Practice Guidelines

Diagnosis and assessment of food allergy in children and young people: summary of NICE guidance

BMJ 2011; 342 doi: (Published 23 February 2011) Cite this as: BMJ 2011;342:d747
  1. A Sackeyfio, technical analyst1,
  2. A Senthinathan, assistant technical analyst1,
  3. P Kandaswamy, technical analyst, health economics1,
  4. P W Barry, consultant in paediatric intensive care2, honorary senior lecturer3,
  5. B Shaw, technical adviser1,
  6. M Baker, clinical adviser1
  7. On behalf of the Guideline Development Group
  1. 1Centre for Clinical Practice, National Institute for Health and Clinical Excellence, Manchester M1 4BD, UK
  2. 2University Hospitals of Leicester NHS Trust, Leicester LE5 4QF, UK
  3. 3Department of Child Health, University of Leicester, Leicester LE1 6TP

Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in westernised countries, and their prevalence seems to be rising, as does the prevalence of all allergic diseases.1 Correct diagnosis of food allergy in children and young people is essential to reduce the incidence of adverse reactions that result from true food allergies that are missed, and to reduce cases of unnecessary treatment after an incorrect diagnosis. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and assessment of food allergy in children and young people in primary care and community settings.2


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Assessment and allergy focused clinical history

  • Consider the possibility of food allergy in children and young people who have one or more of the signs and symptoms listed in the table. Pay particular attention to persistent symptoms that involve different organ systems. [Based on low quality evidence from diagnostic and observational studies and the experience and opinion of the Guideline Development Group (GDG)]

  • If food allergy is suspected (by a healthcare professional or the parent, carer, child, or young person), a healthcare professional with the appropriate competencies (a general practitioner or other healthcare professional) should take an allergy focused clinical history that is tailored to the presenting symptoms and age. This should include:

    • -Any personal or family history (in parents or siblings) of atopic disease (such as asthma, eczema, allergic rhinitis, or food allergy)

    • -Details …

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