The Role of Allergists in the Diagnosis and Management of Food Hypersensitivity

RATIONALE: The prevalence of food allergy (FA) in children has increased over the past decade. Current FA testing modalities have a high false positive rate, which can lead to over-diagnosis of FA. There are limited studies that examine the referral patterns by both primary care physicians and subspecialists to allergists.

METHODS: We reviewed the charts of patients referred to the allergy clinic in a tertiary care medical center for evaluation of possible food hypersensitivity from January-February 2016. Data collected include patient demographics, results of allergy testing, and outcomes of the visit.

RESULTS: Over two-months, 194 patients were referred for possible FA and 70% completed a new patient visit. The median age was 3 years (interquartile range [1-6]) and 53% were male. Thirty-three percent of those patients had previous testing (skin testing, serum IgE levels, or both) for FA. During initial evaluation, 77% of patients had skin testing performed and 36% of patients had serum IgE levels obtained. The most common food sensitizations by skin prick testing were egg (41%), peanut (31%), tree nut (26%), and milk (24%). Sixty percent of patients had at least one other atopic co-morbidity. Eighty-seven percent of the referrals came from PCPs. Fifty-one percent of patients were discharged with concerns for an IgE-mediated hypersensitivity and 47% with self-injectable epinephrine.

CONCLUSIONS: Food allergy is a common disease of children. In this study of children referred to allergy clinic for a history concerning for food hypersensitivity, only half were instructed to avoid specific foods or required a prescription for self-injectable epinephrine.