Last reviewed: June 2020
Last updated: October  2019



History and exam

Key diagnostic factors

  • milk, egg, nut, fish, shellfish, wheat, or soy ingestion
  • reproducible symptoms
  • flushing, urticaria, or angioedema of the skin
  • sneezing, rhinorrhea, or nasal congestion
  • dyspnea, tachypnea, wheezing, coughing, or cyanosis
  • hoarseness, stridor, or sense of choking
  • nausea and vomiting
  • abdominal cramping or bloating
  • diarrhea
  • conjunctival injection or lacrimation
  • periorbital edema
  • abrupt onset of symptoms
  • reaction caused by small amount of food
  • presence of other allergic disease
  • laryngeal edema

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
More 1st investigations to order

Emerging tests

  • atopy patch testing
  • component-resolved diagnostics
More emerging tests

Treatment algorithm


A. Wesley Burks

Curnen Distinguished Professor and Chair

Department of Pediatrics

University of North Carolina

Chapel Hill



AWB receives grant support to his institution from the National Institutes of Health, Food Allergy Research & Education, and Allergen Research Corporation; royalties from UpToDate; consulting honorariums from Aravax, Astella Pharma Global Development, DBV Technologies and N-Fold, LLC, as well as Aimmune Therapeutics, Consortia TX, Inc., Intrommune Therapeutics, and Prota Therapeutics for his service on their respective Scientific Advisory Boards. AWB has consulted for the following companies (which are all now expired): Biomerica, Inc., Evelo Biosciences/Epiva, Genentech, Insys Therapeutics, PPD Development, Sanofi US Services, Valeant Pharmaceuticals North America, LLC, LEK Consulting, LLC, Hycor Biomedical. AWB has received payments for speaking at the Gordon Research Conferences, the Pediatric Allergy and Asthma Meeting, and the American College of Allergy Asthma and Immunology. AWB is a minority stockholder of both Allertein and Mastcell Pharmaceuticals stock. These interests do not directly relate to the article but are being shared for full disclosure. AWB is an author of references cited in this topic.

Associate Professor

Department of Pediatrics

Division of Allergy and Immunology

University of Texas Southwestern Medical Center




JAB has received fees from Food Allergy Research and Education; personal fees and nonfinancial support from the American College of Allergy, Asthma and Immunology; grants from Nestle Health Sciences; personal fees from Nutricia North America; personal fees from Pharm-Olam International LTD; consulting work for and personal fees from Pfizer Pharmaceuticals; grants, personal fees and nonfinancial support from Aimmune Therapeutics; personal fees from Prota Therapeutics; personal fees from Allergy Therapeutics Ltd; grants from NIH-NIAID; grants from Novartis; personal fees from AllerGenis; personal fees from Abbott Nutrition International; grants and personal fees from DBV Technologies.

Peer reviewersVIEW 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 topic.

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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