EAACI guidelines on the diagnosis of IgE-mediated food allergy.
Alexandra F SantosCarmen RiggioniIoana AgacheCezmi A AkdisMübeccel AkdişAlberto Alvarez-PereaMontserrat Álvaro-LozanoBarbara Ballmer-WeberSimona BarniKirsten BeyerCarsten Bindslev-JensenHelen Annaruth BroughBetul BuyuktiryakiDerek ChuStefano R Del GiaccoAudrey Dunn GalvinBernadette EberleinMotohiro EbisawaPhilippe EigenmannThomas EiweggerMary FeeneyMontserrat Fernández-RivasHelen R FisherDavid M FleischerMattia GiovanniniClaudia GrayKarin Hoffmann SommergruberSusanne HalkenJonathan O'B HourihaneChristina J JonesMarek JutelEdward KnolKonstantinou GeorgeGideon LackSusanne LauMaria Andreina Marques-MejiasMary Jane MarchisottoRosan W MeyerCharlotte Gotthard MortzBeatriz MoyaAntonella MuraroCaroline NilssonLucila Camargo Lopes de OliveiraCorina M BersetPapadopoulos G NikolaosKirsten PerrettRachel L PetersMarcia PodestaLars K PoulsenGraham C RobertsHugh A SampsonJürgen K J SchwarzePeter SmithElizabeth Huiwen ThamEva UntersmayrRonald Van ReeCarina VenterBrian P VickeryBerber J Vlieg-BoerstraThomas WerfelMargitta WormGeorge du ToitIsabel J SkypalaPublished in: Allergy (2023)
This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.