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The disparity between reported and diagnosed food allergy makes robust diagnosis imperative. The allergy-focussed history is an important starting point, but published literature on its efficacy is sparse. Using a structured approach to connect symptoms, suspected foods and dietary intake, a multi-disciplinary task force of the European Academy of...
Context in source publication
Context 1
... order to gather evidence of links between reported symptoms, trigger foods and dietary intake, and the existence of any published diagnostic questionnaires, a search on Pub Med and Medline was undertaken. The search terms shown in Table 1 were used, and papers from 1990 to January 2012 were se- lected in the order given below: 1) Randomized controlled trials 2) Non-randomized controlled clinical trials 3) Before and after clinical trials 4) Prevalence studies employing oral food challenge 5) Systematic reviews and other meta analyses 6) Observational studies -cohort or case reports 7) Other subject reviews ...
Citations
... Symptom history should be taken in conjunction with a detailed dietary history. 21 This should include questions on habitual dietary intake (meals, snacks, beverages); breast/bottle feeding, growth and feeding issues in children and eating disorders in older children and adults; body mass index (BMI) and weight loss in adults; and dietary ...
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.
... A multi-disciplinary task force of the European Academy of Allergy and Clinical Immunology developed a paediatric diet history tool with the goal to develop a structured approach to connect symptoms, suspected foods, and dietary intake (129). Another awareness tool based on 25 questions has been tested in 43 infants aged up to 2 years (130). ...
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 1 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost and quality of life.
... The most common sign and symptoms of food allergy include tingling and itching in the skin and mouth, rashes, angioedema, dermatitis, as well as in the gastrointestinal tract including vomiting, abdominal cramping, nausea, diarrhea and in the respiratory tract disorder including rhinitis, asthma and laryngeal edema. [23][24][25] Anaphylactic shock is the most frightening symptom which is induced by a particular food that is acute in onset, occurring within minutes or hours, and without proper treatment, it may lead to death badly. [26,27] Much other allergic disorder has been found in different organ systems that increase the risk of other allergic condition due to consuming allergic food items. ...
Background: Atopic dermatitis (AD), also called atopic eczema, is a common chronic or recurrent inflammatory skin disease and affects 15-20% of children.
... These tools will provide a practical approach to support food allergy diagnosis. Unfortunately, both tools were not yet validated in diverse age groups, disease entities and in different countries [3], [4]. There is a third score for the diagnosis of allergy to cow's milk protein that has been validated in several centers [5], however, its approach based on these verity of the symptoms is opposite to our position of the timely and early diagnosis and does not make it applicable for this condition (DEMC) that we are postulating, where the subtlety of the symptoms is the rule and not the exception. ...
Background: Gastrointestinal malabsorption of proteins from the diet of the mother can induce diseases in breast fed infants. The malfunction of the gastrointestinal tract (GI) of the mother is the basic process causing this disease. This new entity is under the scope of “diseases of the entero-mammary circle” (DEMC). Proteins different from homologues proteins of the breast milk, present in breast milk offered to the infant develops food allergy with clinical manifestation in different organs of the newborn and infant. Here we describe the most relevant clinical symptoms associated to this new entity the DEMC. Methods: From January 2015 to January 2021, 100 charts from infants, age 0 to 6 months, were randomly selected from our clinic of Pediatric Gastroenterology and Food Allergy at Santa Casa da Misericordia do Rio de Janeiro, Rio de Janeiro, Brazil. The inclusion criteria were: 1) To be exclusively breast fed since birth and 2) Diagnosis of food allergy through strict diet to the mother without cow's milk, egg, soy and wheat protein and subsequent oral challenge with ingestion of the seafood by the mothers and recurrence of gastrointestinal, respiratory or dermal symptoms by oral challenge positive. The exclusion criteria were the use of other any food besides the breast milk. Results: The onset of symptoms in the patients studied starts early in life. In the GI system the prevalent clinical symptoms were blood in stool, gastro-esophageal reflux, abdominal distention, abdominal pain, diarrhea, constipation, bulky stools, flatus and vomiting, colic’s and nauseas and hiccups. In the respiratory system of the patients, the clinical disturbance was snoring and rhinitis, sinusitis, excess of mucus, chronic cough, and asthma. In the skin system, was prevalent the pallor, atopic eczema, eczema of folds, erythema of the cheeks, per oral erythema and seborrheic dermatitis. Related to the central nervous system we found sleep disorder, insomnia, irritability, and lethargy. Conclusion: The present study was developed to explore the broad spectrum of the DEMC, presented as different clinical pictures in infants, exclusively breast fed, compromising all systems such the GI tract, the skin, the respiratory system, and the central nervous system.
