Diagnosis and assessment of food allergy in children and young people in primary care and community settings: NICE clinical guideline

Abstract

Food allergy is recognised as a major paediatric health problem in western countries. The true prevalence is unknown but Europe and the US report ranges from 6% to 8% in children aged up to 3 years. The National Institute for Health and Clinical Excellence (NICE) has developed a guideline on the symptoms that should prompt consideration of food allergy when a child or young person presents in primary or community care.1 Food allergy is an adverse immune response to food allergens. Reactions can be classified into those that are immunoglobulin E (IgE) mediated or non-IgE mediated. Some children may have both IgE and non-IgE mediated reactions to food; in this guideline, these are referred to as mixed reactions. In both IgE and non-IgE reactions, there is a response by the immune system to a protein within food. IgE mediated reactions are immediate type 1 hypersensitivity reactions while non-IgE mediated reactions usually occur several hours after allergen exposure. The exact mechanism is not clearly understood but, in both reactions, elimination of the allergenic food protein is required to prevent symptoms. The correct diagnosis of food allergy should decrease the incidence of adverse food reactions that are a result of true food allergies; and help prevent the unnecessary exclusion of foods that are safe and that should be eaten as part of a normal, healthy diet. This guideline does not cover children and young people with food intolerances (such as intolerance to lactose), reactions to pharmacological agents (such as salicylates), or reactions to those substances that naturally occur in foods (such as benzoic acid). When to suspect food allergy Food allergy should be suspected when the following are present: persistent eczema, gastro-oesophageal reflux disease and bowel symptoms, including constipation, that do not respond to normal …