Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Diagnostic evaluation of food allergy

Wesley Burks, MD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


The evaluation of a patient with possible food allergy is a clinical exercise that includes some combination of the following diagnostic tools, although not all of these elements are necessary in every patient [1-6]:

History and physical examination

Prick/puncture skin testing

In vitro testing

Gastroenterologic tests


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Oct 20, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Burks AW, Sampson HA. Diagnostic approaches to the patient with suspected food allergies. J Pediatr 1992; 121:S64.
  2. Du Toit G, Santos A, Roberts G, et al. The diagnosis of IgE-mediated food allergy in childhood. Pediatr Allergy Immunol 2009; 20:309.
  3. NIAID-Sponsored Expert Panel, Boyce JA, Assa'ad A, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010; 126:S1.
  4. Burks AW, Jones SM, Boyce JA, et al. NIAID-sponsored 2010 guidelines for managing food allergy: applications in the pediatric population. Pediatrics 2011; 128:955.
  5. Sampson HA, Aceves S, Bock SA, et al. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016.
  6. Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69:1008.
  7. Fleischer DM, Bock SA, Spears GC, et al. Oral food challenges in children with a diagnosis of food allergy. J Pediatr 2011; 158:578.
  8. American College of Allergy, Asthma, & Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol 2006; 96:S1.
  9. Burks AW, James JM, Hiegel A, et al. Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998; 132:132.
  10. Eigenmann PA, Sicherer SH, Borkowski TA, et al. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics 1998; 101:E8.
  11. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999; 104:S114.
  12. Devenney I, Fälth-Magnusson K. Skin prick tests may give generalized allergic reactions in infants. Ann Allergy Asthma Immunol 2000; 85:457.
  13. Reid MJ, Lockey RF, Turkeltaub PC, Platts-Mills TA. Survey of fatalities from skin testing and immunotherapy 1985-1989. J Allergy Clin Immunol 1993; 92:6.
  14. Eigenmann PA, Sampson HA. Interpreting skin prick tests in the evaluation of food allergy in children. Pediatr Allergy Immunol 1998; 9:186.
  15. Ortolani C, Ispano M, Pastorello EA, et al. Comparison of results of skin prick tests (with fresh foods and commercial food extracts) and RAST in 100 patients with oral allergy syndrome. J Allergy Clin Immunol 1989; 83:683.
  16. Rancé F, Juchet A, Brémont F, Dutau G. Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges. Allergy 1997; 52:1031.
  17. Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy 2000; 30:1540.
  18. Hill DJ, Heine RG, Hosking CS. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol 2004; 15:435.
  19. Roberts G, Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol 2005; 115:1291.
  20. Sampson HA. Update on food allergy. J Allergy Clin Immunol 2004; 113:805.
  21. Sicherer SH, Teuber S, Adverse Reactions to Foods Committee. Current approach to the diagnosis and management of adverse reactions to foods. J Allergy Clin Immunol 2004; 114:1146.
  22. Lockey RF. Adverse reactions associated with skin testing and immunotherapy. Allergy Proc 1995; 16:293.
  23. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997; 100:444.
  24. García-Ara C, Boyano-Martínez T, Díaz-Pena JM, et al. Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the infant. J Allergy Clin Immunol 2001; 107:185.
  25. Celik-Bilgili S, Mehl A, Verstege A, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 2005; 35:268.
  26. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107:891.
  27. Wang J, Godbold JH, Sampson HA. Correlation of serum allergy (IgE) tests performed by different assay systems. J Allergy Clin Immunol 2008; 121:1219.
  28. Osterballe M, Bindslev-Jensen C. Threshold levels in food challenge and specific IgE in patients with egg allergy: is there a relationship? J Allergy Clin Immunol 2003; 112:196.
  29. Komata T, Söderström L, Borres MP, et al. The predictive relationship of food-specific serum IgE concentrations to challenge outcomes for egg and milk varies by patient age. J Allergy Clin Immunol 2007; 119:1272.
  30. Ando H, Movérare R, Kondo Y, et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol 2008; 122:583.
  31. Perry TT, Matsui EC, Kay Conover-Walker M, Wood RA. The relationship of allergen-specific IgE levels and oral food challenge outcome. J Allergy Clin Immunol 2004; 114:144.
  32. Sicherer SH, Wood RA. Advances in diagnosing peanut allergy. J Allergy Clin Immunol Pract 2013; 1:1.
  33. Hamilton RG, Franklin Adkinson N Jr. In vitro assays for the diagnosis of IgE-mediated disorders. J Allergy Clin Immunol 2004; 114:213.
  34. Sicherer SH. Food allergy: when and how to perform oral food challenges. Pediatr Allergy Immunol 1999; 10:226.
  35. Lozinsky AC, Meyer R, De Koker C, et al. Time to symptom improvement using elimination diets in non-IgE-mediated gastrointestinal food allergies. Pediatr Allergy Immunol 2015; 26:403.
  36. David TJ. Anaphylactic shock during elimination diets for severe atopic eczema. Arch Dis Child 1984; 59:983.
  37. Beyer K, Teuber SS. Food allergy diagnostics: scientific and unproven procedures. Curr Opin Allergy Clin Immunol 2005; 5:261.
  38. Huston DP, Cox LS. Evidence-based evaluation for allergies to avoid inappropriate testing, diagnosis, and treatment. JAMA Intern Med 2014; 174:1223.
  39. Lemon-Mulé H, Sampson HA, Sicherer SH, et al. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol 2008; 122:977.
  40. Aalberse RC, Stapel SO, Schuurman J, Rispens T. Immunoglobulin G4: an odd antibody. Clin Exp Allergy 2009; 39:469.
  41. Matsumoto N, Okochi M, Matsushima M, et al. Peptide array-based analysis of the specific IgE and IgG4 in cow's milk allergens and its use in allergy evaluation. Peptides 2009; 30:1840.
  42. Tomicić S, Norrman G, Fälth-Magnusson K, et al. High levels of IgG4 antibodies to foods during infancy are associated with tolerance to corresponding foods later in life. Pediatr Allergy Immunol 2009; 20:35.
  43. Savilahti EM, Rantanen V, Lin JS, et al. Early recovery from cow's milk allergy is associated with decreasing IgE and increasing IgG4 binding to cow's milk epitopes. J Allergy Clin Immunol 2010; 125:1315.
  44. Caubet JC, Bencharitiwong R, Moshier E, et al. Significance of ovomucoid- and ovalbumin-specific IgE/IgG(4) ratios in egg allergy. J Allergy Clin Immunol 2012; 129:739.
  45. Skripak JM, Nash SD, Rowley H, et al. A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow's milk allergy. J Allergy Clin Immunol 2008; 122:1154.
  46. Jones SM, Pons L, Roberts JL, et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol 2009; 124:292.
  47. Stapel SO, Asero R, Ballmer-Weber BK, et al. Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy 2008; 63:793.