Food Allergy in India: Delphi Consensus Statement by Indian Academy of Pediatrics (IAP)—Allergy and Applied Immunology Chapter

Food allergy is an emerging public health concern in India, driven by rapid urbanisation, changing dietary patterns, environmental influences, and increasing recognition of allergic diseases. Despite the growing burden, food allergy care in India is challenged by limited epidemiological data, variable diagnostic practices, and inadequate access to specialised services. These gaps underscore the need for standardised, context-specific guidance tailored to the diverse sociocultural and dietary landscape of the country. This consensus document was developed by a multidisciplinary panel of allergy experts using a structured Delphi methodology to ensure methodological rigour and expert agreement. It provides a comprehensive overview of evidence-based approaches to the diagnosis and management of food allergy, adapted to Indian clinical practice. The consensus recommends adoption of a standardised diagnostic framework incorporating detailed clinical history, skin prick testing, serum-specific IgE estimation, and supervised oral food challenges, where appropriate. Recognition of region-specific allergens-including milk, wheat, egg, peanut, fish, chickpea, lentils, and sesame-is emphasised to improve diagnostic accuracy and culturally relevant patient counselling. The document highlights the importance of comprehensive management strategies that integrate strict allergen avoidance with balanced, culturally appropriate nutritional planning and psychosocial support. Standardisation of clinical practice is advocated to reduce heterogeneity in care, facilitate early diagnosis, and improve patient outcomes. At a broader level, the consensus emphasises strengthening public health policies through clear food labelling, enhanced allergy education, and school-based preparedness programs. Preventive strategies, including early supervised introduction of allergenic foods, are encouraged in appropriate settings. Advanced therapeutic options such as biologic agents and oral immunotherapy are recommended only for selected patients with severe disease and under specialist supervision. Finally, the consensus underscores the urgent need for robust epidemiological studies, improved diagnostic infrastructure, and enhanced professional training to address existing knowledge gaps. Collectively, these recommendations aim to improve quality of care, reduce disease burden, and support the development of effective, evidence-based food allergy management in India.