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Assessment and allergy-focused history

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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 in tables below. Pay particular attention to persistent symptoms that involve different organ systems (1)
- dermatological

IgE-mediated	non-IgE-mediated
pruritus	pruritus
Erythema	Erythema
Acute urticaria – localised or generalised	Atopic eczema
Acute angioedema – most commonly of the lips, face and around the eyes

gastrointestinal

IgE-mediated	non-IgE-mediated
Angioedema of the lips, tongue and palate	Gastro-oesophageal reflux disease
Oral pruritus	Loose or frequent stools
Nausea	Blood and/or mucus in stools
Colicky abdominal pain	Abdominal pain
Vomiting	Infantile colic
Diarrhoea	Food refusal or aversion
	Constipation
	Perianal redness
	Pallor and tiredness
	Faltering growth in conjunction with at least one or more gastrointestinal symptoms above (with or without significant atopic eczema)

respiratory - (usually in combination with one or more of the above symptoms and signs)

IgE-mediated	non-IgE-mediated
Upper respiratory tract symptoms (nasal itching, sneezing, rhinorrhoea or congestion [with or without conjunctivitis])
Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath)	Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath)

other

IgE-mediated	non-IgE-mediated
Signs or symptoms of anaphylaxis or other systemic allergic reactions

Consider the possibility of food allergy in children and young people whose symptoms do not respond adequately to treatment for:

atopic eczema
gastro-oesophageal reflux disease
chronic gastrointestinal symptoms, including chronic constipation

If food allergy is suspected (by a healthcare professional or the parent, carer, child or young person), a healthcare professional with the appropriate competencies (either a GP or other healthcare professional) should take an allergy-focused clinical history tailored to the presenting symptoms and age of the child or young person

should include:
- any personal history of atopic disease (asthma, eczema or allergic rhinitis)
- any individual and family history of atopic disease (such as asthma, eczema or allergic rhinitis) or food allergy in parents or siblings
- details of any foods that are avoided and the reasons why
- an assessment of presenting symptoms and other symptoms that may be associated with food allergy, including questions about:
  - the age of the child or young person when symptoms first started
  - speed of onset of symptoms following food contact
  - duration of symptoms
  - severity of reaction
  - frequency of occurrence
  - setting of reaction (for example, at school or home)
  - reproducibility of symptoms on repeated exposure
  - what food and how much exposure to it causes a reaction
  - cultural and religious factors that affect the foods they eat
  - who has raised the concern and suspects the food allergy
  - what the suspected allergen is
  - the child or young person's feeding history, including the age at which they were weaned and whether they were breastfed or formula-fed - if the child is currently being breastfed, consider the mother's diet
  - details of any previous treatment, including medication, for the presenting symptoms and the response to this
  - any response to the elimination and reintroduction of foods
- based on the findings of the allergy-focused clinical history, physically examine the child or young person, paying particular attention to:
  - growth and physical signs of malnutrition signs indicating allergy-related comorbidities (atopic eczema, asthma and allergic rhinitis).

Reference:

1) NICE (February 2011).Food allergy in children and young people Diagnosis and assessment of food allergy in children and young people in primary care and community settings

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