Diagnosis and Differential Diagnosis of Food Allergy

  • Efren Rael
  • Vanitha Sampath
  • Kari Christine NadeauEmail author


Food allergies vary in allergen type, severity, and underlying etiology, making diagnosis challenging. Cross-reactivity between allergens, the presence of multiple food allergies, and food intolerances that often mimic food allergy add additional complexity to the diagnosis. Food intolerances include enzyme and metabolic deficiencies, functional defects, pharmacologic effects, psychosomatic effects, sensitivity to food additives, or reactions to naturally occurring chemicals or toxins in foods. Correct identification of food allergy and causative allergen(s) is important in order to prevent unnecessary dietary restrictions or future allergic reactions. There is currently no single universal method that adequately meets the safety, sensitivity, and specificity required to diagnose a food allergy. The diagnosis of food allergy is primarily based on a combination of clinical history, presence of IgE antibodies, elimination diets, and food challenges. The presence of IgE can be determined by skin prick tests or serum tests, both of which have high sensitivities but low specificities and are associated with a high number of false positives. Currently, the double-blind placebo-controlled food challenge still remains the gold standard for diagnosing an IgE-mediated food allergy, but is resource consuming and carries with it the risk of severe reaction during the challenge.


Food allergy Diagnosis Skin prick test Oral food challenge IgE Allergen Basophil activation test Component-resolved diagnostics Anaphylaxis 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Efren Rael
    • 1
  • Vanitha Sampath
    • 1
  • Kari Christine Nadeau
    • 2
    Email author
  1. 1.Sean N. Parker Center for Allergy and Asthma Research at Stanford UniversityStanfordUSA
  2. 2.Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Department of Medicine and PediatricsStanfordUSA

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