Serum sensitization does not always represent food allergy

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Objectives. The diagnosis of food allergy requires, beyond documented serum sensitization, the presence of reproducible symptoms triggered by the implicated allergen. We report the case of a polysensitized child to illustrate the diagnostic approach used to distinguish clinically relevant sensitizations from those without clinical significance and to underline the risk of overdiagnosis and unjustified dietary restriction associated with the indiscriminate use of extended specific IgE panels. Materials and methods. A 6-year-old child was evaluated for recurrent digestive symptoms and urticarial eruptions occurring within minutes after the consumption of chicken and fish. The work-up included a detailed clinical history, abdominal ultrasound, celiac disease screening, a pediatric specific IgE panel, an extended molecular allergen component panel (ALEX MADx), and prick-to-prick skin testing with fresh raw foods. Results. Both panels revealed a polysensitization profile, with high values for fish allergens, including parvalbumins and cod β-enolase, bovine serum albumin (Bos d 6), cashew 2S albumin (Ana o 3), and chicken meat, along with sensitizations to cow’s milk proteins, mammalian epithelia, and aeroallergens. Prick-to-prick testing was positive for chicken and fish but negative for turkey, cashew, beef, and pork. Turkey, beef, and pork were regularly consumed and clinically tolerated, whereas the status of cashew remained uncertain because of a lack of regular consumption. Correlation of the clinical history with the serologic pro­file and skin testing allowed clinically relevant sensitizations to be distinguished from asymptomatic ones, so that dietary elimi­­nation was restricted to chicken and fish, with precautionary avoidance of cashew pending a controlled oral food challenge. Conclusions. This case highlights the essential role of correlating clinical findings with allergy investigations in the evaluation of children with food polysensitization. An integrated approach prevents the overdiagnosis of primary allergic reactions and unnecessary dietary restrictions, thereby reducing their negative impact on nutritional status, quality of life, and associated healthcare and socioeconomic costs.

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