UPDATED PRACTICE PARAMETER: DIAGNOSING AND TREATING FOOD ALLERGIES
Sampson HA, Aceves S, Bock SA, et al. Food allergy: a practice parameter update—2014. J Allergy Clin Immunol. 2014. pii: S0091-6749(14)00672-1. doi: 10.1016/j.jaci.2014.05.013. [Epub ahead of print]
Over the past decade, health care providers have been confronted with a growing number of patients with suspected food allergies, but data supporting an increase in confirmed allergy cases is limited.
The 2014 practice parameter update on food allergies from the American Academy of Allergy, Asthma & Immunology advises clinicians to keep in mind that self-reported food allergy is more common than proven food allergy; that allergy is more common in children and in patients with other atopic conditions; and that the majority of allergic reactions are from peanuts, tree nuts, fish, shellfish, milk, eggs, wheat, soy, and seeds.
The update of the 2006 guidelines includes 64 new summary statements. Highlights include
• Clinicians should advise patients about the risk for cross-reactions from foods similar to their allergens, such as other tree nuts, vertebrate fish, crustaceans, or milk from cows, goats, or other mammals.
• Patients with a seafood allergy should be advised that they are not at increased risk for a reaction to radiocontrast media.
• Patients with food allergies do not need to be concerned about eating genetically modified foods (GMO), due to current FDA screening requirements to rule out allergenicity.
• Patients with chronic idiopathic urticaria or hyperactivity/attention-deficit disorder should not routinely be advised to avoid food additives.
• Patients with asthma should not routinely be advised to avoid sulfates, unless they have had a previous reaction to them.
The guidelines also include a new section on diagnosing and treating non-IgE-mediated food allergies, such as food-protein–induced enterocolitis syndrome, allergic proctocolitis, enteropathy, eosinophilic esophagitis, and gastroenteritis.
COMMENTARY
Food allergies are a commonly encountered and difficult area of practice for those of us in primary care. They can be life threatening; yet many patients who are concerned about the possibility of food allergy do not actually have a food allergy, so making an accurate diagnosis is important. Allergic evaluation starts with a careful history, and then laboratory testing can begin with specific IgE testing to foods suspected to have caused the clinical reaction of concern. The IgE results need to be carefully interpreted in light of the clinical context in which they were ordered. Oral food challenge can be helpful in addition to IgE testing. Consultation with an allergy-immunology specialist is often helpful as well. —NS