Diagnostic Algorithm of Food Allergy at the Child Age
Jeseňák M.1,2, Havlíčeková Z.1, Buchanec J.1, Villa M. P.2, Ronchetti R.2, Bánovčin P.1
Klinika detí a dorastu, Univerzita Komenského, Jesseniova lekárska fakulta, Martin1 prednosta prof. MUDr. P. Bánovčin, CSc. Clinica Pediatrica, Universita „La Sapienza“, Ospedale Sant’Andrea, Via Grottarossa, Rome, Italy2 prednosta prof. M. P. Villa, MD., PhD. |
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Summary:
Diagnostics of food allergy (FA) belongs to complicated matters of child immunoallergology
and gastroenterology. Clinical diagnosis is established on the basis of results
of individual standardized methods in vivo as well as in vitro. FA is based on immunological
grounds and the specialist should uncover them.
The diagnostics of FA in clinical practice is based on a panel of standardized examinations
which include: the determination of specific IgEs against food allergens, skin
prick tests and atopic patch tests, elimination diets and oral load tests. In addition to
these tests there is a group of other examinations which could soon become the part of
standardized algorithms for FA: the test of activation and degranulation of basophiles
and some new markers of allergic inflammation in stools, blood or urine (eosinophil
protein X, eosinophil cationic protein, tryptase, α1-antitrypsin, leukotriene E4, eotaxin,
TNF-α, histamine, methyl-histamine). On the other hand there is a group of diagnostic
procedures of speculative nature which should not be further recommended as suitable
methods (e.g. skin application food tests, labial load test, the determination of specific antibodies of class IgG, sublingual and intradermal provocation/neutralization
tests, cytotoxic tests, applied kinesiology, electrodermal testing, etc.).
Diagnostics and therapy of food allergy belongs exclusively into the hands of an experienced
specialist (child gastroenterologist in cooperation with immuno-allergologist
and dermatologist) with extensive experience in interpretation of results of individual
methods of examination, which are the basis for subsequent indication of
a therapeutic diet or other therapeutic procedures.
Key words:
atopic patch tests, diagnostic algorithm, child, elimination diet, skin prick
tests, oral load tests, food allergy, specific IgEs, standardized tests
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