Arrange referral to a specialist for allergy testing if a person has had one or more acute systemic reactions, or severe delayed reactions, or if there is a history of moderate to severe reactions, or if they are at increased risk of anaphylaxis such as with a history of food allergy and poorly controlled asthma NICE CKS.
Referral is also recommended if the diagnosis is uncertain, if there is clinical suspicion of multiple food allergies, or if the person has not responded to a single allergen elimination diet NICE CKS.
In children and young people, consider referral to secondary or specialist care based on allergy-focused clinical history, including if they have faltering growth with gastrointestinal symptoms, or if there is a strong suspicion of IgE-mediated food allergy despite negative allergy test results NICE CG116.
For suspected IgE-mediated cow's milk allergy, arrange referral to a specialist allergy clinic for allergy testing if there are systemic symptoms, suspected anaphylaxis, or if the history suggests severe reactions or multiple food allergies NICE CKS.