Diagnostic evaluation of food allergy
- Wesley Burks, MD
Wesley Burks, MD
- Chair of Pediatrics
- University of North Carolina
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
- Burks AW, Sampson HA. Diagnostic approaches to the patient with suspected food allergies. J Pediatr 1992; 121:S64.
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- 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.
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- 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.
- Aalberse RC, Stapel SO, Schuurman J, Rispens T. Immunoglobulin G4: an odd antibody. Clin Exp Allergy 2009; 39:469.
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- 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.
- 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.
- 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.
- 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.
- Jones SM, Pons L, Roberts JL, et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol 2009; 124:292.
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- ROLE OF ALLERGY TESTS IN DIAGNOSIS
- SKIN TESTING
- Prick/puncture skin tests
- - Precautions and preparations
- - Technique
- - Accuracy
- Intradermal skin tests
- Atopy patch tests
- IN VITRO TESTING
- Component testing
- Basophil histamine release
- TRIAL ELIMINATION DIETS
- FOOD DIARIES
- FOOD CHALLENGES
- UNVALIDATED METHODS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS