Menu Search Donate

Food Allergy

This site does not accept referrals or provide clinical advice in response to questions. If you are a New Zealand health professional seeking clinical advice, please use your local clinical pathway. If you are a New Zealand child patient, parent or caregiver seeking clinical advice, please contact your usual doctor. You can read the full site disclaimer here.

Within this Document

•  Introduction
•  Diagnosis
•  Referral
•  Management in Primary Care

Introduction

Food allergy (FA) is a common condition in early childhood, affecting up to 10% of children under 5 years. It is defined as an adverse immunologic reaction to a food protein. Many FA are IgE-mediated immediate hypersensitivity reactions, while immunologic mechanisms other than IgE also occur. These are referred to as non IgE-mediated reactions. Food intolerance does not have an immunologic mechanism.

Guidelines on the diagnosis and management of food allergy are available as follows:

Diagnosis

Diagnosis is based on clinical history, with the history of an immediate allergic reaction critical in the interpretation of skin-prick test (SPT) or serum specific IgE (ssIgE, also referred to as RAST or EAST).

The Allergy CN is currently finalising guidelines for Allergy Testing in New Zealand, but in the interim recommends the following:

Signs and symptoms of an IgE-mediated allergic reaction:

Cutaneous Urticaria
Angiodema
Flushing/erythema
Itch
Respiratory Watery rhinorrhoea
Sneezing
Tongue swelling*
Hoarseness/laryngeal oedema*
Cough*
Wheeze*
Stridor*
Gastrointestinal Tract Vomiting
Abdominal pain
Diarrhoea
Cardiovascular/general Pallor*
Dizziness*
Collapse*

*Features of anaphylaxis, defined as a severe allergic reaction with involvement of cardiovascular and/or respiratory systems.

Referral

Specialist paediatric referral and dietetic support is recommended for children with food allergy with:

Note: Links to individual DHB Clinical Pathways for allergies in children and young people will be published here as they become available.

Management in Primary Care

Allergen avoidance, risk management (particularly in relation to the potential for anaphylaxis), dietetic support, and follow-up are the main features of the management of food allergy. Eventual referral for specialist supervised food challenge may be necessary. Patient education in all aspects is important. Patients should be provided with an Action Plan - Allergy or Anaphylaxis - signed by their doctor. These are available from the ASCIA website on:http://www.allergy.org.au/health-professionals/anaphylaxis-resources

The Paediatric Allergy Clinical Network has more information on the management of anaphylaxis.

Clinical Update for Dietitians: ASCIA has published a Clinical Update to complement the ASCIA food allergy e-training for dietitians. The main purpose of this document is to provide an evidence-based, 'quick reference guide' to assist dietitians in the management of patients with IgE and non-IgE mediated food allergy. The Clinical Update for Dietitians is available here:
http://www.allergy.org.au/images/stories/pospapers/ASCIA_HP_Clinical_Update_Food_Allergy_2016_dietitian_version_UPDATED.pdf

References

IgE-mediated food allergy - diagnosis and management in New Zealand children: Sinclair et al,. NZMJ 2013

Document last reviewed: April 2017

More From Starship