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This referral pathway covers IgE and non IgE mediated food allergies in children under 18.
Specific links to information about cow's milk to and egg allergy in management section.
Other atopic or non allergy related conditions
The most common foods causing allergies in children are:
Milk, egg, peanut, tree nuts, soya, fish, shellfish, wheat and kiwi fruit
IgE mediated reactions occur quickly within 2 hours and are acute.
Non IgE mediated symptoms can be much more delayed.
NICE lists the following symptoms:
|Acute urticaria – localised or generalised||Atopic eczema|
|Acute angioedema – most commonly of the lips,|
face and around the eyes
|Angioedema of the lips, tongue and palate ||Gastro-oesophageal reflux disease|
|Oral pruritus||Loose or frequent stools|
|Nausea||Blood and/or mucus in stools|
|Colicky abdominal pain||Abdominal pain|
|Diarrhoea||Food refusal or aversion|
|Pallor and tiredness|
|Faltering growth in conjunction with at least one or more |
gastrointestinal symptoms above (with or without significant atopic eczema)
|Upper respiratory tract symptoms (nasal itching, sneezing, rhinorrhoea or congestion [with or without conjunctivitis])|
|Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath)||Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath)|
|Signs or symptoms of anaphylaxis or other systemic allergic reactions|
A history of anaphylaxis (airway or circulatory compromise, unstoppable vomiting) should trigger a referral to the allergy clinic. See also the anaphylaxis referral guideline
Multiple food allergies causing moderate or severe dietary restriction
Blood in stool causing haematological changes
Unusual history or concern about history
Specific IgE blood tests can be performed to single allergens if there is a clear history.
Avoid a scatter gun approach with panels of tests being performed.
Alternative testing such as kinesiology, hair analysis, IgG or Vega testing are not recommended.
Skin prick testing if facilities are available, or can sometimes be arranged in the allergy clinic.
Cow's milk allergy is common. Formulary chapter 9 gives primary care advice on the diagnosis and management of cow's milk allergy and includes information leaflets for families.
Egg is the most common allergy in small children. It can present as an IgE mediated or non IgE mediated reaction. Baked egg is less allergenic and some will tolerate baked egg much earlier, or from the start of their allergy. A copy of the BSACI "egg ladder" can be found on page 1121 of this paper.
As per the NICE guidelines please refer if there are any of the following criteria:
e-Referral Service Selection
This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.
Publication date: 6 July 2016