Paediatric Allergy Assessment
Specialist assessment of children with suspected food allergy, allergic rhinitis, atopic eczema, or asthma including skin prick testing and specific IgE to confirm diagnoses and guide management.
Overview
Overview
Paediatric Allergy Assessment is a comprehensive specialist evaluation of children with suspected or confirmed food allergy, allergic rhinitis, atopic eczema, asthma, or anaphylaxis to confirm the diagnosis, identify the specific causative allergens, and develop a personalised and safe management plan. Food allergy affects 6 to 8% of children making it the most common cause of anaphylaxis in the paediatric population. Accurate diagnosis is clinically critical — over-diagnosis leads to unnecessary dietary restriction with significant nutritional consequences, while under-diagnosis risks potentially fatal anaphylaxis from unrecognised allergen exposure. Skin prick testing, specific IgE measurement, and supervised oral food challenges are the core diagnostic investigations.
Types of Paediatric Allergy Assessment
- IgE-mediated food allergy assessment — evaluation of immediate hypersensitivity reactions within minutes to 2 hours of food ingestion with anaphylaxis risk
- Non-IgE-mediated food allergy assessment — investigation of delayed immune responses causing gastrointestinal symptoms hours to days after ingestion
- Aeroallergen sensitisation assessment — skin prick testing and specific IgE for house dust mite, pet dander, grass pollen, and mould
- Oral food challenge — supervised incremental food introduction in the allergy clinic confirming or excluding food allergy definitively
- Drug and venom allergy assessment — evaluation of adverse reactions to medications or insect stings requiring specific management planning
Risk Factors of Paediatric Allergy Assessment
- Family history of allergic disease (asthma, eczema, food allergy) in first-degree relatives indicating atopic genetic predisposition
- Severe atopic eczema in infancy significantly increasing the probability of IgE-mediated food allergy development
- Delayed introduction of allergenic foods (peanut, egg, milk) beyond 6 months of age in susceptible infants
- Sensitisation to birch pollen increasing the risk of oral allergy syndrome to tree nuts, fruits, and vegetables
- Vitamin D deficiency in early life associated with increased food allergy risk in genetically predisposed infants
- Previous confirmed anaphylaxis episode requiring reassessment to identify the causative allergen and prescribe appropriate emergency medication
Symptoms of Paediatric Allergy Assessment
- Urticaria (raised red itchy wheals) appearing within minutes of eating the causative food suggesting IgE-mediated food allergy
- Angioedema — rapid swelling of the lips, tongue, face, or throat — following allergen exposure with potential airway compromise
- Vomiting, abdominal pain, and diarrhoea within 2 hours of food ingestion in IgE-mediated food allergy reactions
- Wheeze and breathlessness (bronchospasm) as part of an anaphylactic reaction to food or aeroallergen exposure
- Cardiovascular collapse and loss of consciousness from anaphylactic shock requiring immediate epinephrine administration
- Chronic persistent diarrhoea, blood in stools, and faltering growth in non-IgE-mediated cow's milk protein allergy
- Worsening eczema flares consistently and reproducibly triggered by exposure to a specific food
- Nasal congestion, sneezing, and itchy watery eyes from allergic rhinitis triggered by pollen, dust mites, or pet dander
Key Benefits
Discover the advantages of choosing our paediatric allergy assessment services.
Accurate diagnosis prevents unnecessary dietary restriction from unconfirmed allergy diagnoses
Oral food challenge safely confirms or excludes allergy reducing unnecessary avoidance
Baked milk and baked egg ladders accelerate natural tolerance development in 80% of milk and egg allergic children
Epinephrine auto-injector prescribing prevents anaphylaxis fatality from delayed emergency treatment
Component testing (Ara h 2) stratifies peanut allergy severity guiding challenge and management decisions
Clinical Features
The technology, techniques and clinical approach behind our paediatric allergy assessment.
Reaction classification drives the investigation pathway -- IgE versus non-IgE allergy require different testing
Oral food challenge performed in clinic with emergency equipment immediately available
Ara h 2 specific IgE component testing guides peanut allergy management and challenge decision
Epinephrine auto-injector prescribed and device training provided at diagnosis of IgE food allergy
Written photographic allergy action plan provided for school and all carers
Preparation Instructions
Do not give antihistamines for 5 days before skin prick testing as they suppress the wheal response. Bring a detailed written record of any reaction episodes. Bring any previous allergy test results. Do not withhold food from your child before the appointment unless specifically instructed.
The Procedure
Step-by-step guide to what you can expect during your paediatric allergy assessment procedure.
Allergy History and Reaction Classification
A detailed allergy history characterises the reaction type timing from exposure severity and any treatment given. Distinguishing IgE-mediated from non-IgE-mediated reactions determines the investigation and management pathway.
Skin Prick Testing
Standardised allergen extracts are placed on the forearm and a lancet pricks through each drop. A positive wheal of 3mm above the negative control at 15 minutes confirms sensitisation. Common food and aeroallergen panels are tested.
Specific IgE Blood Testing
Specific IgE to individual allergens provides quantitative sensitisation levels. Higher specific IgE levels for peanut component Ara h 2 correlate with persistent allergy and help guide whether oral food challenge is appropriate.
Oral Food Challenge
Supervised oral food challenges are performed in the allergy clinic for foods where history or test results are uncertain. Emergency equipment and trained staff are immediately available throughout.
Anaphylaxis Action Plan and Epinephrine Prescribing
All children with confirmed IgE-mediated food allergy and previous anaphylaxis are prescribed epinephrine auto-injectors. A written photographic allergy action plan is provided for school and all carers.
Allergen Introduction and Tolerance Development
For milk and egg allergy evidence-based baked milk and baked egg ladders are provided -- structured home introduction protocols enabling safe tolerance development at the child's own pace.
What to Expect
Skin prick testing involves placing small drops of allergen extracts on the forearm and pricking through the drop. A positive result (wheal forming within 15 minutes) indicates sensitisation. Blood is taken for specific IgE measurement. The allergist interprets results in the context of the full clinical history.
Recovery
Follow the personalised allergen avoidance plan provided by the allergist. Ensure all carers and school staff are trained in the use of the epinephrine auto-injector if prescribed. Attend follow-up appointments as arranged -- food allergies in children are dynamic and tolerance often develops with age.
Frequently Asked Questions
Common questions about paediatric allergy assessment.
Related Services
Explore other services in our Paediatrics department.
Neonatal Assessment and Care
Childhood Immunisation Programme
Paediatric Development Assessment
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