EAACI guidelines on the diagnosis of IgE-mediated food allergy

EAACI guidelines on the diagnosis of IgE-mediated food allergy

This important document provides recommendations for best practice for an accurate diagnosis of immediate-type food allergies.

The EAACI Guidelines on Food Allergy Diagnosis were led by Professor Alexandra Santos from King’s College London together with Dr Isabel Skypala from the Brompton Hospital in London, Professor George Du Toit from Guy’s and St Thomas’ Hospital and Dr Carmen Riggioni from the National University Hospital and National University of Singapore with contribution from over 50 experts from top Allergy centres around the world, including Europe, North and South America, Africa, Asia and Australia. Food allergy diagnosis should start  with an allergy focused clinical history, followed by recommended tests to determine IgE sensitization, which include skin and blood test to look for specific IgE antibodies to the suspected food. The latest EAACI Food Allergy Guideline, published a decade after the previous version, introduces new recommendations such as the utilization of tests to detect specific IgE antibodies targeting distinct allergen components within the bloodstream and the evaluation of basophil reactivity, the blood cells responsible for triggering allergic reactions.When in doubt, after blood and skin testing, the clinician seeing individuals with suspected food allergy need to do an oral food challenge (OFC) in a medically supervised setting – open OFC in most cases with double-blind placebo-controlled food challenges being reserved for equivocal cases and for research.

Food allergy affects up to 10% of children and adults and the number of hospital admission for severe allergic reactions to foods has increased over the last few decades. A diagnosis of food allergy requires avoidance of the culprit allergens and often leads to changes to life-style and anxiety related to the fear of accidental allergic reactions. An accurate diagnosis of food allergy is therefore extremely important. The new EAACI Food Allergy guidelines summarise the evidence and the rationale supporting the best practice recommendations for confirming or ruling out the diagnosis in children and adults with possible food allergy.

An accurate diagnosis of food allergy is extremely important – in the new EAACI Food Allergy Guidelines, clinicians will have clear guidance on the approach to patients with suspected food allergy.

The expert group advising on the EAACI Food Allergy Guidelines included patient representatives, who ensured the patients’ perspectives were taken into account. An important stage after the launch of the EAACI Guidelines on Diagnosis of Immediate-type Food Allergy is the implementation of the guidelines, which includes information of healthcare professionals looking after patients with suspected food allergy and also the information of patients and the public.

Dr Scott H. Sicherer, MD, Director, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York commented on the launch if the new EAACI Food Allergy Guidelines: “The accurate diagnosis of IgE-mediated food allergy is paramount for ensuring patient safety, nutrition and quality of life. These updated diagnostic guidelines, with 8 evidence-based recommendations, will help reduce the current state where tests are often over-used and misinterpreted, and provide clinicians with the knowledge and tools needed to effectively arrive at an appropriate diagnosis.” Dr Aikaterini Anagnostou stated “The diagnosis of food allergy places a significant burden on individuals and their families, as well as healthcare systems, so it is very important for all, to ‘get it right’. Carefully designed algorithms (as included in the updated EAACI guidelines) are key in this area and can assist clinicians in the – often complicated- diagnostic process. The emergence of novel diagnostics in food allergy will likely provide testing modalities that are complementary to existing, traditional methods and enhance the accuracy of a food allergy diagnosis. Shared decision-making will play a key role when deciding which test (or combination of tests) to be used in individual patients.” Dr Kari Nadeau, John Rock Professor of Climate and Population Studies of Harvard University, said “These EAACI guidelines are an unparalleled next step to meet the needs of a critical area in food allergy around the globe.” Indeed with a global reach, the new EAACI guidelines were also commented by Professor Mike Levin Head of Division of Asthma and Allergy at University of Cape Town: “Food allergy is one of the most difficult conditions to manage due to the lack of any absolute test to determine the presence of food allergy or not, apart from an oral challenge.  IgE results indicate sensitisation and significance need to be interpreted along with a clinical history, and levels may vary in different populations studied.  The EAACI Guidelines for Food Allergy comprehensively addresses diagnosis of food allergy with meta-analyses of data on IgE testing and including advances in component resolved diagnosis and cellular tests, serving as an excellent resource for clinicians working in the field.”

EAACI has launched the new guidelines on diagnosis of immediate type food allergies. This key document provides clear recommendations for best clinical practice and summarises the evidence supporting it. This guideline was informed by a systematic review of studies looking at the diagnostic accuracy of any test for any food allergy that were published since the last EAACI Food Allergy Guidelines were published in 2014, was elaborated by a global group of experts in food allergy and is aimed at healthcare professionals seeing patients with possible food allergies for best possible care.