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EAACI guidelines on the diagnosis of IgE‐mediated food allergy

Allergy2023Vol. 78(12), pp. 3057–3076

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Alexandra F. Santos, Carmen Riggioni, Ioana Agache, Cezmi A. Akdiş, Mübeccel Akdiş, Alberto Álvarez‐Perea, Montserrat Álvaro‐Lozano, Barbara Ballmer‐Weber, Simona Barni, Kirsten Beyer, Carsten Bindslev‐Jensen, Helen A. Brough, Betül Büyüktiryaki, Derek K. Chu, Stefano Del Giacco, Audrey DunnGalvin, Bernadette Eberlein, Motohiro Ebisawa, Philippe Eigenmann, Thomas Eiwegger, Mary Feeney, Montserrat Fernández‐Rivas, Helen R. Fisher, David M. Fleischer, Mattia Giovannini, C L Gray, Karin Hoffmann‐Sommergruber, Susanne Halken, Jonathan O’B Hourihane, Christina Jones, Marek Jutel, Edward F. Knol, George Ν. Konstantinou, Gideon Lack, Susanne Lau, Andreina Marques‐Mejias, Mary Jane Marchisotto, Rosan Meyer, Charlotte G. Mørtz, Beatriz Moya, Antonella Muraro, Caroline Nilsson, Lucila Camargo Lopes de Oliveira, Liam O’Mahony, Nikolaos G. Papadopoulos, Kirsten P. Perrett, Rachel L. Peters, Márcia Helena Miranda Cardoso Podestá, Lars K. Poulsen, Graham Roberts, Hugh A. Sampson, Jürgen Schwarze, Peter Smith, Elizabeth Huiwen Tham, Eva Untersmayr, Ronald van Ree, Carina Venter, Brian P. Vickery, Berber Vlieg‐Boerstra, Thomas Werfel, Margitta Worm, George Du Toit, Isabel Skypala

Abstract

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.

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Abstract

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