Updated clinical food allergy guidelines published

New clinical guidelines on food allergies updating recommendations on best practice and accurate diagnosis, European specialists say.

The European Academy of Allergy and Clinical Immunology (EAACI) EAACI guidelines on the diagnosis of IgE-mediated food allergy, published in Allergy, includes contributions from more than 50 experts from allergy centres around the world, including Europe, North and South America, Africa, Asia and Australia.

Led by Professor Alexandra Santos from King’s College London, Dr Isabel Skypala from the Brompton Hospital in London, Professor George Du Toit from Guy’s and St Thomas’ Hospital and Dr Carmen Riggioni from the National University Hospital and National University of Singapore, it is the first update in a decade and includes eight new recommendations.

It recommends that food allergy diagnosis should start with an allergy-focused clinical history. This should be followed by recommended tests to determine IgE sensitisation, which include skin and blood test to look for specific IgE antibodies to the suspected food.

New recommendations include the use of tests to detect specific IgE antibodies targeting distinct allergen components within the bloodstream and the evaluation of basophil reactivity, the blood cells responsible for triggering allergic reactions.

The report adds that if there is any doubt, after blood and skin testing, individuals with suspected food allergy should undergo an oral food challenge (OFC) in a medically supervised setting.

Dr Scott Sicherer, of the Icahn School of Medicine at Mount Sinai, New York, USA, said: “The accurate diagnosis of IgE-mediated food allergy is paramount for ensuring patient safety, nutrition and quality of life. These updated diagnostic guidelines, with eight evidence-based recommendations, will help reduce the current state where tests are often over-used and misinterpreted, and provide clinicians with the knowledge and tools needed to effectively arrive at an appropriate diagnosis.”

Professor Mike Levin, head of the Division of Asthma and Allergy at the University of Cape Town, South Africa, added: “Food allergy is one of the most difficult conditions to manage due to the lack of any absolute test to determine the presence of food allergy or not, apart from an oral challenge.

“IgE results indicate sensitisation and significance need to be interpreted along with a clinical history, and levels may vary in different populations studied. The EAACI Guidelines for Food Allergy comprehensively addresses diagnosis of food allergy with meta-analyses of data on IgE testing and including advances in component resolved diagnosis and cellular tests, serving as an excellent resource for clinicians working in the field.”

The expert group advising on the EAACI Food Allergy Guidelines included patient representatives, who ensured the patients’ perspectives were taken into account. An important stage after the launch of the is the implementation of the guidelines, which includes information of healthcare professionals looking after patients with suspected food allergy and also the information of patients and the public.

Santos AF, Riggioni C, Agache I et al. EAACI Guidelines on the Diagnosis of IgE-mediated Food Allergy. Allergy 10 October 2023; doi: 10.1111/all.15902


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