Broad Food Allergy Testing

Broad food allergy panels are not recommended for routine use in pediatric patients with atopic dermatitis. While food allergies are more common in young children with moderate-to-severe atopic dermatitis, broad serum IgE food panels have poor specificity and frequently lead to false positives, unnecessary dietary restrictions, nutritional deficiencies, and possible new IgE-mediated allergies after prolonged food avoidance.1‑3 The AAAAI/ACAAI 2023 guidelines strongly recommend against routine food allergy panel testing and empiric elimination diets, advising that testing be limited to specific allergens (e.g., egg, milk, peanut) only when there is a clear history of immediate reactions or persistent, atopic dermatitis despite optimized topical therapy.³ The AAP 2025 clinical report reinforces that food induced atopic dermatitis is rare, warns against overemphasis on food allergy as a cause of atopic dermatitis, and highlights the risks of unnecessary avoidance diets.4

1. Ramírez-Marín HA, Singh AM, Ong PY, Silverberg JI. Food allergy testing in atopic dermatitis. JAAD Int. 2022;9:50-56. doi:10.1016/j.jdin.2022.08.004.
2. Parrish CP. A review of food allergy panels and their consequences. Ann Allergy Asthma Immunol. 2023;131(4):421-426. doi:10.1016/j.anai.2023.04.011.
3. Chu DK, Schneider L, Asiniwasis RN, et al; AAAAI/ACAAI Joint Task Force on Practice Parameters. Atopic dermatitis (eczema) guidelines: 2023 AAAAI/ACAAI GRADE-based recommendations. Ann Allergy Asthma Immunol. 2024;132(3):274-312. doi:10.1016/j.anai.2023.11.009.
4. Schoch JJ, Anderson KR, Jones AE, Tollefson MM; Section on Dermatology. Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report. Pediatrics. 2025;155(6):e2025071812. doi:10.1542/peds.2025-071812.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.