Food Allergy in Children and Young People

Excerpt

Food allergy is an adverse immune response to a food. It can be classified into IgE-mediated and non-IgE-mediated reactions. Many non-IgE reactions, which are poorly defined both clinically and scientifically, are believed to be T-cell-mediated. Some reactions involve a mixture of both IgE and non-IgE responses and are classified as mixed IgE and non-IgE allergic reactions. Food allergy may be confused with food intolerance, which is a non-immunological reaction that can be caused by enzyme deficiencies, pharmacological agents and naturally occurring substances. Food intolerance will not be covered in this guideline. The starting point for the guideline is a suspicion of food allergy, and the use of an allergy-focused clinical history will help to determine whether a food allergy is likely.

Contents

• Introduction
• Patient-centred care
• 1. Summary
  • 1.1. List of all recommendations
  • 1.2. Care pathway
  • 1.3. Overview
• 2. How this guideline was developed
  • 2.1. Introduction
  • 2.2. Assessment and allergy-focused clinical history
  • 2.3. Diagnosis of IgE-mediated food allergy
  • 2.4. Diagnosis of non-IgE-mediated food allergy
  • 2.5. Providing information and support
  • 2.6. Referral to secondary or specialist care
  • 2.7. Alternative diagnostic tools
• 3. Research recommendations
  • 3.1. Prevalence and natural history of non-IgE-mediated food allergy
  • 3.2. Clinical predictors of non-IgE-mediated food allergy
  • 3.3. Information needs for children and young people during their care pathway to diagnosis of food allergy
  • 3.4. Values of skin prick testing and specific IgE antibody testing and their predictive value
  • 3.5. Modes of provision of support to healthcare professionals
• 4. Other versions of this guideline
  • Quick reference guide
  • ‘Understanding NICE guidance’
• 5. Related NICE guidance
  • 5.1. Guidance under development in parallel with NICE
• 6. Updating the guideline
• 7. References, glossary and abbreviations
  • 7.1 References
  • 7.2 Glossary
  • 7.3 Abbreviations
  • 7.4. Appendices
• 8. Contributors
  • 8.1. The Guideline Development Group
  • 8.2. The short clinical guidelines technical team
  • 8.3. The short clinical guidelines team
  • 8.4. Centre for clinical practice
  • 8.5. The Guideline Review Panel
  • 8.6. Declarations of interest
  • 8.7. Authorship and citation
• Appendix 1: Scope, literature search, review protocol and evidence
  • Appendix 1.0. Scope
  • Appendix 1.1. Review protocol
  • Appendix 1.2. Literature search & search strategies
  • Appendix 1.3. Evidence tables
• Appendix 2. Excluded studies
• Appendix 3: Health economics
  • Appendix 3.0. Non-IgE-mediated food allergy – Cost effectiveness analysis
  • Appendix 3.1. IgE-mediated food allergy – Cost effectiveness analysis
• Appendix 4. Declarations of interest

NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales. This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, and informed by the summary of product characteristics of any drugs they are considering.

Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.