NICE targets high-street allergy testing

NEW NICE guidance on food allergies in children and young people aims to steer patients away from online and high street testing centres and into GP surgeries.

The first evidence-based guideline on the diagnosis and assessment of food allergy in children and young people has been developed to support GPs, nurses, healthcare professionals working in community and primary care as well as patients and provides clear recommendations on diagnosis and assessment.

Food allergies are now recognised as a major paediatric health problem in western countries with hospital admissions in the UK having increased by 500 per cent since 1990. Prevalence has increased by an estimated 6 to 8 per cent in children up to the age of 3 years across Europe and North America. Among the most common food allergies are those to cow's milk, fish and shellfish, hen's eggs, peanuts, tree nuts and sesame, soy, wheat and kiwi fruit.

Many parents are now turning to alternative methods of diagnosis such as the Vega test, kinesiology and hair analysis which can retail for up to £60 online and significantly more on the high street. NICE states there is currently very little evidence to show that these tests work.

Food allergy in children can manifest in a range of symptoms and the guideline recommends that it should be considered in children with one or a combination of symptoms including skin conditions such as eczema or acute urticaria, gastrointestinal problems such as vomiting, nausea or constipation, respiratory complaints such as sneezing or shortness of breath, and anaphylaxis and other allergic reactions.

NICE advises a high index of suspicion in children who do not adequately respond to treatment for atopic (allergic) eczema, gastro-oesophageal reflux disease and chronic constipation.

In suspected food allergies the guideline advises treating GPs and other healthcare professional to take a focused clinical history and include a family history of allergies, symptom assessment and details of any foods that are avoided and reasons why, including feeding history as an infant. Physical examination should pay particular attention to growth and signs of malnutrition.

Diagnosis may involve excluding specific foods from the diet and reintroducing these foods to check for reoccurrence of the allergic reaction. Skin prick and/or blood tests for IgE (immunoglobulin) antibodies can also suggest particular allergic reactions.

Dr Adam Fox, Consultant in Paediatric Allergy, Guy's and St Thomas' Hospital NHS Foundation Trust, London, and Guideline Development Group member, said: "We are seeing more and more children and young people being diagnosed with food allergy in the UK, so this guideline will be absolutely crucial in helping to diagnose and assess this condition, which can be both upsetting and frustrating for both children and their parents.

"Many parents often turn to alternative methods to help diagnose their child, but there is currently little evidence base for these approaches, and parents often end up putting their children on very extensive restriction diets following the inaccurate diagnosis, which can leave them malnourished, as well as wasting time and money."

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