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NICE has recently opened the consultation on its draft clinical guideline on the diagnosis and assessment of food allergies in children and young people. Its aim is to support GPs and other health professionals in primary care and community settings in recognising the signs and symptoms of food allergy, by giving clear recommendations on taking allergy-focussed histories to assess the condition.

Food allergies are adverse immune responses to food allergens¹. They are among the most common of the allergic disorders and are recognised as a major paediatric health problem in western countries. Reactions can be extremely severe; hospital admissions in the UK for food allergies have increased by 500%since 19902, and there has been a dramatic increase in prevalence in the last twenty years, ranging from 6% to 8% in children up to the age of 3 years across Europe and North America. The most common foods to which children and young people are allergic include cow’s milk; fish and shellfish; hen’s eggs; peanuts, tree nuts and sesame; soy; wheat and kiwi fruit.

Food allergies in children can result in a number of symptoms, therefore the draft guideline recommends that the condition should be considered if the child has one or a combination of the following, including:

• skin conditions such as eczema or acute urticaria (itchy rash)
• respiratory complaints such as sneezing or shortness of breath
• gastrointestinal problems such as vomiting, difficulty swallowing or constipation
• anaphylaxis (severe, hyper-sensitive reaction) and other allergic reactions.

Food allergies should also be considered in children who are not adequately responding to treatment for atopic (allergic) eczema, gastro-oesophageal reflux disease (where stomach contents leak out of the stomach and into the oesophagus), and chronic constipation.

If a food allergy is suspected, the GP or other healthcare professional should take an allergy-focused clinical history, tailored to the presenting symptoms and age of the child or young person. This should include a family history of allergies, an assessment of the symptoms, and feeding history as an infant. A physical examination should pay particular attention to growth, and physical signs of malnutrition.

The draft guideline also recommends offering the appropriate information based on the type of allergy suspected, the risk of allergic reaction, and the diagnostic process which may include excluding specific foods from the diet, reintroducing these foods with reoccurrence of the allergic reaction confirming diagnosis. Diagnosis may also include skin prick and blood tests for IgE (immunoglobulin) antibodies; specific antibodies suggest particular allergic reactions. Alternative methods of diagnosis such as hair analysis and kinesiology are not recommended. Referral to secondary care should be considered if the child has ongoing problems including faltering growth, vomiting, abdominal pain, loose or frequent stools, or constipation.

Dr Judith Richardson, Associate Director, Centre for Clinical Practice at NICE, said: “Food allergies in children are becoming more common, therefore it is important that there are appropriate, evidence-based approaches in treating those with this condition. Many of the symptoms are common to other conditions, so it’s not always easy to identify and diagnose food allergy correctly. This will be the first evidence-based guideline on how health professionals and others who work with young children should diagnose and assess food allergies in children. It will be a very welcome addition in improving outcomes for those children affected by this troublesome condition, and supporting better use of resources across the health system. The draft guideline is now open for consultation and we would welcome comment from registered stakeholders.”

This draft guidance has been issued for consultation; NICE has not yet issued final guidance to the NHS. The draft guideline is available on the food allergy in children and young people webpage.

Notes to Editors

About the guidance

1. The draft short clinical guideline can be found at http://guidance.nice.org.uk/CG/Wave21/2.

2. The final guideline is expected to be published in January 2011.

3. This guideline does not cover children and young people with food intolerances, such as intolerance to lactose.

Footnotes

1 A substance that causes an allergy.

2http://www.nature.com/embor/journal/v7/n11/full/7400846.html