EAACI Guideline on IgE-mediated Food Allergy

1. Consensus on IgE-mediated food allergies:

• There is clear consensus that IgE-mediated food allergies exist.

2. Medical history and IgE measurements:

• The medical history is important, but not sufficient on its own for making the diagnosis.
• IgE measurements are essential and highly important.

3. Differential diagnoses:

• There are other mechanisms and differential diagnoses to IgE-mediated food allergy, such as FPIES, eosinophilic esophagitis, and fructose intolerance.

4. Skin tests and specific IgE measurements:

• Skin tests, whole-allergen extracts, and molecular components of specific IgE (sIgE) are compared quantitatively.
• There are cut-off values for skin tests (wheal diameter), whole-allergen sIgE, and molecular sIgE, particularly for allergies to cow’s milk, hen’s egg, wheat, peanut, hazelnut, cashew, sesame, and shrimp.
• It is recommended never to measure only molecular components without whole-allergen extracts.

5. Provocation tests:

• Provocation tests are primarily intended for cases of doubt and should be performed as open challenges, not as double-blind ones.
• Food cross-reactivity with pollen is an indication for provocation testing.

6. Dynamics of food allergy:

• The development of the allergy depends on the patient’s age and the allergen. Molecular components are not yet taken into account in this context, even though they can provide important indications regarding the risk of anaphylaxis and the persistence of the allergy.

Internal comments and practice:

• It is internally recommended to measure all available molecular components in order to avoid misjudgments.
• Provocation tests are recommended when molecular sIgE values (e.g., ovomucoid) have decreased by half or fall below a certain cut-off value.
• Regular measurement of the components every 1–2 years is advised.

Conclusion:

• The new EAACI guideline helps to further standardize the approach when food allergy is suspected.
• Clinical practice is largely consistent with the EAACI guideline and should continue to be closely discussed and adjusted.

Source: EAACI Leitlinie zur IgE-vermittelten Nahrungsmittelallergie

The EAACI guideline helps improve and standardize the approach to diagnosing and treating food allergies.