Many children’s food allergies might be going identified, due to underuse of the best diagnostic test, a new study reports. Oral food challenges are the best method of detecting allergies, although the procedure is time-consuming, and yet only 15% of children receiving an allergy diagnosis completed the test.
Oral food challenges are the gold standard for diagnosis of food allergy, yet few physicians are using the diagnostic method, according to a study presented at the American College of Allergy, Asthma and Immunology Annual Meeting in Boston, Nov. 3-8. Among the 40,104 children surveyed, 3,339 cases of food allergy were identified.
Only 61.5 percent received a formal physician diagnosis. About 15 percent of children who received a physician diagnosis underwent an oral food challenge. Children with any severe symptoms such as anaphylaxis, wheezing, trouble breathing, and low blood pressure were more frequently diagnosed by a physician, and more frequently confirmed by oral food challenge.
Authors conclude that, because a large proportion of children with convincing food allergy are not diagnosed by a physician and not given a food challenge, food allergy may be under diagnosed in the U.S. When food allergy is suspected, ACAAI recommends patients be referred to an allergist who can determine which food allergy tests to perform, determine if food allergy exists, and counsel patients on food allergy management.
“Oral food challenge provides a definitive diagnosis which is critical to providing proper disease management and prevents unnecessary avoidance of certain foods,” says Ruchi Gupta, MD, MPH, Children’s Memorial Hospital, Chicago. “Physicians may not be conducting the test due to the length of time it takes, 3-6 hours, and the low reimbursement for a food challenge.”
By the numbers: Of the 12 million Americans with food allergies, three million are children. That’s about one in 20 children.