Evidence-Based Clinical Recommendations on the Appropriateness of Prescriptions and Diagnostic Tests in Paediatric Allergology: Focus on IgE-Mediated and Non-IgE Mediated Food Allergy, Eosinophilic Gastrointestinal Disease, Urticaria, Angioedema and

Background: Appropriate diagnostic testing is essential to quality pediatric allergy care, affecting diagnostic accuracy, treatment decisions, resource use, and patient outcomes. This study aimed to develop evidence-based recommendations for specialist consultations and diagnostic investigations in children with food allergies, eosinophilic gastrointestinal diseases, urticaria, angioedema, and atopic dermatitis. Methods: A multidisciplinary panel convened for the Italian National Institute of Health formulated and prioritized clinical questions using the PICO framework and structured expert consensus. A systematic review of the literature from 2015 to 2026 informed the recommendations, with certainty of evidence assessed using GRADE methodology. Results: In food allergy, sensitization tests alone are insufficient for diagnosis, while oral food challenges remain central to diagnostic confirmation. Endoscopic biopsies are essential for diagnosing eosinophilic gastrointestinal diseases. In chronic urticaria, specialist consultation is recommended, whereas routine allergy testing should be avoided without a suggestive clinical history. In angioedema, distinguishing histaminergic from bradykinin-mediated forms is critical, with targeted laboratory testing for hereditary or acquired conditions. In atopic dermatitis, standardized severity assessment should guide management and consideration of biologic therapies, while patient and family education represent key components of care. Conclusions: These recommendations provide a framework for standardized pediatric allergy diagnostic pathways, aiming to improve quality and equity of care while reducing unnecessary investigations and optimizing healthcare resource use.

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Publication Details

Journal
Children
Published
2026-08-26
DOI
https://doi.org/10.3390/children13091146
Primary Topic
Food Allergy and Anaphylaxis Research
Type
article
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0.00
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article

Evidence-Based Clinical Recommendations on the Appropriateness of Prescriptions and Diagnostic Tests in Paediatric Allergology: Focus on IgE-Mediated and Non-IgE Mediated Food Allergy, Eosinophilic Gastrointestinal Disease, Urticaria, Angioedema and

Susanna Esposito, Rachele Antignani, Carlo Caffarelli, Antonella Giudice et al.
Children
Food Allergy and Anaphylaxis Research
article

Evidence-Based Clinical Recommendations on the Appropriateness of Prescriptions and Diagnostic Tests in Paediatric Allergology: Focus on IgE-Mediated and Non-IgE Mediated Food Allergy, Eosinophilic Gastrointestinal Disease, Urticaria, Angioedema and

Susanna Esposito, Rachele Antignani, Carlo Caffarelli, Antonella Giudice, Rita Nocerino, Daniela Cunico, Amelia Licari, Fabio Cardinale, Matteo Riccò, Iria Neri, Valentina Fainardi, Michele Miraglia del Giudice, Massimiliano Esposito, Diego Giampietro Peroni, Roberto Grandinetti, Elena Chiappini, Cristina Piersantelli, Elisabetta Palazzolo, Maria Marsella, Anna Montanari, Giuseppe Squazzini, Mariangela Tosca, Simona Bellodi, Alberto Martelli, Maria Angiola Crivellaro, Mauro Calvani, Giuseppe Pingitore
article en

Abstract

Background: Appropriate diagnostic testing is essential to quality pediatric allergy care, affecting diagnostic accuracy, treatment decisions, resource use, and patient outcomes. This study aimed to develop evidence-based recommendations for specialist consultations and diagnostic investigations in children with food allergies, eosinophilic gastrointestinal diseases, urticaria, angioedema, and atopic dermatitis. Methods: A multidisciplinary panel convened for the Italian National Institute of Health formulated and prioritized clinical questions using the PICO framework and structured expert consensus. A systematic review of the literature from 2015 to 2026 informed the recommendations, with certainty of evidence assessed using GRADE methodology. Results: In food allergy, sensitization tests alone are insufficient for diagnosis, while oral food challenges remain central to diagnostic confirmation. Endoscopic biopsies are essential for diagnosing eosinophilic gastrointestinal diseases. In chronic urticaria, specialist consultation is recommended, whereas routine allergy testing should be avoided without a suggestive clinical history. In angioedema, distinguishing histaminergic from bradykinin-mediated forms is critical, with targeted laboratory testing for hereditary or acquired conditions. In atopic dermatitis, standardized severity assessment should guide management and consideration of biologic therapies, while patient and family education represent key components of care. Conclusions: These recommendations provide a framework for standardized pediatric allergy diagnostic pathways, aiming to improve quality and equity of care while reducing unnecessary investigations and optimizing healthcare resource use.

ChildrenVol. 13(9)
University of Pisa (IT), University of Parma (IT), University of Padua (IT), Università degli Studi di Enna Kore (IT), Società Italiana di Fisica (IT), Istituto Giannina Gaslini (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Società Italiana di Cardiologia (IT), Azienda Ospedaliera San Camillo-Forlanini (IT), Associazione Nazionale Medici Cardiologi Ospedalieri (IT), Fondazione FADOI (IT), Azienda Ospedaliera S.Giuseppe Moscati (IT), Meyer Children's Hospital (IT), Azienda USL di Bologna (IT), Società Italiana di Nefrologia (IT), University of Campania "Luigi Vanvitelli" (IT), Società Italiana di Reumatologia (IT), Società Italiana di Medicina Generale (IT), Ospedale Pediatrico Giovanni XXIII (IT), Azienda Ospedale - Università Padova (IT), Policlinico San Matteo Fondazione (IT), Carlo Forlanini Hospital (IT)
Openalex Percentile: Top 12%
Food Allergy and Anaphylaxis Research
DOIOpen Access PDFOpenAlex
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