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Food allergy in children

Dr Adam Fox discusses new NICE guidance to help GPs diagnose and assess food allergy in children.

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This podcast was added on 23 Feb 2011

Podcast transcript

Hello and welcome to this podcast from NICE. Today sees the launch of a new piece of guidance to help GPs diagnose and assess food allergy in children.  

Joining me to discuss the guidance is Dr Adam Fox from Guys and St Thomas Hospital in London, and a leading allergy specialist on the guideline development group.

Q1: “So Adam, just how big a problem is food allergy in England?”

AF:  “Food allergy is actually a very common problem in the UK and we estimate that actually around 1 in 20 children are affected by it.”

Q2: “When we talk about food allergy, what are the main things that kids are allergic to?”

AF: “There are two sorts of food allergies that cause problems for small children in particular.

“There are immediate allergies, so these are the reactions where if somebody eats something, for example milk or egg or peanuts which is a particularly common food allergy, and then almost instantaneously they have swelling and itchiness. And if they are really unlucky they can have a very severe even life-threatening reaction which we refer to as anaphylaxis.

“The other types of reactions - more delayed or chronic reactions - again typically affect infants. A child may have problems such as chronic eczema or colic or diarrhoea or not be gaining weight very well and it’s actually being caused by a delayed food allergy, typically to either milk or less commonly to soy.”

Q3: “Now, allergy services are often referred to as a Cinderella service of the NHS. What are the current levels of care like for children with food allergies?

AF: “Well the reality of it is that you can’t really, unfortunately, compare the level of service provision currently in the NHS to other European countries or the USA.  We have lagged behind a little bit.

“Things certainly have got better over the last few years for children. Mainly because in district general hospitals around the country general paediatricians,  in response to the huge burden of disease that they are seeing, are having to become better trained and skilled up to deal with the allergic disease that they are seeing.

“In primary care there has been something of a problem over the last few years because allergy is a new pattern of disease.

“We are seeing so much more of it then we saw in the past and many GPs will not have had the experience or the training at medical school to equip them as well as they would like to recognise and diagnose food allergy appropriately.“

Q4: “You mention it’s very much a problem for GPs. Now this new guideline is the first ever national guideline on food allergy in children and is aimed specifically at GPs. So how will this help them?”

AF: “I think this is a really exciting development because this gives us the opportunity to empower GPs to have a consistent approach to diagnosing and assessing food allergy when it first presents.

“It’s GPs who are the first people who get to hear about these particularly delayed type problems of chronic eczema, diarrhoea, colic and they are the ones that need to make that decision as to whether there is an allergic cause underlying it. The guideline gives them a framework to be able to do that effectively.”

Q5: “What are the main diagnostic tests that GPs can do?”

AF: “What the guideline suggests is that in the first instance an allergy focused clinical history is taken so that the GP can decide whether he suspects a food allergy at all. If food allergy is the cause of the problem, then decide whether it’s the immediate type of food allergy or a delayed type allergy.

“If he suspects an immediate type allergy then  possible tests that can be done are either a skin prick test, although you need the facilities to do that and most GPs won’t have that in their practice, or a blood test called a specific IgE test.

“If a delayed type allergy is suspected then unfortunately there aren’t any validated tests to do and what the GPs will recommend is completely excluding the suspect food from the diet to see if the symptoms go away and then recommending that the food is reintroduced to see if it comes back, and a diagnosis is made that way.”

Q6: “Are there any tests that GPs should avoid doing?”

AF: “Well unfortunately over the last few years we have seen a huge growth in the amount of allergic disease around and because the NHS services have sometime lagged behind that demand, there has been a real growth in the alternative sector around allergy.

“As a result, a trip down to the high street  or a search on the internet will reveal a huge number of different types of tests being offered, which are unfortunately not scientifically validated and really do not have any role to play in the diagnosis of food allergy.

“As a result of these sorts of alternative tests, often children find themselves on difficult and restrictive diets which can comprise their nutrition to the degree that they don’t grow properly or develop properly.

“So we are very keen through this guidance to ensure that GPs, as well as families, understand that there is no place for kinesiology, vega testing or hair analysis in the diagnosis of food allergy.”

Dr Fox thank you very much.

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Disclaimer

This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.

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This page was last updated: 19 September 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.