New Guidelines Reveal the Complexity of Food Allergy Management

Allergists representing three organizations developed evidence-based guidelines for food allergy diagnosis and management, which has become more sophisticated and challenging in recent years due to the increase in prevalence of certain food allergies and important scientific developments.

The Joint Task Force guidelines, "Food Allergy: A Practice Parameter," are published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI). The Joint Task Force on Practice Parameters, representing the ACAAI, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Joint Council of Allergy, Asthma and Immunology (JCAAI), has published 20 practice parameters for the field of allergy-immunology.

"The practice parameter on food allergy represents more than 10 years of research and investigation of literature by members of the Joint Task Force," said Jean A. Chapman, M.D., Cape Girardeau, Mo., a chief editor. "Designed to improve patient care, the guidelines provide practicing physicians with an evidence-based, broadly accepted approach to the diagnostic evaluation and management of IgE-mediated (allergic) food reactions."

Although adverse food reactions have been reported in up to 25 percent of the U.S. population at some point in their lives, the prevalence of food allergy, an IgE-mediated response to a food, is much lower than the number of suspected food allergies. It varies between 2 percent (adults) and 5 percent (children) in most studies, and is higher in individuals with atopic dermatitis, certain pollen sensitivities or latex sensitivities.

"The guidelines reinforce the need for physicians to think about food allergy as the potential cause of a patient's symptoms, whether it be GI complaints or skin problems," said John Oppenheimer, M.D., UMDNJ-New Jersey Medical School, New Brunswick, N.J., a chief editor of the practice parameter.

"Likewise, if a patient has a list of foods they think they are allergic to, it's important to differentiate what's truly an allergy and what isn't. If a patient is trying to avoid 10 or 15 foods, it becomes really cumbersome, and if someone does have an allergy on that list, it is much more difficult to avoid the important allergen," Dr. Oppenheimer said.

Food allergies are more common in children than in adults. According to the authors, the most common food allergens in infants and young children are cow's milk, hen's egg, peanut (a legume), tree nuts, soybeans and wheat. Although sensitivity to most allergens is lost in late childhood, allergy to peanut, tree nut and seafood is likely to continue throughout the patient's life. Only approximately 20 percent of children with peanut allergy lose their sensitivity. The most common foods causing allergy in adults are peanuts, tree nuts (walnut, hazelnut, Brazil nut, and pecan), fish, crustaceans, mollusks, fruits and vegetables.