Clinical Presentation and Nutrition Management of Non‐IgE‐Mediated Food Allergy in Children

Non-IgE-mediated food allergy encompasses a wide spectrum of allergic disorders ranging from mild to severe presentations, including food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome, and food protein-induced enteropathy. Other gastrointestinal symptoms such as constipation and gastroesophageal reflux disease have not previously been recognised as symptoms of non-IgE-mediated food allergy in food allergy guideline publications. Recently, two new consensus documents from the European Academy of Allergy, Asthma and Immunology address a potential role of food allergens in these disorders, where standard treatment has failed, and provide guidance for diagnosis and management of these conditions. Additional updates include the World Allergy Organisation guidance on the diagnosis and management of cow's milk allergy, the most commonly implicated food in non-IgE-mediated food allergy. These documents all help practitioners to distinguish between common manifestations in infancy that are not pathologic and non-IgE-mediated food allergy. Understanding diagnostic criteria is vital to prevent overdiagnosis, limit unnecessary elimination diets and preserve breastfeeding. Conversely, proper diagnosis may reduce symptoms in infants who are affected. Therefore, the first step in management of non-IgE-mediated food allergy is establishing a correct diagnosis, which requires understanding the clinical presentations and if needed, applying an appropriate short-term diagnostic elimination diet to observe for symptom resolution, followed by food reintroduction to assess for symptom recurrence. Once diagnosed, treatment requires removal of the trigger food, most commonly cow's milk, which is not without burden and nutrition risk. Non-IgE-mediated food allergies typically resolve early in childhood with some disorders resolving in infancy therefore early reassessment for tolerance is vital. Management of non-IgE-mediated food allergy entails following diagnostic algorithms, developing an individualised dietary plan, and timely assessment of tolerance development to reduce burden and nutrition risk.