Specific IgE levels can be raised without being clinically relevant or even be false-positive.
What is known about IgE tests:
- Interpretation without relating clinical symptoms may lead to unnecessary and potentially harmful dietary restrictions, with nutritional implications for children – and unnecessary fear and anxiety for the family or carers.
- Testing should be selected based on the medical history and should not include large screening panels.
How to talk with patients and parents about IgE tests:
- Explain the possibility of raised IgE levels without a food allergy (especially in children with eczema). Remind that there is no evidence to support empirical dietary exclusions in patients with eczema without a history of immediate food allergy.
- Highlight the risks associated with imposing restrictive diets on children.
- Educate about symptoms of an allergic reaction like rash, vomiting etc. occurring within minutes to hours of eating the specific food.
- If necessary, take an allergy-focused clinical history.
This EAP recommendation is in accordance with Choosing Wisely recommendations of:
-
Australia: https://www.choosingwisely.org.au/recommendations/ascia4
-
Canada: https://choosingwiselycanada.org/wp-content/uploads/2017/02/Paediatrics.pdf
-
Germany: https://register.awmf.org/de/leitlinien/detail/061-031
-
Switzerland: https://www.paediatrieschweiz.ch/choosingwisely/
-
UK: https://www.bsaci.org/wp-content/uploads/2020/02/Choosing-Wisely-on-IgE-request-in-eczema.pdf
-
USA: https://education.aaaai.org/pipro/choosingwisely_fa
Norway: https://www.legeforeningen.no/kloke-valg/til-helsepersonell/legeforeningens-anbefalinger/norsk- barnelegeforening/allergitesting/
References:
- ASCIA. Position Paper: Evidence-Based Versus Non Evidence- Based Allergy Tests and Treatments [Internet]. 2021. Available from: https://www.allergy.org.au/images/stories/pospapers/ASCIA_HP_Evidence-Based_Vs_Non_Evidence- Based_Allergy_Tests_Treatments_2021.pdf
- Burks W. UpToDate: Diagnostic evaluation of IgE-mediated food allergy [Internet]. 2023. Available from: https://www.uptodate.com/contents/diagnostic-evaluation-of-ige-mediated-food-allergy
- Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014 Aug;69(8):1008–25. PMID: 24909706 NICE guidelines. Recommendations | Food allergy in under 19s: assessment and diagnosis | Guidance |
- NICE [Internet]. NICE; 2011 [cited 2024 Feb 27]. Available from: https://www.nice.org.uk/guidance/cg116/chapter/Recommendations#ige-mediated-food-allergy