Food allergy has increased in developed countries over the past 20–30 years and is a common reason for referral of children to paediatric services. Diagnosing and managing food allergy in children is dependent on a thorough and well-targeted history with questions focused at differentiating the nature of the reaction for each suspected allergen. Along with skin prick testing or specific immunoglobulin (IgE blood testing), it should be possible to classify reactions into four groups: IgE-mediated food allergy; non-IgE mediated food allergy; non-allergic food hypersensitivity; and symptoms falsely assumed to be due to foods. This is helpful as there are significant differences in the risk profile, dietary approach and management between each group.