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New NIH Guidelines for Food Allergies Released
December 6, 2010
The National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, today released guidelines for defining, diagnosing and treating food allergies.
As common as food allergies are, there haven’t been uniform clinical guidelines on diagnosing and managing food allergies until now. Concern about widespread differences in how food allergies are diagnosed and managed led to the NIAID’s guideline project, a collaboration of 34 professional organizations, federal agencies and patient advocacy groups.
The guidelines were developed for healthcare professionals but they contain a number of key points of interest for those with food allergies.
- Sensitization to a particular food doesn’t necessarily translate into a true clinical food allergy. Blood (IgE) and skin prick tests can show that an individual has an antibody response to a food – that he or she is sensitized – but these tests don’t indicate whether or not this person will actually have symptoms when that food is ingested. The guidelines emphasize that physicians use a combination of medical history, physical examination, lab tests and, when appropriate, an oral food challenge, to diagnose food allergy. The goal is to nail down the specific allergen(s) so that the correct food allergy is treated and a patient’s diet is not unnecessarily restricted.
- Studies suggest a true rise in food allergy prevalence over the past 10 to 20 years. However, prevalence may be a “moving target.” Most children will outgrow milk, egg, soy and wheat allergies. Tree nut and peanut allergy are often life-long.
- Epinephrine is the first-line treatment in all cases of anaphylaxis.
- Those with a history of severe egg allergy should avoid egg-based vaccinations, like flu vaccine. However, as manufacturers continue to lower the amount of egg protein in vaccines, this recommendation may change.
- Foods with precautionary labeling, such as “this product may contain trace amounts of allergen,” should be avoided.
- Food allergy is associated with severe asthma.
- Immunotherapy (oral and sublingual) to treat food allergy is showing promise but is not yet ready for clinical use. Too many questions about safety and efficacy remain.
- Avoiding potentially allergic foods during pregnancy or breastfeeding isn’t necessary for food allergy prevention. However, exclusive breast-feeding in the first 4 to 6 months of life is recommended.
The guidelines are designed to be a resource to assist health care professionals; they may not be appropriate in all cases. However, it’s hoped that the guidelines will help standardize care and focus future food-allergy research.
A patient-friendly version of the guidelines is planned. For now, a summary of the guidelines can be found at:
The NIH has also issued a news brief on these guidelines that can be found at: