NICE guidelines for diagnosing and treating food allergy in children and young people

The National Institute for Health and Clinical Excellence (NICE) has released guidelines for diagnosing and treating food allergy in children and young people.

These guidelines stress that a clinical history of the food allergy taken by a competent practitioner is most important in diagnosing an allergy and that allergy tests, done in isolation, can be misleading. Skin Prick tests and specific IgE testing on a blood sample are the most reliable food allergy tests available. Diagnosing food allergies and intolerances using Vega testing, applied kinesiology, hair analysis, leucocytotoxic testing and IgG blood tests are inaccurate and should be discouraged.

Food allergies are adverse immune responses to food allergens and are among the most common of the allergic disorders and are recognised as a major paediatric health problem in western countries. Reactions can be extremely severe; hospital admissions in the UK for food allergies have increased by 500%since 1990, and there has been a dramatic increase in prevalence in the last twenty years, ranging from 6% to 8% in children up to the age of 3 years across Europe and North America. The most common foods to which children and young people are allergic include cow's milk; fish and shellfish; hen's eggs; peanuts, tree nuts and sesame; soy; wheat and kiwi fruit.

Food allergies in children can result in a number of symptoms, therefore the guideline recommends that the condition should be considered if the child has one or a combination of the following, including:

skin conditions such as eczema or acute urticaria (itchy rash)
respiratory complaints such as sneezing or shortness of breath
gastrointestinal problems such as vomiting, difficulty swallowing or constipation
anaphylaxis (severe, hyper-sensitive reaction) and other allergic reactions.
Food allergies should also be considered in children who are not adequately responding to treatment for atopic (allergic) eczema, gastro-oesophageal reflux disease (where stomach contents leak out of the stomach and into the oesophagus), and chronic constipation.

If a food allergy is suspected, the GP or other healthcare professional should take an allergy-focused clinical history, tailored to the presenting symptoms and age of the child or young person. This should include a family history of allergies, an assessment of the symptoms, and feeding history as an infant. A physical examination should pay particular attention to growth, and physical signs of malnutrition.

The guideline also recommends offering the appropriate information based on the type of allergy suspected, the risk of allergic reaction, and the diagnostic process which may include excluding specific foods from the diet, reintroducing these foods with reoccurrence of the allergic reaction confirming diagnosis. Diagnosis may also include skin prick and blood tests for IgE (immunoglobulin) antibodies; specific antibodies suggest particular allergic reactions. Alternative methods of diagnosis such as hair analysis and kinesiology are not recommended. Referral to secondary care should be considered if the child has ongoing problems including faltering growth, vomiting, abdominal pain, loose or frequent stools, or constipation.