Evidence-based diagnosis of food allergy

Abstract 

There is an increasing body of robust, evidence-based practice allowing refinement of current diagnostic approaches outside the setting of research-orientated practice.

The diagnosis of IgE-associated food allergy is a synthesis of history, examination, serum-specific IgE, skin tests and food challenge/elimination diets. Food challenges remain the gold standard for diagnosis, but these can be avoided in those with a good history and positive skin tests or positive specific IgE, especially if these levels are above the 95% positive predictive value (PPV). Negative tests are very important in ruling out possible triggers, due to the excellent negative predictive value (NPV) of both specific IgE and skin prick tests.

An unconvincing history, even if associated with positive IgE/skin tests, still requires a food challenge.

Keywords: children, allergy, food allergy, food hypersensitivity, skin prick tests, IgE, food challenge

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• f1 Correspondence to: JH. Tel.: +44-23-80794989; Fax: +44-23-80777222; E-mail: j.hourihane@soton.ac.uk