Diagnosis and Assessment
ÎUse the medical history, including the resolution of symptoms while the causative food is avoided, and positive patch tests to establish the diagnosis of systemic contact dermatitis. (B-III)
ÎUse the medical history, including the absence of symptoms while the causative food is avoided, positive sIgE tests or SPTs, and positive immediate epicutaneous skin tests (for example, positive immediate responses to APTs), to establish the diagnosis of food-induced IgE- mediated contact urticaria. (B-III)
ÎConsider children less than 5 years old with moderate to severe AD for FA evaluation for milk, egg, peanut, wheat, soy, and any other food that the parents reported to trigger atopic dermatitis, if at least one of the following conditions is met: (B-III)
> The child has persistent AD in spite of optimized management and topical therapy.
Follow-up
ÎUse follow-up testing for individuals with FA depending on the specific food to which the individual is allergic. Whether testing is done annually or at other intervals depends on the food in question, the age of the child, and the intervening medical history. (B-II)
Prevention
ÎPatients at risk* for developing FA do not need to limit exposure to foods that may be cross-reactive with the 8 major food allergens in the United States (milk, egg, peanut, tree nuts, soy, wheat, fish, and crustacean shellfish) or to potential nonfood allergens (for example, dust mites, pollen, or pet dander). (B-III)
ÎIndividuals with documented or proven IgE-mediated or non-IgE- mediated FA should avoid ingesting their specific allergen or allergens. (A-III)
ÎPatients with FA and their caregivers should be provided with information on food allergen avoidance and emergency management that is age and culturally appropriate. (A-III)
ÎIndividuals without documented or proven FA need not avoid potentially allergenic foods as a means of managing AD, asthma, or EoE. (A-II)
ÎAll children with FA should have nutritional counseling and regular growth monitoring. (A-III)
* Patients at risk for developing FA are defined as those with a biological parent or sibling with existing, or history of, allergic rhinitis, asthma, AD, or FA.
6
> The child has a reliable history of an immediate reaction after ingestion of a specific food.
