EAACI guidelines on the diagnosis of IgE‐mediated food allergy

Abstract

This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE‐mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy‐focused clinical history followed by tests to determine IgE sensitization, such as serum allergen‐specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen‐sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.

Feast for thought: A comprehensive review of food allergy 2021-2023

“…Recently, EAACI guidelines on the diagnosis of IgE-mediated FA recommend open OFC for most clinical situations, with double-blind placebo-controlled food challenge being reserved for cases in which open OFCs are equivocal and for research. 93 The PRACTALL guidelines on how to perform OFC are widely used. The Consortium for Food Allergy Research, version 3 (CoFAR, v3), which uses less-objective symptoms and less-rigid challenge stop criteria, was recently proposed.…”

“… 106 Recently, the BAT was, for the first time, included as a recommended test to support the diagnosis of IgE-mediated FA in clinical guidelines. 93 However, it was decided that the MAT and peptide-sIgE required more research before being used clinically.…”

“… All ranges in parentheses are 95% CIs. Data from Santos et al 93 and Riggioni et al. 98 Ana o , Anacardium occidentale ; Cor a , Corylus avellana ; Pen a , Penaeus aztecus ; SPT, skin prick test .…”

Redefining the Role of Nutrition in Infant Food Allergy Prevention: A Narrative Review

“…The U.S. numbers above are largely based upon two large cross-sectional population-based surveys in which reported food allergies were considered IgE-mediated if the reported symptoms to specific allergens met well-defined criteria consistent with IgE-mediated reactions. Specific IgE (sIgE) or skin prick tests are frequently utilized in population studies despite their association with higher rates of false positives, since diagnosis based on oral food challenges (the gold standard) are insufficiently performed due to cost and risk [ 28 ]. Studies may also base numbers on data from other clinical reports and testing, including self-reported clinical history of food allergy, clinical or hospital visits for food allergy, or determination of allergen-specific IgE (sIgE) either by skin prick test or by serum sIgE [ 22 ].…”

The future of cow’s milk allergy – milk ladders in IgE-mediated food allergy

“…Diagnosis of CMA includes taking a clinical history, deciding on appropriate testing, followed by an oral food challenge (OFC) for IgE-mediated CMA or a period of avoidance followed by reintroduction/OFC for non-IgE mediated cow's milk allergies (FPIES, Eosinophilic Esophagitis [EoE], FPIAP). According to the recent EAACI guidelines "A medically supervised oral food challenge (OFC) is recommended to confirm or exclude food allergy in patients with an unclear diagnosis despite IgE-sensitization tests (high certainty of evidence)" (3). Current management strategies include individualized avoidance of foods containing cow's milk (CM), and precautionary advisory labelling.…”