Food allergy guidelines urge doctors to be thorough

Posted on Dec 4, 2010 in Uncategorized

Wheat, milk, eggs, soy, peanuts and shellfish are among common food allergies.


By Mary Brophy Marcus, USA TODAY

Doctors should take a thorough medical history when they suspect a patient might have a food allergy, according to the first-ever clinical guidelines for diagnosing and managing such allergies, made public today. The guidelines include a list of the most useful tests to determine the nature of the allergy.

Food allergies affect 5% of U.S. children and 4% of adults — about 10 million to 12 million people — and appear to be on the rise, says the National Institute of Allergy and Infectious Diseases (NIAID), which developed the new set of standards.

Allergic reactions to certain foods — including eggs, dairy, wheat, and peanuts — can be severe, even cause death, and there are no cures. Peanut allergies in particular appear to be increasing and can be difficult to treat, says Matthew Fenton, chief of the Asthma, Allergy and Inflammation Branch of the Division of Allergy, Immunology and Transplantation at NIAID.

Developing the guidelines was an “incredibly complex process that involved a lot of different organizations and points of view,” he said at a press conference. More than 30 professional organizations, federal agencies and patient advocacy groups were involved, including RAND Corp., which did a systematic literature review to assess the state of science in food allergy.

A summary appears in the Journal of Allergy and Clinical Immunology and the full report is available online at Fenton said NIAID plans to publish a synopsis of the new guidelines for parents.

The guidelines include:

•The definition of a food allergy and allergens, as well as food-induced conditions such as anaphylaxis, a life-threatening symptom.

•Foods that commonly cause reactions, including tree nuts and seafood.

•Symptoms, including skin reactions, breathing, and gastrointestinal problems.

•Diagnostic guidelines, including when food allergy should be suspected and tests conducted.

•Tests and combinations of tests that are useful and not useful in determining certain types of food allergies.

•Management of disease depending on type of allergy.

“I’m very excited about the guidelines project and very hopeful we’re going to see similar strides in diagnosis and treatment of food allergies that we saw after the introduction of asthma guidelines years ago,” said Fenton.

The guidelines stress the importance of taking a thorough medical history. “The way to diagnose someone with a food allergy is like putting a puzzle together and the major piece is the clinical history,” says Wesley Burks, professor and chief of Pediatric Allergy and Immunology at Duke University Medical Center.

Also emphasized: Doing the proper lab studies, which may include skin, blood, and oral challenges where the patient actually consumes a food.

“We looked deeply at which tests were most helpful based on scientific evaluation,” Fenton said. Some children are unnecessarily being deprived of foods they’re not truly allergic to because they’ve been improperly diagnosed and the new guidelines should change that, he said.

What’s more, hospital emergency rooms — where many food allergy patients turn up when suffering from anaphylactic shock, a life-threatening condition — will be able to turn to a recommended standard of treatment in the new document.

Fenton said that while there’s no cure for food allergies, immunotherapy researchers are closing in on effective treatments — vaccines and oral medications that can help turn off the body’s self-attack when everyday foods are eaten — that should be available within a few years.

Parents will likely gain some peace of mind from the publication of the new guidelines, says Nancy Sander, president and founder of Allergy and Asthma Network Mothers of Asthmatics, a group involved in their development. Her grown daughter has had serious food allergies all her life.

“Hopefully we’re going to replace fear with facts.”