Comprehensive Food Allergy Guidelines Released

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New guidelines from an expert panel sponsored by the National Institute of

Allergy and Infectious Diseases (NIAID) aim to standardize the diagnosis and

management of food allergy across clinical care settings.

The recommendations, published in the December issue of the *Journal of

Allergy and Clinical Immunology*, are meant to be easily understood and

implemented by clinicians in varied specialties, according to

Fenton, PhD, of the NIAID's Division of Allergy, Immunology, and

Transplantation in Bethesda, Md. Fenton was one of the primary authors and

led the guidelines development project for NIAID.

The recommendations also addressed the use of multiple types of tests for

reaching a diagnosis for IgE-mediated food allergy:

- A skin prick test should be used to identify foods that may be

provoking an allergic reaction, but it cannot stand alone for diagnosis.

Intradermal testing and routine use of measuring total serum IgE should not

be used to make a diagnosis.

- Allergen-specific IgE tests should be used to identify foods that could

potentially provoke allergic reactions, but are not diagnostic of food

allergy alone.

- An atopy patch test should not be used in routine evaluation of

noncontact food allergy.

- A combination of skin prick tests, allergen-specific IgE tests, and

atopy patch tests should not be used for routine diagnosis.

- Several nonstandardized and unproven procedures should not be used for

diagnosis, including the allergen-specific IgG4 test used by some

clinicians.

- Oral food challenges should be used for diagnosing food allergy. A

double-blind, placebo-controlled food challenge is the gold standard,

although a single-blind or open food challenge may be considered diagnostic

in two cases: if either of these challenges elicits no symptoms, then food

allergy can be ruled out. But when either type of food challenge elicits

symptoms consistent with medical history and are supported by lab tests,

then a diagnosis of food allergy is supported.

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