A NEW report from the Global Network of Centres of Excellence for Anaphylaxis & Food Allergy (ANAcare) provides clinicians with a unified, practical pathway for diagnosing IgE-mediated food allergy. The initiative addresses long-standing gaps between evidence-based guidelines and real-world diagnostic practice, aiming to reduce both under- and overdiagnosis and improve patient outcomes.
Addressing Variability in Food Allergy Diagnosis
Although recent international guidelines summarise best evidence for diagnosis, considerable variation persists in how centers interpret and apply these recommendations. Differences in test availability, staffing, clinical thresholds for oral food challenges, and local practice patterns have contributed to inconsistent diagnostic pathways worldwide. ANAcare experts highlight that tests such as skin prick testing and serum-specific IgE remain fundamental but require careful interpretation alongside a detailed clinical history to avoid misclassification.
Building a Practical, Unified Diagnostic Pathway
To create a standardized approach, ANAcare reviewed global guidelines, incorporated emerging research, and collected feedback from clinicians across 13 countries. The resulting pathway offers pragmatic advice for taking structured allergy histories, selecting and interpreting sensitisation tests, and determining when controlled oral food challenges are necessary. Importantly, the authors emphasise that sensitisation alone does not equate to clinical allergy, reinforcing the central diagnostic role of correlation with symptoms.
Overcoming Barriers to Implementation
The report acknowledges the real-world challenges that often hinder adherence to guidelines: limited access to trained specialists, inconsistent testing protocols, variation in clinic capacity to conduct oral food challenges, and regional disparities in reimbursement. By providing an operational, step-by-step framework rather than theoretical guidance alone, ANAcare aims to harmonise practice across centers of varying resources and experience.
Supporting Individualised, Accurate Diagnosis
Accurate diagnosis is essential to ensure patients receive tailored nutritional advice, appropriate avoidance measures, and timely access to emergency treatment. The pathway is designed not only for tertiary allergy units but also for clinicians in primary care and general hospital settings, where many patients first present with suspected food allergy. According to the authors, consistent application of this pathway may also facilitate more comparable data collection globally, strengthening future research.
A Global Effort to Translate Guidance Into Practice
Developed through expert consensus and supported by specialists, dieticians, immunologists, psychologists, and guideline committees, the ANAcare pathway reflects broad agreement on how best to operationalise current evidence. The authors note that although not every clinic can deliver every step, a shared reference framework encourages appropriate referral and fosters capacity building over time.
Reference
Venter C et al. Diagnosing IgE-mediated food allergy: How to apply the latest guidelines in clinical practice. J Allergy Clin Immunol Glob. 2025;DOI:10.1016/j.jacig.2025.100556.
