Clinicians order food allergy panels despite false-positive risk

Most clinicians who order broad serum IgE food allergy panels know the tests frequently return false-positive results, yet many continue to order them for indications experts do not support, according to survey data presented at the 2026 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Phoenix, Arizona.¹ Of 43 respondents, 85% recognized that the panels have high false-positive rates, and 21% said they had ordered one because a patient or family asked for it.²

"Most of the clinicians we surveyed already knew these tests could lead to false positive results, but many still ordered them despite current guidelines advising against their use," said senior author Katelyn Wong, MD, an allergist-immunologist in New Haven, Connecticut, and an ACAAI member.¹ "False positive results can lead families to cut out foods that were never actually unsafe, cause unnecessary stress, and add extra costs."¹

Food allergy panel survey design and respondent characteristics

Investigators emailed or sent Epic messages to 300 clinicians who had ordered at least 1 food allergy panel in 2024 at their institution, where more than 1,700 panels were ordered that year.² The voluntary, anonymous survey was exempted by the institutional review board.²

Forty-three clinicians responded, a response rate of approximately 14%. Most were generalists (55% internal medicine, 27% pediatrics), and 58% were physicians (MD or DO) vs 40% nurse practitioners or physician assistants (NPs or PAs).² Respondents had been in practice for a mean of 16 years (SD, 10), and 44% said they first learned about food allergy panels after completing training.²

Knowledge gaps on appropriate indications for food allergy panels

Respondents considered IgE-mediated food allergy (38%), urticaria (29%), and eczema (14%) appropriate reasons to order a panel.² In practice, they reported having ordered panels for suspected IgE-mediated food allergy (24%), patient or family request (21%), and urticaria (20%).²

A vignette exposed a gap by clinician type. Asked how to evaluate eczema triggers in a patient with a family history of food allergy, 30% of physicians and 63% of NPs and PAs agreed that a food allergy panel was indicated (χ²₁ = 3.946; P = .047).²

Why broad IgE panels lead to food allergy overdiagnosis

Food allergy panels measure IgE sensitization to many foods at once, but sensitization alone does not establish clinical allergy. Under the Choosing Wisely campaign, the American Academy of Allergy, Asthma & Immunology (AAAAI) has noted that false or clinically irrelevant positive food tests are common, that IgE testing should be limited to foods implicated by a history consistent with an IgE-mediated reaction, and that 50% to 90% of presumed food allergies are not IgE mediated.³ Even when IgE-mediated allergy is suspected, then, the recommended approach is targeted testing of the implicated food rather than a broad panel.

The 2023 AAAAI/ACAAI Joint Task Force atopic dermatitis guideline also advises against dietary elimination as a strategy for managing eczema.⁴ ACAAI noted that unnecessary avoidance can restrict a child's diet, add stress at mealtimes, generate extra visits, and may raise the risk of developing a true food allergy.¹

Implications for pediatric allergy testing

The findings suggest that overuse stems less from unawareness of the tests' limitations than from uncertainty about when testing is appropriate. Investigators concluded that targeted education on indications may help reduce panel use.² The eczema vignette is particularly relevant to pediatric practice, as pediatricians made up more than a quarter of respondents.

References

1. American College of Allergy, Asthma and Immunology. Clinicians know food allergy panels can lead to overdiagnosis – but order them anyway. News release. November 12, 2026. Accessed November 12, 2026. https://annualmeeting.acaai.org/food-allergy-panels.cfm

2. Nguyen M, Brady K, Wong K. Exploring ordering clinicians' perspectives of food allergy panels. Abstract R285. Presented at: American College of Allergy, Asthma and Immunology 2026 Annual Scientific Meeting; November 12-16, 2026; Phoenix, AZ.

3. American Academy of Allergy, Asthma & Immunology. Choosing Wisely recommendation: food IgE testing. American Family Physician Choosing Wisely collection. Accessed November 12, 2026. https://www.aafp.org/pubs/afp/collections/choosing-wisely/193.html

4. Chu DK, Schneider L, Asiniwasis RN, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024;132(3):274-312. doi:10.1016/j.anai.2023.11.009