... Dietary elimination must be individualized to the child's allergic symptoms and clinical diagnosis, based on a detailed allergy history alongside the interpretation of relevant allergy tests and where appropriate oral food challenge outcome [7,13]. Comprehensive dietary advice should consider the individuals nutritional requirements, suitable and locally available food alternatives in addition to taking the cooking skills of the family into account [7,14]. In addition, the carers should receive support on how to promote diet diversity, in particular during complementary feeding, and the long-term impact of diet on health and disease prevention should be included in the allergy-focused dietary consultation [15]. ...
Purpose of the Review
The purpose of the review is to review the evidence for the nutritional management of paediatric food allergy and provide a practical approach for healthcare professionals working in this area.
Recent Findings
Dietary elimination remains the mainstay for management of food allergies in children. However, the elimination of food allergens increases the risk for growth faltering, micronutrient deficiencies and feeding difficulties. Breastmilk remains the ideal source of nutrition for infants, but when not available, the vast majority will tolerate an extensively hydrolysed formula, and rice hydrolysate has also been suggested as a suitable alternative. Only in severe cases, including anaphylaxis, eosinophilic oesophagitis and growth faltering, is an amino acid formula indicated. The early introduction of peanut and egg and avoiding the delay in the introduction of other allergens, when not already allergic, has been highlighted by recent studies.
Summary
Whilst the elimination of allergens increases the risk of developing poor growth, micronutrient deficiencies and feeding difficulties, optimal, early dietary input, including advice on active introduction of allergens and alternative feeds, ideally from a registered dietitian/nutritionist, may be prevent and improve outcomes.
... The latter should also guide the need for any allergy testing. Positive family history of atopy and early onset eczema in the infant may suggest a greater risk for allergic disease, but may also be the consequence of coincidence as atopic conditions can occur in at least 20% of all infants.[34][35][36] If no other atopic features are present and/or feeding history indicates worsening ofPractice points • FA-associated GORD symptoms are difficult to distinguish from non-FA-associated GORD and a clinical and allergy-focused history (i.e. ...
Gastro‐oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA‐associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA‐associated GORD and medical and dietary management. The task force (TF) on non‐IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web‐based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA‐associated GORD.
... The evaluation of patients with a possible food allergy starts with an extensive foodspecific medical history. The standardized diet history tool published by S. Skypala et al. provides a practical approach to support food allergy diagnosis, ensuring that all relevant information is captured and interpreted in a robust manner [4]. Although the combination of the allergy-focused diet history with positive sensitization to the specific food allergen in SPT and/or sIgE measurements often leads to a clear diagnosis, in many cases, discrepancies occur. ...
Food-induced anaphylaxis is an immediate adverse reaction, primarily triggered by the cross-linking of allergen-specific immunoglobulin (Ig) E bound to the high-affinity IgE receptor (FcεRI) on mast cells (MCs) after re-exposure to the same food allergen [...]
... The evaluation of patients with a possible food allergy starts with an extensive food specific medical history and a physical examination. The focus should be on possible dietary triggers, the quantity and quality of the ingested food, possible facilitating cofactors around the time of the reaction (exercise, illness, use of medication), and the specific symptoms that led to the allergic reaction [5]. Knowledge of cross-reactivity within protein families would help to decide the ensuing pathway. ...
... SPTs are a quick, reliable, and cheap method to measure sensitization. Although the negative predictive value (NPV) of SPTs often reaches 90% or more [5], false negative SPTs may occur if the used extracts are not standardized or have insufficient quantities of the allergen. In commercially available extracts of fruits and vegetables, the proteins might be destroyed during the manufacturing process, e.g., heating, giving less reliable results [6]. ...
