This article reviews the recent advances in the diagnosis and management of IgE mediated food allergy in children. It will encompass the emerging technology of component testing; moves to standardization of the allergy food challenge; permissive diets which allow for inclusion of extensively heated food allergens with allergen avoidance; and strategies for accelerating tolerance and food desensitization including the use of adjuvants for specific tolerance induction.
The gold standard for the diagnosis of IgE mediated food allergy is the double-blind placebo-controlled food challenge (DBPCFC), but in reality this procedure is generally reserved for clinical trials. More commonly utilised are observed food challenges (OFC) usually unblinded to the administering clinician. These are particularly helpful where sensitisation to a food allergen is present – a positive skin prick test (SPT) or detection of serum specific IgE (ssIgE) – without a history of ingestion, or where the history of the ingestion is in doubt, or the history of symptoms resulting from the food ingestion is not highly suggestive of an IgE mediated reaction. Most commonly, the clinical diagnosis of food allergy relies upon a convincing recent history of immediate objective symptoms, and the confirmation by detection of IgE production directed against the candidate food, either by SPT and/or by detection of ssIgE. Two emerging trends have recently influenced the current diagnosis of food allergies, the evolution of component resolved diagnostics (CRD), and the move towards standardisation of protocols, severity indexes and agreed symptoms for OFC and DBPCFC.
The full article is published online in the journal Asia Pacific Allergy and is free to access.