Allergy in children: which tests are needed and which are not

Evgeniya Loik — GP, pediatrician, gastroenterologist, nutritionist

Allergy and intolerance are different things

Allergy is an immune reaction, most often IgE-mediated: rash, swelling, vomiting, cough or wheeze within minutes to two hours of contact, and in severe cases anaphylaxis. Intolerance — of lactose, for instance — does not involve the immune system and presents with bloating, pain and loose stools, without a threat to life. Confusing the two leads to unjustified restrictions.

Why a 90-food panel does not work

The test shows sensitisation — the presence of antibodies — not clinical allergy. A significant share of positive results in children are not accompanied by any reaction when the food is eaten. The wider the panel, the more such findings, and the longer the list of prohibitions issued without a single episode of reaction. The result: an impoverished diet, nutritional deficiencies, family anxiety and, paradoxically, an increased risk of developing genuine allergy to the excluded food.

Separately: IgG food testing, actively marketed as a "food intolerance test", has no diagnostic value — the position of every major allergy society.

How it is done properly

History first. What was eaten, how long afterwards, what exactly happened, whether it recurred, whether it is reproducible. A food diary helps. Only then targeted testing of the specific suspected allergens — specific IgE or skin prick tests. The gold standard where doubt remains is a supervised oral food challenge.

With respiratory symptoms the suspects differ: house dust mites, mould, animals, pollen. In the UAE it is worth remembering constantly running air conditioning and dust — they contribute more than people assume, and the blame often goes to food instead.

When it is urgent

Difficulty breathing, swelling of the lips and tongue, hoarseness, repeated vomiting with pallor and lethargy after eating — these are signs of anaphylaxis and need immediate help; the emergency number in the UAE is 998. A family whose child has confirmed severe allergy needs an action plan and, as prescribed, an adrenaline auto-injector.

About eczema

Atopic dermatitis correlates with food allergy in roughly 30% of clinical cases, but is not always caused by it. Excluding foods to "cure the skin" without confirmation is a frequent mistake; the foundation remains skin care, covered in detail in our article on atopic dermatitis.

How it works here

In our clinic a pediatrician consultation is AED 600 and a pediatrician-gastroenterologist consultation AED 750. The pediatric allergy panel, AED 1,570, is ordered on indication rather than by default: the doctor first establishes what is worth testing. Lab tests are taken in the same clinic.

What this is based on

• AAAAI. Food Allergy
• American Academy of Pediatrics. Food Allergies in Children

FAQ

How does allergy differ from intolerance?

Allergy is an immune reaction, most often IgE-mediated: rash, swelling, vomiting, cough or wheeze within minutes to two hours of contact, and in severe cases anaphylaxis. Intolerance, of lactose for instance, does not involve the immune system and presents with bloating, pain and loose stools without a threat to life.

Should my child have a 90-food allergy panel?

No. The test shows sensitisation — the presence of antibodies — not clinical allergy. A significant share of positive results in children are not accompanied by any reaction when the food is eaten, and the wider the panel, the longer the list of prohibitions and the poorer the diet.

How is suspected allergy assessed properly?

History first: what was eaten, how long afterwards, what exactly happened, whether it recurred. A food diary helps. Only then targeted testing of the specific suspected allergens — specific IgE or skin prick tests. The gold standard where doubt remains is a supervised oral food challenge.

When do we need emergency care?

With difficulty breathing, swelling of the lips and tongue, hoarseness, repeated vomiting with pallor and lethargy after eating — these are signs of anaphylaxis. The emergency number in the UAE is 998. A family whose child has confirmed severe allergy needs an action plan and, as prescribed, an adrenaline auto-injector.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

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