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EAACI guidelines on the diagnosis of IgE ‐mediated food allergy

Santos, Alexandra F., Riggioni, Carmen, Agache, Ioana, Akdis, Cezmi A., Akdis, Mubeccel, Alvarez‐Perea, Alberto, Alvaro‐Lozano, Montserrat, Ballmer‐Weber, Barbara, Barni, Simona, Beyer, Kirsten, Bindslev‐Jensen, Carsten, Brough, Helen A., Buyuktiryaki, Betul, Chu, Derek, Del Giacco, Stefano, Dunn‐Galvin, Audrey, Eberlein, Bernadette, Ebisawa, Motohiro, Eigenmann, Philippe, Eiwegger, Thomas, Feeney, Mary, Fernandez‐Rivas, Montserrat, Fisher, Helen R., Fleischer, David M., Giovannini, Mattia, Gray, Claudia, Hoffmann‐Sommergruber, Karin, Halken, Susanne, Hourihane, Jonathan O’B., Jones, Christina J., Jutel, Marek, Knol, Edward, Konstantinou, George N., Lack, Gideon, Lau, Susanne, Marques Mejias, Andreina, Marchisotto, Mary Jane, Meyer, Rosan, Mortz, Charlotte G., Moya, Beatriz, Muraro, Antonella, Nilsson, Caroline, Lopes de Oliveira, Lucila Camargo, O’Mahony, Liam, Papadopoulos, Nikolaos G., Perrett, Kirsten, Peters, Rachel L., Podesta, Marcia, Poulsen, Lars K., Roberts, Graham, Sampson, Hugh A., Schwarze, Jürgen, Smith, Peter, Tham, Elizabeth Huiwen, Untersmayr, Eva, Van Ree, Ronald, Venter, Carina, Vickery, Brian P., Vlieg‐Boerstra, Berber, Werfel, Thomas, Worm, Margitta, Du Toit, George, Skypala, Isabel·2023·Allergy
DOI 10.1111/all.15902
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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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Metadata

