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. 2025 Aug 18;4(4):100556.
doi: 10.1016/j.jacig.2025.100556. eCollection 2025 Nov.

Diagnosing IgE-mediated food allergy: How to apply the latest guidelines in clinical practice

Carina Venter  1   2 , Susanne Halken  3   4 , Alice Toniolo  5 , Anna Nowak-Wegrzyn  6   7 , Berber Vlieg-Boerstra  8   9   10 , Caroline A Nilsson  11   12 , David M Fleischer  1   2 , Debra de Silva  13 , Domingo Barber  14 , Ekaterina Khaleva  15 , Edward Knol  16 , Jennifer L P Protudjer  11   17   18 , Laura Morandini  5 , Antonella Muraro  5 ; Global Network of Centres of Excellence for Anaphylaxis & Food Allergy—ANAcare
Collaborators, Affiliations

Diagnosing IgE-mediated food allergy: How to apply the latest guidelines in clinical practice

Carina Venter et al. J Allergy Clin Immunol Glob. .

Abstract

Background: People suspected of food allergy require accurate diagnosis to help manage their condition and get appropriate care. Recent guidelines summarize the latest evidence about diagnosing IgE-mediated food allergy, but they do not describe how to address practical issues when testing. There is a need to translate guideline recommendations into a practical common pathway that all centers dealing with food allergy can use.

Objective: The Global Network of Centres of Excellence for Anaphylaxis & Food Allergy-ANAcare developed a pathway to help clinicians apply the latest diagnostic guidelines and overcome implementation challenges.

Methods: The pathway is based on reviewing guidelines, research and clinical feedback, plus consensus of experts from 13 countries.

Results: We describe practical tips that clinicians can use when taking a detailed clinical history and testing people with suspected IgE-mediated food allergy. Tests for IgE sensitization such as skin prick tests and specific IgE are readily available and inexpensive. However, they only demonstrate sensitization, not clinical allergic disease, so they need to be interpreted in the context of the clinical history. A controlled oral food challenge may also be needed to identify which foods the person is experiencing reactions to and what quantity can be tolerated.

Conclusions: Correct diagnosis is essential to support individualized management. Allergy centers around the world can use our practical tips to help avoid under- and overdiagnosis.

Keywords: Diagnosis; food allergy; oral food challenge; skin prick test; specific IgE.

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Conflict of interest statement

The Global Network of Centres of Excellence for Anaphylaxis & Food Allergy—ANAcare supported experts to attend conferences and meetings where this document was discussed and edited. Disclosure of potential conflict of interest: C. Venter declares institutional grant from Reckitt; and speaker fees from Danone, Reckitt, Nestlé Nutrition Institute, and Abbott Nutrition. S. Halken declares consultation fees from ALK-Abelló, Nestlé Purino, Abigo, Meadjohnson; and data monitoring committee for Stallergenes. A. Nowak-Wegrzyn declares institutional grants from Alladapt Immunotherapeutics, DBV Technologes, Siolta Therapeutics, and Regeneron; speaking fees from Nestlé, Danone, and Thermo Fisher Scientific; consulting fees from Aquestive; royalties from UpToDate; and service as associate editor for Annals of Allergy, Asthma & Immunology, chair of the ABAI board of directors, director of the AAAAI board, and chair of the medical advisory board of the International FPIES Association. B. Vlieg-Boerstra declares institutional grants from Nutricia and OLVG Research; and consulting or speaker’s fees from Nestlé, Vini Mini, Colzaco, and Nutricia. D. M. Fleischer declares grants from DBV Technologies and ARS Pharmaceuticals; royalties from UpToDate; consultancy fees from Aquestive, ARS Pharmaceuticals, Bryn Pharma, DBV Technologies, Genentech, and Nasus Pharma; speaker for Genentech; stock options from Grow Happy; and service as unpaid member of the medical advisory board for the Food Allergy & Anaphylaxis Connection Team (FAACT) and the Medical Advisory Council for the National Peanut Board. D. de Silva declares an institutional grant from ANAcare toward report editing. D. Barber declares lecture fees from Diater Labs. E. Knol declares speaker and/or consultant fees from Sanofi, Thermo Fisher Scientific, and GSK. J. L. P. Protudjer declares consulting fees from Ajonomoto Cambrooke, Novartis, Nutricia, and ALK Abelló; and service as section head of Allied Health, colead of Research Pillar for the Canadian Society of Allergy and Clinical Immunology, and member of the steering committee for Canada’s National Food Allergy Action Plan. A. Muraro declares speaker fees from Aimmune, DBV Technologies, Nestlé Health Science, and Nestlé Purina; and advisory boards for Aimmune, Sanofi, DBV Technologies, Novartis, Regeneron, and Viatris. The rest of the authors declare that they have no relevant conflicts of interest.

Figures

Fig 1
Fig 1
Typology of IgE-mediated, non–IgE-mediated, and mixed-type food allergies.
Fig 2
Fig 2
Things to consider in clinical and nutritional history.
Fig 3
Fig 3
Decision chart for testing to diagnose food allergy.
Fig 4
Fig 4
Likelihood of clinical food allergy based on combination of level of clinical history and test results.
See this image and copyright information in PMC

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