Introduction:
The skin prick test (SPT) is the first step in the diagnosis of an immunoglobulin E (IgE)-mediated food allergy. The availability of commercial food allergen extracts is very limited, resulting in a need for alternative extraction methods of food allergens. The objective of this study was to compare the SPT results of homemade food allergen extracts with commercially available extracts.
Methods:
Adult patients with a suspected food allergy were included. Food allergen-specific symptoms were scored using a questionnaire. SPTs were performed with homemade and commercially available extracts (ALK-Abelló, Kopenhagen, Denmark) from almond, apple, hazelnut, peach, peanut, and walnut. Serum-specific IgE was measured with ISAC or ImmunoCAP™. Intra-class correlation coefficients (ICC) between the SPT results of both extract methods were calculated. The proportion of agreement with food allergen-specific symptoms was analyzed.
Results:
Fifty-four patients (mean age 36; range 19-69 years; female/male: 42/12) were included. The intra-class correlation coefficient (ICC) between the SPT results of both extract methods were strong for hazelnut 0.79 (n = 44) and walnut 0.78 (n = 31), moderate for apple 0.74 (n = 21) and peanut 0.66 (n = 28), and weak for almond 0.36 (n = 27) and peach 0.17 (n = 23). The proportion of agreement between SPT results and food allergen-specific symptoms was comparable for homemade and commercially available extracts, except for peach; 0.77 versus 0.36, respectively.
Conclusion:
In the diagnostic procedures to identify an IgE-mediated food allergy, homemade extracts from hazelnut and walnut appear to be a good alternative in the absence of commercially available food allergen extracts.
... A pharmacist may be the first HCP contacted by a patient with allergic symptoms, while patients whose medication is reviewed by a pharmacist are less likely to have inadequate documentation of drug allergies 92 . A dietitian may suspect food intolerance or FA while completing a dietary history on a patient 93 Another important contribution of nurses and AHPs is to prevent complications in patients with allergy during transitions in care 94 . A recent qualitative study documented young adults with asthma expressed a feeling of being "lost in the transition process" from paediatric care to adult follow-up 95 . ...
Background
Guidelines for management of patients with allergic conditions are available, but the added value of nurses, allied healthcare professionals (AHPs), and general practitioners (GPs), in the management of allergic disease, has not been fully clarified. The European Academy of Allergy and Clinical Immunology (EAACI) appointed a task force to explore this issue.
Aim
To investigate the added value of nurses, AHPs, and GPs in management of allergic diseases, in an integrated model of care.
Methods
A search was made of peer‐reviewed literature published between 2010 and December 2020 (Cochrane Library, PubMed, and CINAHL) on the involvement of the various specific healthcare providers (HCPs) in the management of allergic diseases.
Results
Facilitative models of care for patients with allergies can be achieved if HCP collaborates in the diagnosis and management. Working in multi‐disciplinary teams (MDT) can increase patients' understanding of the disease, adherence to treatment, self‐care capabilities, and ultimately improve quality of life. The MDT competencies and procedures can be improved and enhanced in a climate of mutual respect and shared values, and with inclusion of patients in the planning of care. Patient‐centered communication among HCPs and emphasis on the added value of each profession can create an effective integrated model of care for patients with allergic diseases.
Conclusion
Nurses, AHPs, and GPs, both individually and in collaboration, can contribute to the improvement of the management of patients with allergic disease. The interaction between the HCPs and the patients themselves can ensure maximum support for people with allergies.
... It is vital that physicians have an awareness of the role of dietetics in allergy, including early introduction of food allergens for allergy prevention, 41 taking an allergy-focused diet history, 42 and managing food allergies across the spectrum of IgE 43 and non-IgE mediated intolerances. 44,45 This dietetic care is ideally directed by a specialist dietitian where availability permits. ...
The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of “allergy” as a specialist area. However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence to manage mild disease and recognize when referral is required. The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly.
In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and post-graduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care.
We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergy-related competences required of physicians working with allergic patients and provides recommendations to promote harmonization of allergy training and practice worldwide.
