Diagnostic Tools

of Food Allergy

Sumadiono
Pediatric Department Fac. of Medicine
Gadjah Mada University Yogyakarta

Food Allergy Diagnosis Steps

Allergy History
Clinical Signs and Symptoms
Skin Test
(skin prick test, atopy patch test)
Specific IgE test (RAST)
Elimination & Provocation test
2

Unproven methods:
Procedures used in diagnosis and
treatment that lack scientific credibility.
Have not been shown to have clinical
efficacy
Commercial interests

Invalid tests
Cytotoxic testing

placing a drop of the persons blood onto a glass

microscope slide which has a spesific dried food
already attached to the glass.

Provocation-Neutralization
injecting a various chemicals, pollens, food,
hormone or toxins into the skin of person
results any symptom = provocation dose.
Smaller doses and concentrations of that
same substances are injected until no
symptoms occur = neutralization dose.

Invalid tests
Electrodermal Diagnosis
Diagnose food or other allergies through
changes in skin resistance by measuring
an electric current. The person will hold a
glass vial containing the food in question
in one hand, and source of electrical
current in the other hand.
More D,MD. Controversial and Unproven Tests in the Diagnosis of Allergies. 2011

Invalid tests

Electrodermal Skin Test VEGA test - Bioresonance

Invalid tests
Applied Kinesiology
detection a change in a persons muscle strenght

Reaginic Pulse
measures a persons pulse after eating a particular food.

Body Chemical Analysis

trace amount of chemicals measured in body fluids, hair
and tissue that can leads to allergy symptoms and
disease.
More D,MD. Controversial and Unproven Tests in the Diagnosis of Allergies. 2011

Food Allergy Diagnosis Steps

Allergy History
Clinical Signs and Symptoms
Skin Test
(skin prick test, atopy patch test)
Specific IgE test (RAST)
Elimination & Provocation test
10

 IgE

Food allergy: clinical

manifestations
IgE/Non-IgE

Non-IgE

Urticaria/angioed Atopic
ema
dermatitis
Rhinitis /Asthma
Anaphylaxis

Protein-induced
proctocolitis/
enterocolitis

Oral allergic
syndrome
Gastrointestinal
symptoms

Celiac disease
Contact dermatitis
Herpetiform
dermatitis

Eosinophilic
gastrointestinal
disorders

Adapted from J Allergy Clin Immunol.

1999;103:717-728

Cutaneous food
hypersensitivities:
atopic eczema
Generally begins in early infancy
Characterized by typical distribution,
extreme pruritus, and chronically
relapsing course

Cutaneous food
hypersensitivities

Acute Urticaria and Angioedema:

The most common symptoms of food allergic
reactions
Chronic Urticaria:
Food allergy is an infrequent cause of
chronic urticaria and angioedema

IgE mediated: respiratory

manifestations
Asthma
An uncommon manifestation of food allergy
Usually seen with other food-induced
symptoms

Rhinoconjunctivitis
Usually seen during positive controlled
challenge tests, but occasionally reported
by patients

IgE Mediated: systemic

reaction
anaphylaxis/anaphylaxis
syndrome

Food-induced anaphylaxis
-

Rapid-onset
Multi-organ system involvement
Potentially fatal
Any food, highest risk:
peanut, nut, seafood, milk, egg

Food-dependent - exercise-induced
- Associated with a particular food
- Associated with eating any food

Diagnosing IgE-mediated food

hypersensitivity disorders
Medical history: Timing of reaction
An immediate reaction (1- 2
hours) is suggestive of an IgE
mediated reaction to foods

Adapted from Adverse Reactions to Foods Committee,

Spanish Society of Allergy and Clinical Immunology

Diagnosing IgE-mediated food

hypersensitivity disorders
+

Skin Prick Test

Allergens eliciting a wheal of
at least 3 mm greater than the
negative control
Overall positive predictive
accuracy is 50 %
Negative predictive accuracy
> 95 %

Diameter
3 mm

Diagnosing IgE-mediated
food hypersensitivity
disorders

Skin tests
Prick:

Reproducible, sensitive, not irritant

Prick-prick: Use raw or cooked food. Highly

recommended
for fruits and
vegetables (commercially
prepared extracts are generally inadequate
because of the lability of the allergens, so
the
fresh food must be used for
skin testing)

IgE Specific
Radioimmunosorbant Assay (RAST)

Impracticality of skin testing

Skin disorder, drug inhibition, uncooperatvie patients

Prevention of systemic reactions

Prior history of anaphylactic reaction, severe asthma,

Convenience

Disadvantages
Cost, Results delayed

Diagnosis: elimination
diets and food challenges
Elimination diets (1 - 6 weeks):
- Eliminate suspected food/s, or
- Prescribe limited eat only diet, or
- Elemental diet
Oral challenge testing:
- Physician supervised
- Emergency room medications must be
available

21

Oral Challenge Test

Challenge
Record baseline symptoms
Eat and average portion of the pure food
within 5 minutes
Record symptoms over the 1st hour
May repeat a feeding in no symptoms in the 1st
hour

Observe patient a minimum of 2 hours

Vivo

Atopy Patch Test (APT)

23

24

Specific IgE
Elimination & Provocation Test

- Endoscopy, Biopsy of Gut, Skin

- Atopy Patch Test
- Elimination & Provocation Test
25

THANK YOU