Roberts’ title is apt, but perhaps it should read challenging times for food allergy (or even for paediatricians).¹ We are faced with an epidemic of allergy. The prevalence is rising, and recent data show over 30% of the population and 40% of children are affected.² Food allergy is a particular—and seemingly increasing—problem in children, yet there is a dearth of trained allergists in the UK.^3,4

Children have always suffered from egg or cows’ milk allergy, and it is well known that these resolve in the majority, often by 5 years of age.^5,6 But new IgE mediated food allergies are appearing. The rise in peanut allergy is well documented. This was rare until the early 1990s, the first “big” series being published in 1996.⁷ The prevalence in children rose threefold over 4–6 years from 1 in 200⁸ to 1 in 70,⁹ and allergy to any nut now occurs in 1 in 50 (Dr Gideon Lack, ALSPAC data, personal communication).

We are faced with other new food allergies: allergy to fruits and vegetables, as part of the oral allergy syndrome (OAS) is now the “new” epidemic. These patients have rhinoconjunctivitis due to pollen allergy (especially birch), and through cross reacting proteins also react to fruits and vegetables. Children are also presenting with allergy to kiwi, sesame, and a range of other foods, distinct from OAS, but at lower rates.¹⁰

Good management of any disease requires knowledge of the natural history. While this is well known for egg and milk allergy, it is not for the newer disorders, for example peanut, kiwi, and sesame allergy.

DIAGNOSIS

Diagnosis can usually be made from the history backed up by evidence of specific IgE antibody. It therefore …