Diagnosis of Food Allergy

Food allergies are immunologically mediated adverse reactions to foods. Any food protein can trigger an allergic response, and allergic reactions to a large number of foods have been documented; however, only a small group of foods account for most of these reactions. Eggs, milk, peanuts, soy, fish, shellfish, tree nuts, and wheat are the foods most often implicated.

Diagnosis 

Laboratory studies that may be helpful include the following:

  • Specific immunoglobulin E (IgE) antibody testing: Positive results primarily denote sensitization and may not confirm clinical allergy; specific laboratory tests for some food hypersensitivities are not available
  • Basophil histamine-release assays: These are limited primarily to research settings
  • Skin testing includes the following approaches: 
  1. Prick testing: This is the most common screening test for food allergy; negative predictive accuracy exceeds positive predictive accuracy (>90% vs < 50%)
  2. Intradermal testing: Generally avoided, because of the risk of inducing a systemic reaction
  3. Patch testing: Appears promising, but additional studies are needed and it is not recommended for routine practice

Diet-related diagnostic measures may be helpful, as follows:

  • Diet diary
  • Elimination diet (may be used for diagnostic as well as therapeutic purposes)
  • Food challenge confirmation of food allergy (may be open; single-blind; or double-blind, placebo-controlled)
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