What referral criteria should I consider for patients with suspected food intolerances who do not respond to initial dietary modifications?

Referral to secondary or specialist care should be considered for patients with suspected food intolerances who do not respond to initial dietary modifications, particularly elimination diets. Specific referral criteria include:

• Faltering growth combined with one or more gastrointestinal symptoms suggestive of food allergy.
• Failure to respond to a single-allergen elimination diet.
• One or more acute systemic reactions or severe delayed reactions.
• Confirmed IgE-mediated food allergy with concurrent asthma.
• Significant atopic eczema where multiple or cross-reactive food allergies are suspected.
• Persisting parental or patient suspicion of food allergy despite lack of supporting history.
• Strong clinical suspicion of IgE-mediated food allergy but negative allergy test results.
• Clinical suspicion of multiple food allergies.

Referral should be made to healthcare professionals with appropriate competencies for further assessment, diagnosis, and management, including dietitians and allergy specialists.

Alternative diagnostic tests such as vega testing, applied kinesiology, hair analysis, and serum-specific IgG testing should not be used in the diagnosis of food allergy.

These criteria are based on an allergy-focused clinical history and the response to elimination diets, with specialist input sought when initial management does not resolve symptoms or when complex allergy presentations are suspected.

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