Diagnosing IgE-mediated food allergy: How to apply the latest guidelines in clinical practice

Background: People suspected of food allergy require accurate diagnosis to help manage their condition and get appropriate care. Recent guidelines summarize the latest evidence about diagnosing IgE-mediated food allergy, but they do not describe how to address practical issues when testing. There is a need to translate guideline recommendations into a practical common pathway that all centers dealing with food allergy can use. Objective: The Global Network of Centres of Excellence for Anaphylaxis & Food Allergy-ANAcare developed a pathway to help clinicians apply the latest diagnostic guidelines and overcome implementation challenges. Methods: The pathway is based on reviewing guidelines, research and clinical feedback, plus consensus of experts from 13 countries. Results: We describe practical tips that clinicians can use when taking a detailed clinical history and testing people with suspected IgE-mediated food allergy. Tests for IgE sensitization such as skin prick tests and specific IgE are readily available and inexpensive. However, they only demonstrate sensitization, not clinical allergic disease, so they need to be interpreted in the context of the clinical history. A controlled oral food challenge may also be needed to identify which foods the person is experiencing reactions to and what quantity can be tolerated. Conclusions: Correct diagnosis is essential to support individualized management. Allergy centers around the world can use our practical tips to help avoid under- and overdiagnosis.