Diagnostic methodology in food allergy

The diagnostic tools for the assessment of food allergy in children still lacks reliable in vitro tests that could both ascertain the actuality of food allergy and predict with a good accuracy which allergens mau be involved. Skin prick tests or RASTs are an appropriate first step if an IgE-mediated reaction is suspected. Their interpretation has to be considered according to the age of the child. They can also partially indicate the possible outcome of the disease. More sophisticated tests evaluating a cellular response have not proven valid or are still under evaluation, such as the TNF alpha release by mononuclear cells under stimulation with cow's milk protein in cow's milk protein allergic children. The diagnosis requires food elimination diets, followed bu provocation procedures, ideally in a double blind placebo controlled fashion. Intestinal permeability tests usefully complement the search for offending food by providing a non invasive evaluation of small intestinal suffering.