Figure 2 Approach to diagnosis and management of food allergy

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Figure 2 Approach to diagnosis and management of food allergy Figure 2 | Approach to diagnosis and management of food allergy. In eosinophilic oesophagitis (EoE) and food protein-induced enterocolitis syndrome (FPIES) food-specific IgE can be detectable in a subset of patients. In EoE, patients with detectable food-specific IgE could be at risk of immediate, anaphylactic-type reactions to foods upon reintroduction following a period of elimination. Consequently, evaluation of food-specific IgE is recommended before food reintroduction in EoE; if positive, supervised oral food challenge (OFC) might be warranted; if negative, food reintroduction can be done at home. In FPIES, especially as a result of cow's milk, ∼25% of patients develop detectable cow's-milk-specific IgE (a condition known as atypical FPIES) over time. Of these patients, ∼1 in 3 can progress to immediate-type symptoms, including anaphylaxis. In FPIES, the offending food reintroduction should be done during a supervised OFC (not at home) regardless of IgE positivity, owing to the risk of severe reactions with hypotension. When food-specific IgE is detected, OFC protocol is modified to account for the possibility of anaphylaxis. FPE, food protein-induced enteropathy; FPIAP, food protein-induced allergic proctocolitis; Hct, haematocrit; Hgb, haemoglobin; PST, prick skin test. Nowak‑Wegrzyn, A. et al. (2016) Food allergy and the gut Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2016.187