New Developments Improve Food Allergy Management

Less restrictive dietary options, better detection, targeted avoidance measures, educational directives and potential new therapies are improving food allergy management and giving hope to the more than 12 million Americans affected according to experts at the thirteenth international food allergy conference held during the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Miami Beach, Fla.

“The management of food allergy relies primarily on avoidance of exposure to suspected or proven foods,” said Alessandro Fiocchi, M.D., director of the Pediatric Department at The Melloni University Hospital in Milan, Italy. “This can best be done if the specific foods responsible for the patient’s symptoms are identified by history and appropriate tests.”

Not all foods a patient is sensitized to should be eliminated, and not all sensitized patients should be on a diet, said Dr. Fiocchi. Patients may not need to avoid all in a specific food group, such as different kinds of fish for a person with fish allergy.

ACAAI President-Elect and Program Chair Sami L. Bahna, M.D., Dr.P.H., professor of pediatrics & medicine, and chief of allergy & immunology at Louisiana State University Health Sciences Center in Shreveport, La., said food allergy must sometimes be investigated even without an apparent relationship to eating.

Diagnosing Food Allergy

“The allergist must be a good detective in discovering the cause of some reactions, often seeing a patient multiple times to compile a detailed medical and environmental history. Food allergens can be hidden, very minute, or cross-reactive with other food allergens,” Dr. Bahna said.

“We have seen cases where food allergy is caused by skin contact or smell, such as an allergy to fish, shellfish, egg or milk. Even a touch can be risky to patients with severe food allergy, especially to peanuts,” he said.

An allergist, an expert in the diagnosis and treatment of allergies and asthma, can perform allergy testing to identify the specific food and additives that trigger allergic reactions and determine the most appropriate and effective food allergy management procedures.

Diet Restrictions

Allergists may refer food allergy patients on restricted diets to a dietitian for a nutrition assessment to assure they are getting proper nutrition. Referrals to a dietitian with experience in
food allergy may include patients in the following situations:
• Diagnosis of a food allergy at any age for education on allergen avoidance
• Mother of an allergic child who is breastfeeding and following a restricted diet
• Considering discontinuation of a nutrition formula to an alternative beverage
• Poor growth.

“Restricting common dietary staples creates potential for nutritionally suboptimal diets,” said Mandy Monty, R.D., L.D., Nutrition Therapy at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio.