Journal of Allergy and Clinical Immunology
Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel
Section snippets
Preface
Food allergy is an immune-based disease that has become a serious health concern in the United States. A recent study1 estimates that food allergy affects 5% of children under the age of 5 years and 4% of teens and adults, and its prevalence appears to be on the increase. The symptoms of this disease can range from mild to severe and, in rare cases, can lead to anaphylaxis, a severe and potentially life-threatening allergic reaction. There are no therapies available to prevent or treat food
Definitions of food allergy, food, and food allergens
The EP came to consensus on definitions used throughout the Guidelines.
A food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.
A food is defined as any substance—whether processed, semiprocessed, or raw—that is intended for human consumption, and includes drinks, chewing gum, food additives, and dietary supplements. Substances used only as drugs, tobacco products, and cosmetics (such as lip-care products)
Natural history of food allergy and associated disorders
The EP reviewed the literature on the natural history of FA and summarized the available data for the most common food allergens in the United States: egg, milk, peanut, tree nuts, wheat, crustacean shellfish, and soy. Natural history data for fish allergy were unavailable as of the completion of the systematic literature review (September 2009). In addition, the EP sought to:
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Identify changes in the manifestations of FA over time, as well as changes in coexisting allergic conditions
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Identify the
When should food allergy be suspected?
Guideline 1: The EP recommends that FA should be considered:
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In individuals presenting with anaphylaxis or any combination of symptoms listed in Table IV that occur within minutes to hours of ingesting food, especially in young children and/or if symptoms have followed the ingestion of a specific food on more than 1 occasion
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In infants, young children, and selected older children diagnosed with certain disorders, such as moderate to severe AD, EoE, enterocolitis, enteropathy, and allergic
Management of nonacute allergic reactions and prevention of food allergy
This section of the Guidelines addresses the management and prevention of nonacute and nonsevere allergic reactions to food in individuals diagnosed with FA. Management and prevention of individuals at risk for developing FA and specific concerns about vaccination in individuals with egg allergy also are addressed.
Diagnosis and management of food-induced anaphylaxis and other acute allergic reactions to foods
This section of the Guidelines focuses on the diagnosis and management of food-induced anaphylaxis that arises through IgE-mediated immune mechanisms.
Food-induced anaphylaxis is a potentially fatal disorder and, like other forms of anaphylaxis, is increasing in incidence in industrialized countries.30, 42, 244, 245, 246, 247 Although food-induced anaphylaxis is not always easily recognized, the early recognition of specific signs and symptoms associated with a reaction, the timing of the
Acknowledgments
Primary Authors
Joshua A. Boyce, MD
Division of Rheumatology, Immunology and Allergy
Brigham and Women's Hospital
Department of Medicine Harvard Medical School
Boston, Mass
Amal Assa'ad, MD
Division of Allergy and Immunology
Cincinnati Children's Hospital Medical Center
University of Cincinnati
Cincinnati, Ohio
A. Wesley Burks, MD
Division of Allergy and Immunology
Department of Pediatrics
Duke University Medical Center
Durham, NC
Stacie M. Jones, MD
Division of Allergy and Immunology
Department of Pediatrics
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Sources of funding
Publication of this article was supported by the Food Allergy Initiative.
Disclosure of potential conflict of interest:
J. A. Boyce has served on the Advisory Board of GlaxoSmithKline. He has served as a consultant and/or speaker for Altana, GlaxoSmithKline, and Merck. He has received funding/grant support from the National Institutes of Health.
A. Assa'ad holds, or is listed as an inventor on, US patent application #10/566903, entitled “Genetic markers of food allergy.” She has served as a consultant for GlaxoSmithKline and as a speaker for the American College of Allergy, Asthma, and Immunology, the North East Allergy Society, the Virginia Allergy Society, the New England Allergy Society, and the American Academy of Pediatrics. Dr Assa'ad has received funding/grant support from GlaxoSmithKline.
A. W. Burks holds, or is listed as an inventor on, multiple US patents related to food allergy. He owns stock in Allertein and MastCell, Inc, and is a minority stockholder in Dannon Co Probiotics. He has served as a consultant for ActoGeniX NV, McNeil Nutritionals, Mead Johnson, and Novartis. He has served on the speaker's bureau for EpiPen/Dey, LP, and has served on the data monitoring committee for Genentech. He has served on an expert panel for Nutricia. Dr Burks has received funding/grant support from the Food Allergy and Anaphylaxis Network, Gerber, Mead Johnson, and the National Institutes of Health.
S. M. Jones has served as a speaker and grant reviewer and has served on the medical advisory committee for the Food Allergy and Anaphylaxis Network. She has received funding/grant support from Dyax Corp, the Food Allergy and Anaphylaxis Network, Mead Johnson, the National Peanut Board, and the National Institutes of Health.
