Note: The general population of children does not have pre-existing severe allergic disease and also does not have a family history of FA.
- The signs and symptoms characteristic of anaphylaxis
- The timing of symptoms in association with food ingestion/exposure
- Comorbid conditions, such as asthma, that may affect treatment and outcome
- The limited utility of laboratory parameters in the acute care setting
- In individuals presenting with anaphylaxis or any combination of symptoms listed in Table 1 that occur within minutes to hours of ingesting food, especially in young children and/or if symptoms have followed the ingestion of a specific food on more than one occasion
- In infants, young children and selected older children diagnosed with certain disorders, such as moderate to severe AD, EoE, enterocolitis, enteropathy, and AP
- In adults diagnosed with EoE
- Medical history: The expert panel (EP) recommends using a detailed medical history to help focus the evaluation of an FA. Although the medical history often provides evidence for the type of food-induced allergic reaction and the potential causative food(s) involved, history alone cannot be considered diagnostic of FA.
- Physical examination: The EP recommends performing a focused physical examination of the patient, which may provide signs consistent with an allergic reaction or disorder often associated with FA. However, by itself, the physical examination cannot be considered diagnostic of FA.
Note: The double-blind, placebo-controlled food challenge is the gold standard. However, a single-blind or an open-food challenge may be considered diagnostic under certain circumstances: if either of these challenges elicits no symptoms (ie, the challenge is negative), then FA can be ruled out; but when either challenge elicits objective symptoms (ie, the challenge is positive) and those objective symptoms correlate with medical history and are supported by laboratory tests, then a diagnosis of FA is supported.
- Basophil histamine release/activation
- Lymphocyte stimulation
- Facial thermography
- Gastric juice analysis
- Endoscopic allergen provocation
- Hair analysis
- Applied kinesiology
- Provocation neutralization
- Allergen-specific IgG4
- Cytotoxicity assays
- Electrodermal test (Vega)
- Mediator release assay (Lifestyle Eating and Performance [LEAP] diet
- The child has persistent AD in spite of optimized management and topical therapy.
- The child has a reliable history of an immediate reaction after ingestion of a specific food.
Pregnancy and Infancy
- Dosing with IM epinephrine followed by transfer to an emergency facility for observation and possible further treatment
- Observation for 4-6 hours or longer based on severity of the reaction
- Education for patient and family on:
- Allergen avoidance
- Early recognition of signs and symptoms of anaphylaxis
- Anaphylaxis emergency action plan implementation
- Appropriate IM epinephrine administration
- Medical identification jewelry or an anaphylaxis wallet card
- Epinephrine auto-injector prescription and training provided at the time of discharge
- Continuation of adjunctive treatment after patient discharge:
- H1 antihistamine: diphenhydramine every 6 hours for 2-3 days; alternative dosing with a nonsedating second generation antihistamine
- H2 antihistamine: ranitidine twice daily for 2-3 days
- Corticosteroid: prednisone daily for 2-3 days
- Follow-up appointment with primary health care professional (after a food-induced anaphylactic reaction), with consideration for additional follow-up with a clinical specialist such as an allergist/immunologist.
August 1, 2014
External Publication Status
Country of Publication
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Ambulatory, Childcare center, Correctional facility, Emergency care, Long term care, Medical transportation, School
Nurse, nurse practitioner, physician, physician assistant
Counseling, Assessment and screening, Diagnosis, Prevention, Management, Treatment
D000486 - Allergy and Immunology, D005502 - Food, D005512 - Food Hypersensitivity
food allergies, food allergy, food allergen, adverse food reactions, eosinophilic esophagitis