Diagnosis and Elimination Diets in Pediatric Food Allergy vs Sensitization: From Theory to Practice

Abstract

[EN]Food allergy is an increasing health problem, especially among children with atopic dermatitis, in which food sensitization (specific IgE antibodies without clinical relevance) is also common. Its management can be challenging, and may lead to overdiagnosis and overtreatment. In order to compare theoretical attitude and actual clinical practice, we did a literature search and conducted a small study and survey. In the study we obtained 25 children with atopic dermatitis and food sensitizations but no clear symptoms of IgE-mediated food allergy at referral to our service (Allergy and Respiratory Disease section of the Pediatrics service in External Examination Rooms of Araba University Hospital - HUA CCEE). An important proportion of them had had unjustified referral (28%), unjustified IgE screening (48%) and unjustified therapeutic elimination diet (40%). Besides, nearly all (96'67%) performed oral food challenges were negative. We conclude that there may be overdiagnosis and overtreatment of food sensitizations in children with atopic dermatitis referred to our service. Moreover, sensitizations should always be confirmed by an appropriate diagnostic test (usually an oral food challenge), probably sooner than we are doing nowadays. Likewise, sensitizations alone should not be an indication for therapeutic elimination diets, despite being often viewed as safe and prudent in doubtful cases, as those diets imply potential risks such as loss of tolerance, nutritional deficiencies and patient and parent preoccupation.