Thread by @AllergyKidsDoc

I thought I'd start #FoodAllergyAwarenessWeek by describing how I (a board certified pediatric allergist) establish the diagnosis of #foodallergy.

This is a life altering diagnosis & it's important to get it right;unfortunately many are misdiagnosed. Follow this thread ⬇️ #FAAW

When I first meet a family with concern about #foodallergy, I introduce myself 😁 and ask "How can I help you today?". Then I let them talk...uninterrupted.

I then learn what concerns they have and gain insight into foods, symptoms, etc. #FoodAllergyAwarenessWeek

The clinical history is the MOST important test in diagnosing #foodallergy. I need to know:
What foods cause concern
Timing of symptom onset
Types of symptoms
Duration
Treatment?
Does it happen every time
#FoodAllergyAwarenessWeek

While any food CAN cause #foodallergy, 8 cause >90%: milk, egg, wheat, soy, peanut, tree nuts, fish, shellfish.
Much less likely causes: strawberries, fruits, veggies (oral allergy syndrome more common)
Very unlikely causes: artificial colorings
#FoodAllergyAwarenessWeek

Timing of onset is important when establishing a #foodallergy diagnosis - reactions almost always occur within a few hours of ingestion (typically within minutes), not the following day.

Symptoms typically resolve within hours, not days later
#FoodAllergyAwarenessWeek

Many symptoms can occur during a #foodallergy reaction and on various scales, but revolve around histamine release:
Itching
Hives
Swelling
Vomiting
Nausea
Cough/wheeze
Congestion/sneezing
Passing out (low blood pressure)
#FoodAllergyAwarenessWeek

If someone is eating a food without any symptoms, or they eat some forms without problems (concern for milk allergy but eats cheese/yogurt ok), then #foodallergy is very unlikely to be present and NO testing should be done.

#FoodAllergyAwarenessWeek

After a THOROUGH history (allergists are just cool detectives in disguise), I perform a physical exam. Other conditions such as eczema, allergic rhinitis, asthma, family history of allergies increases risk that #foodallergy may be present.
#FoodAllergyAwarenessWeek

We haven't even gotten to testing yet - to reiterate, the clinical history is the SINGLE MOST IMPORTANT #FOODALLERGY TEST.
If the history is suggestive for allergy, then we discuss either skin prick or serum IgE levels ONLY to the foods in question.
#FoodAllergyAwarenessWeek

Both skin prick and serum IgE #foodallergy tests are very useful in confirming allergy but have high false positive results and are NOT screening tests. These should only be used when the history suggests food allergy and only for the select foods. #FoodAllergyAwarenessWeek

Overuse of #foodallergy IgE tests is rampant & leads to over diagnosis and unnecessary avoidance. The size of test result indicates the likelihood allergy is present, which is determined by the history. Lots of nuance, long read: kidswithfoodallergies.org/page/food-alle… #FoodAllergyAwarenessWeek

I will interpret #foodallergy IgE results in the context of the history and then discuss whether allergy is likely or not. When the history and/or tests are indeterminate, I use oral food challenges to confirm or determine if they are not allergic. #FoodAllergyAwarenessWeek

If you've read this far, hopefully you see how involved it is to diagnose someone with a #foodallergy.
This cannot be properly done online, through social media groups, via at home testing, or by anyone not qualified in the diagnosis of food allergy. #FoodAllergyAwarenessWeek

Things I NEVER do as a pediatric allergist:
Order large panels of #foodallergy tests
Diagnose someone without providing lots of evidence based information & time to answer questions
Leave someone on their own - I am always available for questions
#FoodAllergyAwarenessWeek

I hope this thread offers some insight into the challenging nature of diagnosing #foodallergy as well as the many nuances involved.

There's some additional info here, which may help: huffpost.com/entry/read-thi…
Stay tuned for more info during #FoodAllergyAwarenessWeek!