download the report for yourself so you may be updated on the latest guidelines for food allergy (FA) that many healthcare professionals will be referring to.
The report notes that multiple studies have found 50-90% of presumed food allergies are not actually food allergies! I couldn’t believe as high as 90%! For this reason, I will briefly review the diagnostic recommendations.
Diagnosis of IgE Mediated Food Allergy (Reactions are seen in a short time frame.)
The Expert Panel (EP) stresses the importance of confirming a food allergy. In order to confirm the diagnosis of a FA, it is important the doctor perform a medical history and physical examination In order to identify the food causing the allergies, the EP recommends a doctor perform a skin prick test (SPT). It is important to note that a SPT alone cannot be considered a diagnosis of FA. The EP does not recommend using tests such as intradermal testing, routine use of total serum IgE and atopy patch tests. Interestingly, they suggest food elimination diets as a useful tool for diagnosing FA. It is also recommended for doctors to use oral food challenges to get a FA diagnosis. It is the gold standard for ruling out certain foods.
Diagnosis of Non-IgE Mediated Reactions (Also known as delayed reactions)
In order to diagnose Food Protein-Induced Entercolitis Syndrome (FPIES,) the EP recommends using medical history and oral food challenges. It was noted that when the causative food is removed and the symptoms subside, it may be enough for an FPIES diagnosis. Doctors and families must work closely together to get the best results for their patients.
The report also mentioned that to reevaluate a patient with a food allergen whether its annually or at another interval will depend on the foods in question, the age of the child and the current medical history.
I very much encourage you to read over the guidelines yourself. The more educated we all are, the more we can help each other and your family to ensure those with food allergies are getting the proper treatment for the accurate food allergy diagnosis. Let me know once you have read it, what you think! You can even share this with your doctor.