{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T12:17:30Z","timestamp":1787833050854,"version":"build-2784847793"},"reference-count":116,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Appropriate diagnostic testing is essential to quality pediatric allergy care, affecting diagnostic accuracy, treatment decisions, resource use, and patient outcomes. This study aimed to develop evidence-based recommendations for specialist consultations and diagnostic investigations in children with food allergies, eosinophilic gastrointestinal diseases, urticaria, angioedema, and atopic dermatitis. Methods: A multidisciplinary panel convened for the Italian National Institute of Health formulated and prioritized clinical questions using the PICO framework and structured expert consensus. A systematic review of the literature from 2015 to 2026 informed the recommendations, with certainty of evidence assessed using GRADE methodology. Results: In food allergy, sensitization tests alone are insufficient for diagnosis, while oral food challenges remain central to diagnostic confirmation. Endoscopic biopsies are essential for diagnosing eosinophilic gastrointestinal diseases. In chronic urticaria, specialist consultation is recommended, whereas routine allergy testing should be avoided without a suggestive clinical history. In angioedema, distinguishing histaminergic from bradykinin-mediated forms is critical, with targeted laboratory testing for hereditary or acquired conditions. In atopic dermatitis, standardized severity assessment should guide management and consideration of biologic therapies, while patient and family education represent key components of care. Conclusions: These recommendations provide a framework for standardized pediatric allergy diagnostic pathways, aiming to improve quality and equity of care while reducing unnecessary investigations and optimizing healthcare resource use.<\/jats:p>","DOI":"10.3390\/children13091146","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:04:32Z","timestamp":1787756672000},"page":"1146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evidence-Based Clinical Recommendations on the Appropriateness of Prescriptions and Diagnostic Tests in Paediatric Allergology: Focus on IgE-Mediated and Non-IgE Mediated Food Allergy, Eosinophilic Gastrointestinal Disease, Urticaria, Angioedema and Atopic Dermatitis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4601-7484","authenticated-orcid":false,"given":"Valentina","family":"Fainardi","sequence":"first","affiliation":[{"name":"Paediatric Clinic, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6525-2159","authenticated-orcid":false,"given":"Matteo","family":"Ricc\u00f2","sequence":"additional","affiliation":[{"name":"Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Azienda Unit\u00e0 Sanitaria Locale\u2014Istituto di Ricovero e Cura a Carattere Scientifico (AUSL-IRCCS) Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachele","family":"Antignani","sequence":"additional","affiliation":[{"name":"Primary Care Pediatricians, Societ\u00e0 Italiana Medici Pediatri (SIMPE), 64100 Teramo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Bellodi","sequence":"additional","affiliation":[{"name":"Primary Care Pediatricians, Societ\u00e0 Italiana Medici Pediatri (SIMPE), 64100 Teramo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Calvani","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Allergologia e Immunologia Pediatrica (SIAIP), 20126 Milano, Italy"},{"name":"UOC Pediatria, Ospedale S. Camillo-Forlanini, 00152 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-6152","authenticated-orcid":false,"given":"Fabio","family":"Cardinale","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Allergologia e Immunologia Pediatrica (SIAIP), 20126 Milano, Italy"},{"name":"UOC Pediatria, Ospedale Pediatrico \u201cGiovanni XXIII\u201d, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Chiappini","sequence":"additional","affiliation":[{"name":"UOC Malattie Infettive, Ospedale Meyer, 50139 Firenze, Italy"},{"name":"Societ\u00e0 Italiana di Pediatria Preventiva e Sociale (SIPPS), 81031 Aversa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Angiola","family":"Crivellaro","sequence":"additional","affiliation":[{"name":"UOSD Allergologia, Azienda Ospedale Universit\u00e0 di Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Cunico","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7880-3450","authenticated-orcid":false,"given":"Massimiliano","family":"Esposito","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Medicina Legale e delle Assicurazioni (SIMLA), 00186 Roma, Italy"},{"name":"Medicina Legale, Universit\u00e0 degli Studi di Enna, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Giudice","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1341-761X","authenticated-orcid":false,"given":"Roberto","family":"Grandinetti","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-6482","authenticated-orcid":false,"given":"Amelia","family":"Licari","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Allergologia e Immunologia Pediatrica (SIAIP), 20126 Milano, Italy"},{"name":"UOC Clinica Pediatrica, IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8369-5957","authenticated-orcid":false,"given":"Michele","family":"Miraglia Del Giudice","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Allergologia e Immunologia Pediatrica (SIAIP), 20126 Milano, Italy"},{"name":"Department of Woman, Child and General and Specialized Surgery, Universit\u00e0 della Campania Luigi Vanvitelli, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Marsella","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana Gestori del Rischio in Sanit\u00e0 (SIGeRiS), 00186 Roma, Italy"},{"name":"UOC di Pediatria Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati di Avellino, 83100 Avellino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Martelli","sequence":"additional","affiliation":[{"name":"Network delle Associazioni di Allergologia Pediatrica, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Montanari","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-0771","authenticated-orcid":false,"given":"Iria","family":"Neri","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Dermatologia Pediatrica (SIDeRP), 25124 Brescia, Italy"},{"name":"UOC Clinica Dermatologica, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4681-546X","authenticated-orcid":false,"given":"Rita","family":"Nocerino","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Pediatria Infermieristica (SIPINF), 00186 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Palazzolo","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Medicine and Surgery, University of Parma, 43125 Parma, 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