[Food allergy diagnosis].
The diagnosis of food allergies (FA) relies upon the sequential use of different means and tools, according to a decision tree. Ten clinical characteristics point to a potential FA. A diary for food consumption during a week surveys all labellings, in order to detect masked food allergens. The second step is based on skin prick tests to natural foods, and epicutaneous tests to a few proteins (casein, gluten...). Biological tests using multi detection tests of specific IgEs to numerous allergens are not advised owing to the frequency of clinically not relevant in vitro cross-reactivity. Single determination of specific IgEs, have a 95% predictive positive value of high levels in cases of allergy to milk, egg, fish and peanut, and can spare oral challenges. The primary use of biological tests is not currently advised but may be of interest in litigious cases. Standardized oral challenges are the golden standard. Eviction regimens are an alternative used for cow's milk allergy in infancy, or for suspected digestive allergies in adults.
Moneret-Vautrin
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DA
Service de Médecine Interne, Immunologie Clinique et Allergologie-Hôpital Central-54035, Nancy.
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000485:Allergens; D002648:Child; D002675:Child, Preschool; D003109:Colonic Diseases, Functional / Q000209:etiology; D003429:Cross Reactions; D003876:Dermatitis, Atopic / Q000209:etiology; D003968:Diarrhea, Infantile / Q000209:etiology; D015930:Diet Records; D005512:Food Hypersensitivity / Q000175:diagnosis*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007223:Infant; D011237:Predictive Value of Tests; D012882:Skin Tests
D000485:Allergens; D007073:Immunoglobulin E