September 23, 2025

Before You Counsel About Food Allergy Testing

22 minutes

In this episode, we will discuss all things related to food allergies, including the difference between IgE-mediated and non-IgE-mediated allergies, clinical manifestations, the important questions to ask when taking a history, the options for doing allergy testing, and treatment.

Definition of food allergies

Rates of food allergies

Possible pathophysiology of food allergies

Clinical manifestations of food allergies

IgE mediated food allergies

Cutaneous symptoms

Ocular symptoms

Respiratory symptoms

GI symptoms

Neurological and cardiovascular symptoms

Anaphylaxis = involvement of 2 or more systems

Non-IgE mediated food allergies

Symptoms after 4 hours after ingestion

Eosinophilic esophagitis

Alpha-gal

Food protein induced enterocolitis syndrome (FPIES)

Food protein induced proctocolitis (FPIAP)

Questions to ask to hone your clinical history

Presenting symptoms

When did symptoms occur

Foods ingested

Other symptoms, other exposures

Any prior allergy testing

Family history?

Any food avoidance

Testing options for food allergies

Clinical history

Oral food challenge - gold standard

Skin prick/puncture test

Serum IgE testing

Treatment of food allergy

Referral to allergy/immunology specialist and avoidance of offending food until appointment

Prescription for epinephrine autoinjector

Second generation antihistamines

Resources/Links:

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management Scott H. Sicherer, MD, and Hugh A. Sampson, MD New York, NY

Mendonca CE, Andreae DA. Food Allergy. Prim Care. 2023 Jun;50(2):205-220. doi: 10.1016/j.pop.2023.01.002. Epub 2023 Mar 27. PMID: 37105602.

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