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Food allergy in children and young people
Short Text
Introduction
This pathway covers the diagnosis and assessment of food allergy in children and young people in primary care and community settings.
Food allergy is an adverse immune response to a food. Food allergy is one of the most common allergic disorders and is recognised as a major paediatric problem in western countries. Its prevalence has increased dramatically in recent decades. There is great variation in current practice for allergy care, and there are no agreed treatment pathways or referral criteria. Many people use alternative sources of support instead of NHS services, including non-validated tests and treatments.
Source guidance
The NICE guidance that was used to create the pathway.
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Assessment tools
The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Audit support
Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Costing support
Costing tools estimate national and local costs and benefits of implementing NICE guidance, or explain why costs are not considered to be significant.
Information resources and templates
These include key points for scrutiny or compliance assessment, signposting to resources, checklists and case studies. They are designed to offer practical help in putting NICE guidance into practice and the format depends on the specific topic.
Podcasts
Interviews that focus on practical actions to overcome specific implementation challenges. They are recorded by NICE with experts in the area, who were usually involved in guidance development.
Slide sets
Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Pathway information
Information for patients and the public
NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on the following topic.
Patient centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice that accompanies the Mental Capacity Act. In Wales, healthcare professionals should follow advice on consent from the Welsh Government. If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children.
Updates to this pathway
05 March 2012 Minor maintenance updates
Supporting information
Signs and symptoms of possible food allergy
Note: this list is not exhaustive. The absence of these symptoms does not exclude food allergy.
The skin | |
Acute urticaria (localised or generalised) Acute angioedema (most commonly in the lips and face, and around the eyes) | Pruritus Erythema |
The gastrointestinal system | |
Angioedema of the lips, tongue and palate Oral pruritus Nausea Colicky abdominal pain Vomiting Diarrhoea | Loose or frequent stools Blood and/or mucus in stools Abdominal pain Infantile colic Food refusal or aversion Constipation Perianal redness Pallor and tiredness Faltering growth plus one or more gastrointestinal symptoms above (with or without significant atopic eczema) |
The respiratory system (usually in combination with one or more of the above symptoms and signs) | |
Upper respiratory tract symptoms – nasal itching, sneezing, rhinorrhoea or congestion (with or without conjunctivitis) | |
Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath) | |
Other | |
Signs or symptoms of anaphylaxis or other systemic allergic reactions | |
Glossary
A severe, life-threatening, generalised or systemic hypersensitivity reaction, characterised by rapidly developing life-threatening airway, breathing and/or circulation problems, usually associated with skin and mucosal changes.
Swelling, similar to hives, except that the swelling is beneath the skin rather than on the surface.
A chronic inflammatory skin condition characterised by an itchy red rash that favours the skin creases such as folds of elbows or behind the knees. The word 'atopic' in the term atopic eczema is an indicator of the frequent association with atopy and the need to separate this clinical phenotype from the ten or so other forms of eczema such as irritant, allergic contact, discoid, venous, seborrhoeic and photosensitive eczema. The terms 'atopic eczema' and 'atopic dermatitis' are synonymous.
Allergies that are commonly found to be present in association with other allergies.
Redness.
An adverse immune response to a food. It can be classified into IgE-mediated and non-IgE-mediated reactions. IgE-mediated reactions are triggered by the immunoglobulin E (IgE) antibody and are acute, frequently with rapid onset. Non-IgE-mediated reactions are usually caused by cell reactions in the immune system and are generally characterised by delayed and non-acute reactions.
A chronic digestive disease that occurs when the contents of the stomach, including acid, flows back (refluxes) into the oesophagus (gullet).
Immunoglobulin E (IgE) is a class of antibody. It triggers an excessive activation of certain white blood cells called mast cells and basophils resulting in an extreme inflammatory response.
An allergic reaction triggered by the immunoglobulin E (IgE) antibody. The reaction is acute and frequently has rapid onset.
Mixed reactions involve a mixture of both IgE and non-IgE responses.
This type of allergy is not caused by IgE antibodies (it is usually because of cell reactions in the immune system).These reactions are generally characterised by delayed and non-acute reactions.
Itchy skin.
Allergic reactions involving parts of the body distant to the actual site of allergen contact.
Raised, red, itchy welts (weals or swellings) of various sizes that seem to appear and disappear on the skin.
Child or young person with possible food allergy
Child or young person with possible food allergy
Alternative diagnostic tools not recommended
Alternative diagnostic tools not recommended
Alternative diagnostic tools not recommended
Do not use the following alternative diagnostic tests in the diagnosis of food allergy:
- vega test
- applied kinesiology
- hair analysis.
Do not use serum-specific IgG testing to diagnose food allergy.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeTesting for IgE-mediated food allergy: skin prick test and or blood tests for specific IgE antibodies
Testing for IgE-mediated food allergy: skin prick test and/or blood tests for specific IgE antibodies
Testing for IgE-mediated food allergy: skin prick test and/or blood tests for specific IgE antibodies
Offer a skin prick test and/or blood tests for specific IgE antibodies to the suspected foods and likely co-allergens.
Base choice of test on:
- the clinical history and
- the suitability for, safety for, and acceptability to the child or young person (or their parent or carer) and
- the available competencies of the healthcare professional to undertake the test and interpret the results.
Tests should only be undertaken by healthcare professionals with the appropriate competencies to select, perform and interpret them.
Only undertake skin prick tests where there are facilities to deal with an anaphylactic reaction.
Interpret test results in the context of clinical history.
Do not use atopy patch testing or oral food challenges to diagnose IgE-mediated allergy in primary care or community settings.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeTesting for non-IgE-mediated food allergy: elimination diet
Testing for non-IgE-mediated food allergy: elimination diet
Testing for non-IgE-mediated food allergy: elimination diet
Try eliminating the suspected allergen (normally for between 2–6 weeks), then reintroduce. Seek advice from a dietitian with appropriate competencies about nutritional adequacies, timings of elimination and reintroduction, and follow-up.
Taking into account socioeconomic, cultural and religious issues, offer information on:
- what foods and drinks to avoid
- how to interpret food labels
- alternative sources of nutrition to ensure adequate nutritional intake
- the duration, safety and limitations of an elimination diet
- oral food challenge or reintroduction procedures, if appropriate, and their safety and limitations.
If allergy to cows' milk protein is suspected, offer:
- food avoidance advice to breastfeeding mothers
- information on appropriate hypoallergenic formula or milk substitute to mothers of formula-fed babies.
Seek advice from a dietitian with appropriate competencies.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeConsider referral to secondary or specialist care
View the 'Consider referral to secondary or specialist care' nodePaths in this pathway
Pathway created: December 2011 Last updated: March 2012
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