Last reviewed: May 2019
Last updated: May  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • milk, egg, nut, fish, shellfish, wheat, or soya ingestion
  • reproducible symptoms
  • flushing, urticaria, or angio-oedema of the skin
  • sneezing, rhinorrhoea, or nasal congestion
  • dyspnoea, tachypnoea, wheezing, coughing, or cyanosis
  • hoarseness, stridor, or sense of choking
  • nausea and vomiting
  • abdominal cramping or bloating
  • diarrhoea
  • conjunctival injection or lacrimation
  • periorbital oedema
  • abrupt onset of symptoms
  • reaction caused by small amount of food
  • presence of other allergic disease
  • laryngeal oedema

Other diagnostic factors

  • tachycardia or bradycardia
  • reaction exacerbated by exercise or exertion
  • alcohol or medication ingestion before reaction
  • cardiac arrhythmia
  • hypotension

Risk factors

  • FHx of food allergy
  • atopic dermatitis
  • newborn
  • perinatal peanut oil exposure

Diagnostic investigations

1st investigations to order

  • in vitro IgE specific immunoassay
  • skin prick testing
Full details

Emerging tests

  • atopy patch testing
  • component-resolved diagnostics
Full details

Treatment algorithm


Authors VIEW ALL

A. Wesley Burks

Curnen Distinguished Professor and Chair

Department of Pediatrics

University of North Carolina

Chapel Hill



AWB is an author of a number of references cited in this monograph. AWB has received grant funding from the NIH and FAAN, and he is a board member of FARE, NIH AITC Review Panel, NIH HAI Study Section, and World Allergy Organization; and he is a consultant for Adept Field Solutions, Aimmune Therapeutics, Inc., Dow AgroSciences, Inc., Genetech, GLG Research, Inc., Insys Therapeutics, Merck, Regeneron Pharmaceuticals, Inc., SRA International, Stallergenes, Sanofi US Services, and Valeant Pharmaceuticals North America, LLC. AWB is an independent contractor for PPD Development, LP; he has received a royalty payment from the American Society for Microbiology; and he is a minor stockholder for Allertein.

Associate Professor

Department of Pediatrics

Division of Allergy and Immunology

University of Texas Southwestern Medical Center




JAB is on the speakers' bureau for Abbott Nutrition, Aimmune Therapeutics, DBV Technologies, and Nutricia North America. He sits on the Global Advisory Board for Aimmune Therapeutics and on the Clinical Advisory Board Executive Committee for Food Allergy Research and Education. He has received research support from Aimmune Therapeutics, DBV Technologies, the Foundation of the American College of Allergy, Asthma and Immunology, and Nestle Health Sciences. He has received consulting fees from Wedbush Consulting and travel support from Aimmune Therapeutics and DBV Technologies.

Peer reviewers VIEW ALL

Assistant Professor of Pediatric Allergy and Immunology

Mount Sinai School of Medicine

New York



JS declares that he has no competing interests.

Professor of Pediatrics

Mount Sinai School of Medicine

New York



HAS holds a 4% interest in a biotech company, Allertein Pharmaceuticals LLC, which is developing an engineered recombinant protein vaccine for peanut allergy, and 45% interest in a virtual company, Herbal Springs LLC, that holds a patent application on an herbal product for treating asthma and another for treating food allergy. HAS is an author of a number of references cited in this monograph.

Consultant and Honorary Senior Lecturer in Paediatric Allergy

Evelina Children's Hospital

Guy's & St Thomas' Hospitals NHS Foundation Trust




AF declares that he has no competing interests.

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