Background: The use of allergy tests to guide dietary exclusions for disease control in children with atopic dermatitis (AD) is controversial. We undertook a consensus exercise on how to interpret skin prick test (SPT) results and dietary history for cow’s milk, hen’s egg, wheat and soya in children <2 years old with AD. Methods: Fourteen clinicians from general practice, paediatrics, paediatric dermatology, paediatric allergy and paediatric dietetics from UK and Ireland took part in an online modified Delphi study. Over three rounds, participants gave their anonymous opinions and received individualised and group feedback. The findings were discussed in an online workshop. Results: Of 14 symptoms, 12 were identified as relevant to immediate and 7 to delayed allergy. Regarding SPTs, there was consensus over which allergens to use for wheat and soya but not cow’s milk or hen’s egg; for all study foods, wheal size was determined as 0-1 mm negative, ≥5mm sensitised , but between 2-4 mm categorisation varied by food. During the final workshop, consensus was reached on dietary advice should be given according to SPT results and dietary history. Conclusion: We attained consensus on how SPTs combined with dietary history for four common food allergens should be interpreted in young children under two years of age with AD. These pragmatic recommendations may support clinician education, consistency of decision-making and future research.

Background: Cow’s milk protein allergy (CMPA) is an immune-mediated allergic response to proteins in milk, a common infant food allergy. The wide range and frequency of CMPA symptoms make diagnosis a challenge, particularly in primary care. Symptom scores may improve a clinician’s awareness of symptoms, thus indicating a need for further testing. This systematic review examined the development and evaluation of such symptom scores for use in infants. Methods: Four databases were searched from inception to 3 December 2019, for diagnostic accuracy studies, randomised controlled trials, observational studies, economic evaluations, qualitative studies, and studies reporting on the development of the tools. Experts were consulted for additional studies. Data were not suitable for meta-analysis due to heterogeneity, so were narratively synthesised. Results: We found two symptom scores evaluated in one and fourteen studies, respectively. Estimated sensitivity and specificity ranged from 37-98% and 38-93%. The evaluations of each tool were at high risk of bias or failed to address issues such as clinical and cost-effectiveness. Conclusions: Estimates of accuracy of symptom scores for CMPA offered so far should be interpreted cautiously. Rigorous research based on well-defined roles for the tools and free of potential conflicts of interest is urgently required.