GP (General Practitioner)
Classically eliminating foods and then challenging with them in sequential fahion is regarded as the only legitimate way to identify food allergies, but this method is cumbersome and hardly practical. Reactions to foods can lead to fatigue, digestive disturbances like bloating and a host of other complaints, so when patients present to me with their health issues, I use skin prick testing and blood tests to investigate adverse reactions to foods, which anecdotally I find highly useful in the quest to uncover the underlying reasons for their problems.
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Registered Nurse
Food allergies are diagnosed with taking an accurate clinical history and using skin prick testing. Blood tests are not often used in assessing food allergies. Food allergies are different to food intolerances and the testing for these are different.
Any person who has a food allergy should seek expert advice from a allergist/immunologist specialising in food allergy. The treatment for food allergy is avoidance of the food.
It is imperative that food allergy is accuratley diagnosed and that the patient is given informed advice as to what to do if they have an allergic reaction.
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Allergy Specialist & Immunologist
The key to diagnosing food allergies is taking a careful history of the previous suspected reactions. Carefully considering and correlating foods associated with the reaction, as well as foods that the patient is able to tolerate without symptoms. For severe reactions associations may be clear, but for frequent and milder symptoms a food & symptom diary can be helpful to accurately keep track of them.This history from the patient may either support the diagnosis of a food allergy, or suggest other non-allergic conditions such as Coeliac disease, food intolerances, or Chronic Idiopathic Urticaria. These require specific investigations and treatments of their own.Skin-prick testing and blood tests can be useful in situations with a compatible and suggestive allergic history. However without this positive history, they may give misleading results. A specialist will be able to assist with when they may be useful - as well as their interpretation.Perhaps more importantly a Specialist Allergist can give expert advice on how best to manage food allergies. This can simply include advice on how to best avoid certain foods, but may include a risk assessment and management/action plan. This is especially important for people with a history of a severe reaction (anaphylaxis).
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Typically food allergies have an immune system involvement while food intolerances typically do not.
Differential diagnosis of the two is not always easy.
This (slightly technical but free access) link explains how this is often done: http://www.ncbi.nlm.nih.gov/pubmed/19547751 .
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Allergy Specialist & Immunologist
It is important to differentiate between food allergy and food intolerance and sensitivity. Food allergy results from the production of specific IgE antibodies primaily to proteins in foods such as cow's milk, egg, peanut, tree nuts like cashew and wheat. Therefore, the symptoms of food allergy tend to occur faster after ingestion of the food than the symptoms of food intolerance and sensitivity.
Allergy to wheat protein is often thought by some people to be intolerance to gluten.
Skin tests and RAST blood tests can identify IgE-medated allergy to foods. Blood tests and endoscopy are used to diagnose gluten intolerance. Sensitivity to chemicals occurring naturally in foods, such as amines and salicylates or added to foods, such as MSG can be harder to diagnose as there are no skin or blood tests for these. This requires the patient to keep a food diary chart, together with their symptoms. An elimination or restricted diet, followed by challenge with the suspected food or chemical, is the method used to provide a definitive diagnosis.
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