When children are referred to secondary care for evaluation it is usually to confirm a diagnosis or to get clarity on the precise eliciting food. Many children are avoiding additional foods unnecessarily when they attend the allergy clinic and a key task for secondary care is to ensure only foods that must be avoided are removed from the diet.


The first step towards diagnosis of food allergy in secondary care is taking a good allergy focused history. Clinical features such as the timing (< 2 hrs, usually minutes) specific symptoms (rash, hives, vomiting, breathing difficulties) create a high index of suspicion. Another key feature is that most food allergy reactions are caused by a small group of foods including egg, milk, peanut and tree nuts.


The resources in this section are to guide the evaluation, testing and management of the most common food allergies. These behave differently with some food allergies almost always resolving (milk and egg) but individuals progress at different speeds. These food allergies are also open to resolving more quickly with the introduction of baked egg or milk products (using the egg and milk ladders). This requires guidance from a healthcare professional, especially for milk allergy or following a previous severe reaction. Greater caution is required for children older than 1 year.


Skin prick testing where available is the preferred means of first line testing. Specific IgE testing may also be helpful. There are algorithms to guide diagnosis and management with these results. It is important to re-evaluate all food allergies over time. The ultimate allergy test remains the oral food challenge. There is practical guidance available carrying out food challenges which must be performed in a hospital setting that is able to manage anaphylaxis.

Collection & Use of Personal Information