ÎEliminating one or a few specific foods from the diet may be useful in the diagnosis of FA, especially in identifying foods responsible for some non-IgE-mediated food-induced allergic disorders, such as FPIES, AP, and Heiner syndrome, and some mixed IgE- and non-IgE- mediated food-induced allergic disorders, such as EoE. (B-III)
ÎUse oral food challenges for diagnosing FA. (A-I)
Note: The double-blind, placebo-controlled food challenge is the gold standard. However, a single-blind or an open-food challenge may be considered diagnostic under certain circumstances: if either of these challenges elicits no symptoms (ie, the challenge is negative), then FA can be ruled out; but when either challenge elicits objective symptoms (ie, the challenge is positive) and those objective symptoms correlate with medical history and are supported by laboratory tests, then a diagnosis of FA is supported.
ÎDo NOT use any of the following nonstandardized tests for the routine evaluation of IgE-mediated FA: (A-III)
> Basophil histamine release/activation > Lymphocyte stimulation > Facial thermography > Gastric juice analysis > Endoscopic allergen provocation > Hair analysis > Applied kinesiology > Provocation neutralization > Allergen-specific IgG4 > Cytotoxicity assays > Electrodermal test (Vega) > Mediator release assay (Lifestyle Eating and Performance [LEAP] diet)
ÎSPTs, sIgE tests, and APTs may be considered to help identify foods that are associated with EoE, but these tests alone are not sufficient to make the diagnosis of FA. (B-III)
Note: The role of these tests in the diagnosis of other eosinophilic GI diseases has not been established.
ÎUse the medical history and oral food challenge to establish a diagnosis of FPIES. (A-I)
Note: However, when history indicates that infants or children have experienced hypotensive episodes or multiple reactions to the same food, a diagnosis may be based on a convincing history and absence of symptoms when the causative food is eliminated from the diet.
ÎUse the medical history, resolution of symptoms when the causative food is eliminated from the diet, and recurrence of symptoms following an oral food challenge to diagnose AP. (A-II)
ÎUse the medical history, including the absence of symptoms while the causative food is avoided, and positive patch tests to diagnose ACD. (A-II)
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