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GRADE profile 10The utility of food elimination and other diagnostic tools in the differential diagnosis of non-IgE-mediated food allergy and gastro-oesophageal reflux disease

StudiesOutcome: utility of food elimination in combination with other diagnostic tools for the differential diagnosis of non-IgE-mediated food allergy and gastrooesophageal reflux diseaseLimitations*Inconsistency*Indirectness*Imprecision*Other ConsiderationsQuality
Three studies (Cavataio et al. 1996; Nielsen et al. 2004, 2006)Evaluation of the studies showed that in 200 children, food elimination was used initially to identify possible food allergy and to differentiate between food allergy and primary gastro-oesophageal reflux disease. A cohort of 140 children was differentially diagnosed with either cows' milk protein allergy or primary gastro-oesophageal reflux disease or both, using a combination of food elimination, food challenge and biopsy.YYYYNVery low
StudiesOutcome: utility of food elimination in combination with other diagnostic tools for the differential diagnosis of non-IgE-mediated food allergy and gastrooesophageal reflux diseaseLimitations7Inconsistency8Indirectness9Imprecision10Other ConsiderationsQuality
Three studies (Cavataio et al. 1996; Nielsen 2004, 2006)Serum IgG, 24-hour oesophageal pH metric testing, 48-hour testing in combination with food elimination needed for differential diagnosis of non-IgE food allergy.YYYYNVery low
*

Please see footnotes 7131410 for criteria for downgrading

Limitations: not all cases of food challenge were carried out blind and there was no consistent definition of non-IgE-mediated food allergy diagnosis, causing heterogeneity across study population characteristics.

Inconsistencies: differences in diagnostic performance could not be explained by differences in the study population and so has been downgraded.

Indirectness: not all papers compared the same tests with DBCPFC. Endoscopy was needed to confirm diagnosis in some cases.

Imprecision: cannot be assessed in diagnostic studies so it has been assumed that imprecision exists here and has been downgraded.

Please see footnotes 7131410 for criteria for downgrading

From: 2, How this guideline was developed

Cover of Food Allergy in Children and Young People
Food Allergy in Children and Young People: Diagnosis and Assessment of Food Allergy in Children and Young People in Primary Care and Community Settings.
NICE Clinical Guidelines, No. 116.
Centre for Clinical Practice at NICE (UK).
Copyright © 2011, National Institute for Health and Clinical Excellence.

All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of NICE.

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