The UK’s cost watchdog has begun its first consultation looking at food allergies in children, saying it is alarmed by the rate of hospital admissions over the last 20 years.

The National Institute for Health and Clinical Excellence is drafting a clinical guideline to support doctors in recognising the signs and symptoms of food allergy, “by giving clear recommendations on taking allergy-focused histories to assess the condition”. It goes on to say that food allergies are recognised as “a major paediatric health problem in western countries” and reactions “can be extremely severe”.

NICE notes that hospital admissions in the UK for food allergies have increased by 500% since 1990 and there has been a dramatic increase in prevalence in the last twenty years, ranging from 6% to 8% in children up to the age of three across Europe and North America. The most common foods to which children and young people are allergic include cow’s milk, fish and shellfish, hen’s eggs, peanuts, tree nuts and sesame, soy; wheat and kiwi fruit.

The draft guideline recommends that the condition should be considered if the child has one or a combination of the following, including skin conditions such as eczema or acute urticaria, sneezing or shortness of breath, gastrointestinal problems such as vomiting, difficulty swallowing or constipation; and
anaphylaxis and other allergic reactions.

If a food allergy is suspected, the doctor should take “an allergy-focused clinical history, tailored to the presenting symptoms and age of the child”. This should include a family history of allergies, an assessment of the symptoms, and feeding history as an infant. A physical examination “should pay particular attention to growth, and physical signs of malnutrition”.

NICE adds that diagnosis may also include skin prick and blood tests for IgE (immunoglobulin) antibodies as they suggest particular allergic reactions. Alternative methods of diagnosis such as hair analysis and kinesiology are not recommended, however.

Judith Richardson, associate director for the Centre for Clinical Practice at NICE, said “many of the symptoms are common to other conditions, so it’s not always easy to identify and diagnose food allergy correctly”. She noted that this will be the first such evidence-based guideline and will be “a very welcome addition in improving outcomes for those children affected by this troublesome condition, and supporting better use of resources across the health system”.

The draft guideline is now open for consultation and Dr Richardson said “we would welcome comment from registered stakeholders.”