Monitoring of IgE-mediated food allergy in childhood

Testing for IgE-mediated allergy is performed to reach or refute a suspected allergy. But a positive test does only indicate sensitization and not necessarily clinical allergy. A diagnostic challenge procedure is therefore necessary. Also, in the phase of tolerance development a challenge is needed as clinical tolerance is reached before allergen-specific IgE antibodies have disappeared. During recent years, an increasing interest has been given to the possibility of using the concentration of specific IgE and the size of the skin prick test wheal to tell the optimal time to do a challenge without exposing the child to a risk of a severe reaction.

Algorithms on when to do and when not to do a food challenge may be useful but should be used with great caution. Reasonable consideration should be paid to the severity of previous reactions and the kind of allergen involved.