New guidelines recommend routine use of allergy tests to improve quality of care in children

Feb 24 2011

The first guidelines for food allergy in children and young people issued by NICE, National Institute for health and Clinical Excellence, recommend routine use of allergy tests in NHS primary care and community settings to confirm suspected food allergy. These new evidence-based guidelines support earlier diagnosis and assessment of food allergy and states that testing is cost effective compared to not testing.

The new Guidelines provides important evidence-based recommendations that will if implemented help dramatically to improve the care of the many children and young people with allergy," says Professor Aziz Sheikh, Head of The University of Edinburgh's Allergy & Respiratory Research Group and the Royal College of General Practitioners Clinical Champion for Allergy.

Food has been recognised as a major paediatric health problem in western countries because of the potential severity of reactions and the dramatic increase in prevalence.

Food allergy can cause severe allergic reactions and even death from food induced anaphylaxis. Patients with coexisting asthma often have the most severe reactions leading to intensive care unit visits. There is currently no other treatment than avoiding the food that causes the allergy and treating the symptoms associated with severe reactions. The prevalence of food allergy in Europe and North America, range from 6% to 8% in children up to the age of 3 years.

NICE recommends that all children and young people with suspected IgE-mediated allergy should be offered an allergy test, such as a blood test, e.g. ImmunoCAP, or a skin prick test. Medical history alone is not sufficient to make a diagnosis of food allergy. An allergy test can help define the underlying cause of an allergic reaction, confirm or rule out food allergy and thus avoid unnecessary treatment or dietary restrictions. Food avoidance affects quality of life and can place patients at significant risk for nutritional deficiencies and growth deficit and should be avoided if possible, especially in children and young people. NICE states that a blood test and skin prick test are equally cost-effective compared to no test.

NICE guidelines recommend that skin prick test only should be done where there are facilities to deal with an anaphylactic reaction as skin prick test may provoke this reaction. NICE also states that healthcare professionals undertaking such tests should be competent and aware of the potential risks associated with these tests.

"We welcome these clear guidelines on diagnosing food allergy in primary care. Children and young people with suspected food allergy will get an accurate and timely diagnosis using the correct test for their condition. This is very important since food allergy is a serious condition which can cause significant anxiety in families, but which is manageable with the right diagnosis," says Mandy East from the National Allergy Strategy Group.

A blood test is easy, uncomplicated, safe and reliable. Unlike skin prick testing, it can be done irrespective of a patient's age, skin condition, pregnancy, medication, symptoms and disease activity. In addition it may provide more detailed information on the origin of the allergy.

"It is of great value for children and young people with suspected food allergy that NICE guidelines recommend performing an allergy test, such as ImmunoCAP blood test. A blood test will help physicians to confirm or rule out allergy and consequently avoid unnecessary treatment or dietary restrictions. We are pleased that several food allergy guidelines recommend blood tests in the diagnosis of food allergy," says Jean Forcione, Chief Operating Officer Phadia AB.

NIH food allergy guidelines from December 2010 recognized the superior clinical value of ImmunoCAP. The European Academy of Allergy and Clinical Immunology, EAACI, has also announced that it will develop guidelines for the diagnosis and management of food allergies.