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Who should manage infants and young children with food induced symptoms?
  1. B Niggemann1,
  2. R G Heine2
  1. 1Department of Paediatric Pneumology and Immunology, University Children’s Hospital Charité, Berlin, Germany
  2. 2Department of Paediatric Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
  1. Correspondence to:
    Prof. B Niggemann
    Department of Paediatric Pneumology and Immunology, University Children’s Hospital Charité, Augustenburger Platz 1, 13353 Berlin, Germany; bodo.niggemann{at}charite.de

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A proposal for a unified, interdisciplinary approach

In recent years, many developed countries have experienced a rapid increase in real and perceived food allergic disorders.1,2 This phenomenon has caused a dramatic rise in the need for clinical allergy services, and waiting lists have in many centres become unmanageable. The costs to the NHS for managing allergic disorders in the UK currently exceeds £1 billion per annum.3 Health services have been generally slow to adapt to the increased need for allergy services, and access to specialised paediatric allergy services has remained particularly limited.3 This may potentially lead to adverse clinical outcomes due to unacceptable diagnostic delay or suboptimal management.4 The small number of paediatric subspecialists in tertiary centres is currently unable to assess children with allergies in a timely fashion. As a result, there is an urgent need for re-training of paediatricians in the management of food allergic disorders, including IgE mediated food allergy, gastrointestinal allergic manifestations, and food protein induced infantile atopic eczema.5–8

The overall prevalence of food allergy is about 8% in children under 3 years of age, and 4% in the general American population.9 Prevalence figures from published data on food induced symptoms seem to be influenced by the recruitment method and the clinical setting in which patients were studied—that is, cohorts presenting predominantly with dermatological, gastrointestinal, or IgE mediated clinical manifestations. In a recent German population based study, only 10% of self-reported food induced symptoms were confirmed on subsequent formal assessment, corresponding with a prevalence of 4.2% for proven food induced clinical symptoms.2

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Medical subspecialists may be influenced by specialty based clinical bias and may fail to identify relevant clinical manifestations of allergic disorders outside their area of interest. A model of the current interactions between the three …

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