Authors
Santos, A. F., Riggioni, C., Agache, I., Akdis, C. A., Akdis, M., Alvarez‐Perea, A., Alvaro‐Lozano, M., Ballmer‐Weber, B., Barni, S., Beyer, K., Bindslev‐Jensen, C., Brough, H. A., Buyuktiryaki, B., Chu, D., Del Giacco, S., Dunn‐Galvin, A., Eberlein, B., Ebisawa, M., Eigenmann, P., Eiwegger, T., Feeney, M., Fernandez‐Rivas, M., Fisher, H. R., Fleischer, D. M., Giovannini, M., Gray, C., Hoffmann‐Sommergruber, K., Halken, S., Hourihane, J. O., Jones, C. J., Jutel, M., Knol, E., Konstantinou, G. N., Lack, G., Lau, S., Marques Mejias, A., Marchisotto, M. J., Meyer, R., Mortz, C. G., Moya, B., Muraro, A., Nilsson, C., Lopes de Oliveira, L. C., O’Mahony, L., Papadopoulos, N. G., Perrett, K., Peters, R. L., Podesta, M., Poulsen, L. K., Roberts, G., Sampson, H. A., Schwarze, J., Smith, P., Tham, E. H., Untersmayr, E., Van Ree, R., Venter, C., Vickery, B. P., Vlieg‐Boerstra, B., Werfel, T., Worm, M., Du Toit, G., & Skypala, I.
Affiliations
  • Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences King's College London London UK
  • Department of Allergy and Clinical Immunology, Department of Paediatrics, Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
  • Faculty of Medicine Transylvania University Brasov Romania
  • Swiss Institute of Allergy and Asthma Research (SIAF) University Zurich Davos Switzerland
  • Hospital General Universitario Gregorio Marañón Madrid Spain
  • Pediatric Allergy and Clinical Immunology Department Hospital Sant Joan de Déu Barcelona Spain
  • Clinic for Dermatology and Allergology, Kantonsspital St. Gallen St. Gallen Switzerland
  • Allergy Unit Meyer Children's Hospital IRCCS Florence Italy
  • Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine Charité Universitätsmedizin Berlin Berlin Germany
  • Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital University of Southern Denmark Odense Denmark
  • Division of Pediatric Allergy, Department of Pediatrics Koc University School of Medicine Istanbul Turkey
  • McMaster University Ontario Hamilton Canada
  • Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology University Hospital "Duilio Casula", University of Cagliari Cagliari Italy
  • Paediatrics and Child Health, INFANT Centre, HRB‐CRF University College Cork Cork Ireland
  • Department of Dermatology and Allergy Biederstein, TUM School of Medicine and Health Technical University of Munich Munich Germany
  • Clinical Research Center for Allergy and Rheumatology National Hospital Organization Sagamihara National Hospital Kanagawa Japan
  • Department of Pediatrics, Gynecology and Obstetrics University Hospitals of Geneva Geneva Switzerland
  • Translational Medicine Program, Research Institute Hospital for Sick Children Ontario Toronto Canada
  • Allergy Department Hospital Clinico San Carlos Madrid Spain
  • Children's Hospital Colorado University of Colorado School of Medicine Colorado Aurora USA
  • Red Cross Children's Hospital and Kidsallergy Centre Cape Town South Africa
  • Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
  • Hans Christian Andersen Children's Hospital Odense University Hospital Odense Denmark
  • Royal College of Surgeons in Ireland and Childrens Health Ireland Dublin Ireland
  • Faculty of Medical Sciences, School of Psychology University of Surrey Surrey UK
  • Department of Clinical Immunology Wrocław Medical University, ALL‐MED Medical Research Institute Wroclaw Poland
  • Department of Dermatology/Allergology, Center of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
  • Department of Allergy and Clinical Immunology 424 General Military Training Hospital Thessaloniki Greece
  • EAACI Patient Organisation Committee Zurich Switzerland
  • Department of Medicine Imperial College London UK
  • Department of Allergy Hospital Universitario 12 de Octubre Madrid Spain
  • Food Allergy Referral Centre Padua University Hospital Padua Italy
  • Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
  • Division of Allergy and Clinical Immunology, Department of Paediatrics Federal University of São Paulo São Paulo Brazil
  • Department of Medicine, School of Microbiology, APC Microbiome Ireland University College Cork Cork Ireland
  • Allergy Department, 2nd Pediatric Clinic University of Athens Athens Greece
  • Department of Paediatrics University of Melbourne Victoria Parkville Australia
  • EFA ‐ European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
  • Allergy Clinic Copenhagen University Hospital at Herlev‐Gentofte Copenhagen Denmark
  • Department of Paediatric Allergy and Respiratory Medicine University of Southampton Southampton UK
  • Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute Icahn School of Medicine at Mount Sinai New York New York United States
  • Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair The University of Edinburgh Edinburgh UK
  • Clinical Medicine Griffith University Queensland Southport Australia
  • Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
  • Departments of Experimental Immunology and of Otorhinolaryngoloy Amsterdam University Medical Centers Amsterdam The Netherlands
  • Section of Allergy and Clinical Immunology, Children's Hospital Colorado University of Colorado Colorado Aurora USA
  • Emory University School of Medicine and Children's Healthcare of Atlanta Georgia Atlanta USA
  • Department of Paediatrics OLVG Hospital Amsterdam the Netherlands
  • Department of Dermatology and Allergy Hannover Medical School Hannover Germany
  • Division of Allergy and immunology, Department of Dermatology, Venerology and Allergology Charité Universitätsmedizin Berlin Berlin Germany
  • Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust London UK
ORCID
Venue
Allergy
Publisher
Wiley
Published
2023-10-10
Volume
78
Issue
12
Pages
3057-3076
ISSN
  • 0105-4538
  • 1398-9995
DOI
10.1111/all.15902
Cited by
342
References
1
Language
en
Licence
creativecommons.org/licenses/by-nc/4.0/ (vor)
Funders
European Academy of Allergy and Clinical Immunology

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