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NICE issues child food allergy guidance



By Lilian Anekwe

GPs should suspect food allergies in children presenting with a range of symptoms, according to new draft NICE guidance.

Children who present with one or a combination of skin conditions, respiratory complaints, gastrointestinal problems or anaphylaxis should be considered potentially allergic to a substance, the draft recommends.

In children with a suspected food allergy, GPs should take an allergy-focused clinical history, which should include details of any family history of allergies, an assessment of the symptoms, and feeding history as an infant.

The history should also include a physical examination which ‘should pay particular attention to growth, and physical signs of malnutrition.’

GPs can diagnose food allergies by excluding specific foods from the diet, reintroducing these foods with reoccurrence of the allergic reaction confirming diagnosis. A diagnosis can also be made if GPs use a skin prick and blood tests for IgE antibodies.

GPs should consider referring children to secondary care if they have ongoing problems including faltering growth, vomiting, abdominal pain, loose or frequent stools, or constipation.

Dr Judith Richardson, associate director of the centre for clinical practice at NICE, said: ‘Many of the symptoms [of food allergy] 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.’

The consultation period on the draft guidance runs until 6 September.

What does the guidance recommend?

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 eczema, gastro-oesophageal reflux disease and chronic constipation.

Source: Food allergy in children and young people, draft NICE guidance, August 2010.