Assessment Of Food Allergy Research Articles

Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience.

Oral food challenges (OFC) are an important tool in the assessment of food allergy. We sought to identify factors available at initial assessment visit which were associated with successful outcome or challenge failure in Australian children. We conducted a retrospective review of all paediatric patients who underwent OFC in our allergy service over a 5-year period. Clinical data comprising patient demographics, co-morbidities, skin prick test (SPT) results, nature of previous reactions, elapsed time since previous reactions and outcome at OFC were recorded. Four hundred and fifty-six OFCs were conducted, with 56 cases (12.3%) resulting in a reaction. Likelihood of reaction at OFC was significantly increased for patients with atopic dermatitis (odds ratio 1.99). When stratified by food substance, atopic dermatitis had the strongest association with reaction within the peanut group (odds ratio 3.2), and no association was demonstrated for soy or prawn. Increasing SPT wheal size (P < 0.001) and previous history of anaphylaxis to the challenge food (P < 0.001) correlated with failure at OFC. A low-risk group was identified, of patients with no clear history of prior reaction to the challenge food, and SPT result <3 mm. Factors identified at assessment visit which correlated with reaction at OFC are atopic dermatitis, prior history of anaphylaxis, and increasing SPT wheal size. Domiciliary OFC could be considered in a select low-risk group of patients undergoing food challenge. This study was performed at a single centre with limited sample size, further large-scale and multicentre study verification of our data will provide more accurate representation of the Australian demographic.

Duplicate skin prick testing in the assessment of food allergy

Duplicate skin prick testing in the assessment of food allergy

Differentiating milk allergy (IgE and non-IgE mediated) from lactose intolerance: understanding the underlying mechanisms and presentations.

Children with food allergy and, in particular, infants with suspected adverse reactions to cow’s milk, commonly present to primary care. It is thought that 6–8% of children aged <3 years have a food allergy1 and up to 4.9% have a cow’s milk allergy.2 Inconsistencies in the management of food allergy prompted the commissioning of projects such as the National Institute for Health and Care Excellence (NICE) clinical guideline on the diagnosis and assessment of food allergy in the community1 and in 2014 the NICE Clinical Knowledge Summary looking specifically at the management of milk allergy.3 It has been shown that GPs’ knowledge of these guidelines is poor. Inconsistencies remain in the management of milk allergy, with a particularly lengthy time period and multiple consultations before diagnosis.4 There is anecdotal evidence of confusion between lactose intolerance and milk allergy among both patients and physicians, which could result in unnecessary dietary restriction or avoidable reactions. Terminology such as suspected ‘milk allergy’, ‘milk intolerance’, and also ‘lactose intolerance’ are often used without a clear sense of the different meanings, understanding of the different mechanisms that underlie them, or the dietary implications of the diagnosis. The management of these conditions is distinctly different, and inappropriate recognition or management may have significant implications for the patient. In the last 15 years, there have been many discussions on the nomenclature of reactions to foods, including milk. The currently accepted nomenclature is …

A practical approach for UK primary care on the management of cow's milk allergy in infants.

The term ‘Cow’s Milk Allergy’ (CMA) is used in this guidance, although the term ‘Cow’s Milk Protein Allergy’ (CMPA) is also widely used in the literature. CMA is the commonest food allergy among children in the UK. Data from 2008 indicated 2.3% of 1–3 year-olds in the UK suffer from CMA.1 In 2011, National Institute for Health and Care Excellence (NICE) published Clinical Guideline (CG)116 on the Diagnosis and Assessment of Food Allergy in Children and Young People in Primary Care and Community Settings.2 It has become increasingly evident that for effective implementation, there needs to be further practical advice, which was outside of the scope of the current NICE guideline, on establishing the initial diagnosis and the further management of infants with CMA. A health economic analysis published in 2010 concluded that CMA imposes a, ‘substantial burden on the NHS’.3 The ‘cost’ of this burden can be kept at a minimum by improving the care provided in the community. As clinicians involved in the development of the NICE guideline, we have therefore aimed to provide a practical tool for the management of CMA in primary care. The algorithm we have produced is intended as an adjunct to the published NICE guideline2 …

Diagnosis and management of non‐IgE‐mediated cow's milk allergy in infancy ‐ a UK primary care practical guide

The UK NICE guideline on the Diagnosis and Assessment of Food Allergy in Children and Young People was published in 2011, highlighting the important role of primary care physicians, dietitians, nurses and other community based health care professionals in the diagnosis and assessment of IgE and non-IgE-mediated food allergies in children. The guideline suggests that those with suspected IgE-mediated disease and those suspected to suffer from severe non-IgE-mediated disease are referred on to secondary or tertiary level care. What is evident from this guideline is that the responsibility for the diagnostic food challenge, ongoing management and determining of tolerance to cow’s milk in children with less severe non-IgE-mediated food allergies is ultimately that of the primary care/community based health care staff, but this discussion fell outside of the current NICE guideline. Some clinical members of the guideline development group (CV, JW, ATF, TB) therefore felt that there was a particular need to extend this into a more practical guideline for cow’s milk allergy. This subset of the guideline development group with the additional expertise of a paediatric gastroenterologist (NS) therefore aimed to produce a UK Primary Care Guideline for the initial clinical recognition of all forms of cow’s milk allergy and the ongoing management of those with non-severe non-IgE-mediated cow’s milk allergy in the form of algorithms. These algorithms will be discussed in this review paper, drawing on guidance primarily from the UK NICE guideline, but also from the DRACMA guidelines, ESPGHAN guidelines, Australian guidelines and the US NIAID guidelines.

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

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 …

Diagnostic methodology in food allergy

Summary The diagnostic tools for the assessment of food allergy in children still lacks reliable in vitro tests that could both ascertain the actuality of food allergy and predict with a good accuracy which allergens may be involved. Skin prick tests or RASTs are an appropriate first step if an IgE-mediated reaction is suspected. Their interpretation has to be considered according to the age of the child. They can also partially indicate the possible outcome of the disease. More sophisticated tests evaluating a cellular response have not proven valid or are still under evaluation, such as the TNF alpha release by mononuclear cells under stimulation with cow's milk protein in cow's milk protein allergic children. The diagnosis requires food elimination diets, followed by provocation procedures, ideally in a double blind placebo controlled fashion. Intestinal permeability tests usefully complement the search for the offending food by providing a non invasive evaluation of small intestinal suffering.