This is not needed in the majority of cases. Most children with mild to moderate eczema which respond well to treatment do not have a food allergy especially if there has been no link identified by parents with a flare-up of eczema with a particular food. In such cases, no investigations are recommended. Allergy testing should be considered in children with mild to moderate eczema that does not respond to treatment, children with moderate to severe eczema, children with co-existing gastrointestinal symptoms (diarrhoea, vomiting, reflux, colic etc.) and if eczema is associated with a perioral flare when eating and perianal erythema. Food allergy can also manifest as hives/urticaria, angioedema and anaphylaxis. This is seen with peanuts, tree nuts, shellfish, white fish (e.g. cod), egg white, cows milk, soya, wheat and sesame seeds. These are called type 1 or immediate hypersensitivity reactions as the reactions occur within minutes of ingesting or contact with an allergen. Most of the time patient or parents in case of children are able to identify the cause. If it is not clear from history then allergy testing is recommended to identify the potential allergen. Patients with nut allergies, often have multiple allergies and usually require further investigations.

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