H. A. Sampson holds, or is listed as an inventor on, multiple US patents related to food allergy. He owns stock in Allertein Therapeutics. He is the immediate past president of the American Academy of Allergy, Asthma, and Immunology. He has served as a consultant for Allertein Therapeutics, the American Academy of Allergy, Asthma, and Immunology, the Food Allergy Initiative, and Schering Plough. He has received funding/grant support for research projects from the Food Allergy Initiative, the National Institutes of Health (Division of Receipt and Referral, National Institute of Allergy and Infectious Diseases, National Center for Complementary and Alternative Medicine), and Phadia AB. He is a co-owner of Herbal Spring, LLC.
R. A. Wood has served as a speaker/advisory board member for GlaxoSmithKline, Merck, and Dey. He has received funding/grant support from Genentech and the National Institutes of Health (National Institute of Allergy and Infectious Diseases).
S. H. Arshad has received funding/grant support from the National Institutes of Health and the National Institute of Health Research, UK.
S. L. Bahna has received funding/grant support from Genentech.
L. A. Beck has received funding/grant support from the American Academy of Allergy, Asthma, and Immunology, the National Eczema Association, and the National Institutes of Health.
C. Byrd-Bredbenner owns stock in Johnson & Johnson. She has received funding/grant support from the US Department of Agriculture, the Canned Food Alliance, and the New Jersey Department of Health and Senior Services.
C. A. Camargo Jr has consulted for Dey and Novartis. He has received funding/grant support from a variety of government agencies and not-for-profit research foundations, as well as Dey and Novartis.
L. Eichenfield has received funding/grant support from a variety of not-for-profit foundations, as well as Astellas, Ferndale, Johnson & Johnson, Novartis, Sinclair, Stiefel, and Therapeutics Inc.
G. T. Furuta has served as a consultant and/or speaker to Ception Therapeutics and TAP. He has received funding/grant support from the American Gastrointestinal Association and the National Institutes of Health.
J. M. Hanifin has served as served as a consultant for ALZA, Anesiva, Inc, Barrier Therapeutics, Inc, Milliken & Company, Nordic Biotech, Novartis Pharmaceuticals Corporation, Shionogi USA, Taisho Pharmaceutical R&D, Inc, Teikoku Pharma USA, Inc, UCB, York Pharma, ZARS, Inc, and ZymoGenetics. He has served as an investigator or received research funding from ALZA, Astellas Pharma US, Inc, Asubio Pharmaceuticals, Inc, Centocor, Inc, Corgentech, Novartis, Nucryst Pharmaceuticals, Seattle Genetics, and Shionogi USA.
M. Kraft has served as a consultant and/or speaker for Astra-Zeneca, Genentech, GlaxoSmithKline, Merck, Novartis, and Sepracor. She has received funding/grant support from Genentech, GlaxoSmithKline, the National Institutes of Health and Novartis.
B. D. Levy holds, or is listed as an inventor on, US patent applications #20080064746 entitled “Lipoxins and aspirin-triggered lipoxins and their stable analogs in the treatment of asthma and inflammatory airway diseases” and #20080096961 entitled “Use of docosatrienes, resolvins and their stable analogs in the treatment of airway diseases and asthma.” He owns stock in Resolvyx Pharmaceuticals. He has served as a consultant for Bayer Healthcare and Resolvyx Pharmaceuticals. Dr Levy has received funding/grant support from the National Institutes of Health.
P. Lieberman has served as a consultant and/or speaker to Dey Laboratories, Novartis, Schering-Plough, AstraZenica, Merck, TEVA, Pfizer, MEDA, Alcon, Genentech, Intelliject, and the Food Allergy and Anaphylaxis Network. He is past president of the American Academy of Allergy, Asthma, and Immunology.
L. C. Schneider has served as a consultant/clinical advisor for the Food Allergy Initiative. She has received funding/grant support from a variety of not-for-profit research foundations, as well as Novartis and the National Institutes of Health.
R. A. Simon has served as a speaker for Dey Laboratories, Genentech, GlaxoSmithKline, Merck, Novartis, and the US Food and Drug Administration.
F. E. R. Simons holds a patent on “Fast-disintegrating epinephrine tablets for sublingual administration.” She is a past-president of the American Academy of Allergy, Asthma, and Immunology and of the Canadian Society of Allergy and Clinical Immunology. She is a member of the advisory boards of Dey, Intelliject, and ALK-Abello. She has received funding/grant support from AllerGen, the Canadian Allergy, Asthma and Immunology Foundation/Anaphylaxis Canada, and the Canadian Institutes of Health Research.
S. J. Teach has served as a speaker for AstraZeneca. He has received funding/grant support from the AstraZeneca Foundation, Aventis, the Child Health Center Board, the CNMC Research Advisory Council, the National Association of Chain Drug Stores Foundation, the National Institutes of Health (National Institute of Allergy and Infectious Diseases; National Heart, Lung, and Blood Institute), Novartis/Genentech, the Robert Woods Johnson Foundation, the US Centers for Disease Control and Prevention, the US Public Health Service, and the Washington, DC, Department of Health.
The other authors have declared that they have no conflict of interest.