Photo Credit: Tetiana Soares

Pediatricians play a critical role in prevention, diagnosis, and management of IgE-mediated food allergies, especially when allergist availability is limited.

Food allergies impose significant burdens on patients, families, and healthcare systems, necessitating a multidisciplinary approach to management. Due to knowledge gaps and variations in guideline adherence, a review published online in Frontiers in Pediatrics emphasized the importance of pediatricians, especially in scenarios with limited allergist availability. The research team, led by Ruchi S. Gupta, MD, MPH, highlighted the need for improved diagnostic tools, confirmatory testing, and preventative strategies to optimize patient care.

“The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers,” Dr. Gupta and colleagues wrote.

“Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted.”

Pediatricians are essential to preventing, diagnosing, and managing immunoglobulin E (IgE)-mediated food allergies, especially when allergist availability is limited. However, timely allergist referral is vital. A multidisciplinary team, including nurses, dietitians, pharmacists, pediatricians, and allergists, is crucial for accurate diagnosis and effective management, helping to alleviate the burden on affected individuals and healthcare systems. As new diagnostic tools and therapies emerge, collaboration becomes increasingly important to ensure optimal patient care.

Knowledge Gaps and Guideline Adherence

Despite the growing prevalence of food allergies, with IgE-mediated food allergies affecting up to 8% of children and 10.8% of adults in the US, there are substantial discrepancies between self-reported and clinically diagnosed cases. This gap underscores the need for improved diagnostic tools and confirmatory testing. Complicating matters further, variation in guideline adherence across pediatric clinics can result in inconsistent patient care and management outcomes.

Distinguishing Food Allergies From Other Conditions 

Due to similar clinical presentations, food allergies are frequently confused with other conditions, such as food intolerance. To differentiate between them, physicians must consider several factors. Key diagnostic tools include medical history, physical examination, skin prick tests, serum-specific IgE tests, and oral food challenges (OFC). Accurate diagnosis is vital to prevent unnecessary dietary restrictions, which can negatively affect patients’ quality of life.

Consultation and Referral to Allergists

Timely referral to an allergist is crucial for children with a confirmed diagnosis of IgE-mediated food allergy. Factors necessitating expedited referral include a history of anaphylaxis, the need for specialized testing (eg, skin testing or OFC), nutritional concerns due to food allergies, and the need for repeated instruction on injectable epinephrine. Delays in referral can lead to increased healthcare utilization, poorer patient experiences, and greater psychosocial burden.

Follow-up and Re-testing

Annual follow-up with an allergist is recommended, with more frequent visits for younger patients or those with risk factors such as poorly controlled asthma or frequent accidental ingestions. The frequency of re-testing depends on the specific allergen. Allergens like milk and egg are often outgrown earlier, requiring annual testing, whereas allergens like peanut and tree nuts may need testing at intervals of up to 2–3 years. Long-term management involves shared decision-making based on allergy type, testing results, reaction severity, and patient preferences.