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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:
- "IgE-mediated food allergy - diagnosis and management in New Zealand children" (Sinclair et al, NZMJ 2013) provides an overview of clinical guidelines for New Zealand.
- The Australasian Society of Clinical Immunology and
Allergy (ASCIA) has published an evidence-based, 'quick
reference guide' to assist health professionals in the management
of patients with IgE and non-IgE mediated food allergy http://www.allergy.org.au/images/stories/pospapers/ASCIA_HP_Clinical_Update_Food_Allergy_2016_HP_version_UPDATED.pdf
This complements ASCIAs food allergy e-training for health professionals, which is recommended by the Allergy Clinical Network. There is no charge for this and other ASCIA e-training modules. See Training and Resources for more information and links to these courses.
- The Irish Food Allergy Network has provided a useful summary of food allergy: http://ifan.ie/food-allergy-in-summary/summary/
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:
*Features of anaphylaxis, defined as a severe allergic reaction with involvement of cardiovascular and/or respiratory systems.
Specialist paediatric referral and dietetic support is recommended for children with food allergy with:
- Definite or possible anaphylaxis.
- Allergy to cow's milk or multiple food allergies, where expert advice is needed.
- Where there is uncertainty about the diagnosis or interpretation of results.
- Food sensitisation on ssIgE / SPT, where supervised challenge may be necessary to clarify whether there is clinical allergy.
- Allergy to foods such as peanut and nut where the risk of severe allergic reactions is higher.
- Children with asthma and FA, with asthma a risk factor for severe food allergic reaction on accidental exposure.
- Children whose FA persists past 5 years of age.
Note: Links to individual DHB Clinical Pathways for allergies in children and young people will be published here as they become available.
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
Document last reviewed: April 2017
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