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KFA's Medical Advisory Team Explains the New NIAID Guidelines for Diagnosing and Treating Food Allergy
Up-To-Date Allergy Advice
New NIAID guidelines help physicians better diagnose and manage food allergiesBy Beth Puliti
An estimated 5% of children age 5 years and younger have food allergies, reports the National Institute of Allergy and Infectious Diseases (NIAID)*. In an effort to address this rising public health problem, NIAID worked with the American Academy of Allergy, Asthma & Immunology and other organizations to create food allergy guidelines.
The Guidelines for the Diagnosis and Management of Food Allergy in the United States were released in December 2010 and published as a supplement to the Journal of Allergy and Clinical Immunology. A committee of 34 professional medical organizations, groups and agencies helped to oversee its development.
Consisting of 43 clinical recommendations, the guidelines are intended to aid physicians in diagnosing and managing patients with food allergies. Additionally, they help to inform parents about advised diagnostic tests, treatment and prevention.Below, members of KFA's medical advisory team provide insight into which recommendations they feel parents should be made aware of and why.
Guideline #7: The Expert Panel (EP) recommends specific IgE (sIgE) tests for identifying foods that potentially provoke IgE-mediated food-induced allergic reactions, but alone these tests are not diagnostic of Food Allergy.
“Testing for specific IgE to foods, through either skin or serum testing, is very helpful in diagnosing IgE-mediated food allergic reactions, but these tests should never take the place of a good history or possibly a food challenge,” said Todd D. Green, MD, assistant professor of pediatrics in the Division of Pulmonary Medicine, Allergy & Immunology at Children's Hospital of Pittsburgh of UPMC.
In general, a bigger skin test size or higher level of specific IgE in serum means that allergy is more likely, but the distinction between sensitization (positive skin test, or detectable specific IgE in serum) and clinical allergy (development of specific signs and symptoms of a reaction that develop after exposure) is very important to recognize. It is well-established that individuals may be sensitized, and therefore test "positive," but may not be clinically allergic.
This guideline also highlights the fact that there are differences between the systems used to measure specific IgE, so that values may differ depending on the system used, Dr. Green explained.
“Generally, if someone is tolerating a food, it is not necessary to perform any allergy testing to that food. Testing that is not indicated may lead to adverse consequences, such as unwarranted dietary changes, heightened anxiety and possibly adverse nutritional effects,” he said.
Guideline #30: The EP recommends that patients with Food Allergy and their caregivers be provided with information on food allergen avoidance and emergency management that is age and culturally appropriate.
“While it may seem like a simple thing, patients and families need to know that there is information out there for them and for someone who may care for their child. This guideline is really about being proactive in your management of food allergiesóboth food avoidance and the management of an emergency,” noted David W. Hauswirth, MD, FAAAAI, FACAAI, clinical assistant professor of Internal Medicine and Pediatrics, Allergy and Immunology at The Ohio State University Medical Center in Nationwide Children's Hospital.
Patients and families need to work with their doctors to get the information they need; for each patient this will be different, Dr. Hauswirth explained. As a patient, one must make sure he understands the information and that it applies to the foods he eats and how he lives his life. If the foods that are a natural part of one's diet are not discussed, inquire specifically about those foods, whether they are safe and how to make them safe.
“Parents should also work with the tools they have available to them to introduce the concept of food avoidance to their child in a safe, comfortable, age-appropriate way,” he said.
Emergency management of food allergies is a difficult item to teach as each situation and person is different. However, families need to insist on knowing what to do and asking the right questions so that the doctor or nurse educating them can tailor the learning to their needs. More importantly, families need to know how to teach other caregivers about avoidance and treating a reaction.
“This may mean coming up with a strategy to teach a younger babysitter about snacks or food in your home. It may mean training a daycare provider what your child does and doesn't eat,” said Dr. Hauswirth. “At the same time, you will need to teach these people how to determine when your child is having a reaction and what to do.”
The key to this, which is written into this guideline statement, is that the information is easy for them to understand, age-appropriate and culturally sensitive.
“The best teaching in the world will not overcome cultural or comprehension barriers,” Dr. Hauswirth commented.
Attention to good teaching will give parents peace of mind when they have to leave their child with someone else, as well as a better, safer situation for your child.
Guideline #36 - The EP does not recommend restricting maternal diet during pregnancy or lactation as a strategy for preventing the development or clinical course of Food Allergy.
This particular point has been the center of debate for many years. At the heart of the discussion is the desire for parents to decrease the chance that their child will develop food allergies. Older advice suggested avoiding highly allergenic foods during pregnancy and when breastfeeding as a strategy to decrease the risk of food allergies. Unfortunately, this strategy has not been proven effective at reducing food allergies.
“The best advice at this time is to eat a balanced, healthy diet that provides all the nutrition necessary for a pregnant mother and a growing infant,” said Dr. Hauswirth.
The authors of the guidelines looked at the available research on this topic and concluded that the best studies and information supported an unrestricted diet. Proper nutrition is of the utmost importance here.
Dr. Hauswirth noted that the follow-up to this is the recommendation that (unless there is a medical reason not to) mothers breastfeed their children exclusively for the first four to six months. In this section of the guidelines, the authors focus on the evidence and infant nutrition.The new food allergy guidelines cover much more information than what was mentioned in this article. Visit http://www.jacionline.org/article/S0091-6749(10)01566-6/fulltext for the complete guidelines.
You can also download the summary written for families, caregivers and patients.
*The prevalence of food allergy quoted by NIAID was based on a 2007 study by the Centers for Disease Control. In 2011, Pediatrics published a study that found food allergy affects 8% of children in the United States.
Approved by KFA's Medical Advisory Team 2012.