Accurate food allergy diagnosis begins with a detailed medical history and often involves using diagnostic tools as an adjunct to confirm a diagnosis. For food allergies associated with immunoglobulin E (IgE) antibody (primarily acute reactions), these additional tools include skin prick tests and serum food-specific IgE. Food allergic disease that is not caused by IgE antibodies, such as food protein–induced enterocolitis syndrome, is not diagnosed with skin or serum tests. Skin or serum tests for foods detect sensitization (presence of specific IgE). Sensitization does not equate with clinical allergy; however, increasingly larger skin test wheal sizes or increasingly higher concentrations of serum food–specific IgE correlates with increasing risk of clinical allergy. Judicious selection and interpretation of the tests are key to avoid overdiagnosis. Skin prick testing (SPT), when used under the appropriate circumstances, is a powerful tool to help confirm or rule out IgE-mediated food hypersensitivity and is the focus of this chapter. Ultimately, both skin and serum tests, including specialized serum tests to “component” proteins of foods, even in the context of a history, may not provide a firm diagnosis, and an oral food challenge is required to determine if clinical allergy is present. A pragmatic approach to diagnosing IgE-mediated food allergy incorporating SPT will be discussed along with details on the procedure and how to interpret test results.

Original languageEnglish
Title of host publicationAllergic and Immunologic Diseases
Subtitle of host publicationA Practical Guide to the Evaluation, Diagnosis and Management of Allergic and Immunologic Diseases
Number of pages19
ISBN (Electronic)9780323950619
ISBN (Print)9780323953238
StatePublished - 1 Jan 2022


  • Food allergy
  • IgE-mediated
  • diagnosis
  • diagnostic tool
  • skin prick testing


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