Diagnosis and Treatment of Food Allergy in Children

Kim, Woo Kyung

Abstract

Food allergy is a common allergic manifestation in early childhood. However, some medical practitioners remain sceptical about the role of food allergies in a number of clinical syndromes, such as atopic dermatitis, colic and gastrooesophageal reflux in infancy, despite increasing evidences that food allergy can contribute to these conditions. Symptoms usually begin in the first 2 years of life, often after the first exposure to the known food. Diagnosis is made using medical history and can usually be detected by skin prick testing (SPT) or measuring food-specific serum IgE antibody levels. But to obtain final confirmation a double blind controlled food challenge (DBPCFC) must be performed. Delayed-onset reactions (occurring within several hours to days after ingestion) are often difficult to diagnose. The patients usually show negative SPT, so elimination or challenge protocols are required to make a definitive diagnosis. These forms of food allergy are not usually associated with anaphylaxis. Prevention and treatment are based on the avoidance of the culprit food. Children often develop tolerance to cows milk, egg, soy and wheat by school age, whereas allergies to nuts and shellfish are more likely to be lifelong. This article will help general practitioners and other clinicians understand the principles of diagnosis and management of food allergy in childhood, and suggests when to refer patients to specialist.