Going Gluten-FreeDecember 6, 2010

New NIH Guidelines for Food Allergies Released

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:

http://www.jacionline.org/article/S0091-6749(10)01566-6/abstract

The NIH has also issued a news brief on these guidelines that can be found at:

http://www.niaid.nih.gov/topics/foodAllergy/clinical/Pages/patients.aspx

 

 

Comments (13)

I could call myself lucky or unlucky. I was born with allergies to wheat and cow's milk. Along the way I picked up sodium due to the leaky gut syndrome caused by Celiac Disease. Knowing there is the beginning of a comprehensive diagnostic tool for all food allergies and interances makes it much easier for those in the future having to deal with a child with possible allergies, or an adult who finally connects the dots and realizes that they aren't supposed to feel this bad, it's your body's way of saying Yuck, I don't like this! If I had been listening to my body I would have realized the mouth full of mucous when I drank milk, the foot odor when I ate wheat, the constipation and infertility when I ate wheat, the headache when I drank milk were all ways my immune system was saying Intruder Alert! Intruder Alert!

Posted by: Unknown | December 8, 2010 11:05 PM    Report this comment

Perhaps these guidelines will cause more laboratories to become certified to do the allergen testing that is recommended by Dr. Wangen in his book, "The IBS Solution". Currently there is only one lab, Biotek, in Seattle, WA that is accredited to perform the test because their results are accurate 90+% of the time.

If the guidelines exist that tell doctors (and insurance companies) how to diagnose allergies and this test is specifically recommended then doctors will order it, labs will have to get accredited and insurance companies will be forced to start paying for the test as they are recommended and are now part of the "Standard of Care". Once you get Medicare to admit that the test meets the "Standard of Care" criterion, they will have to start paying for it and the other companies do as Medicare does.

We, as allergic medical consumers, need to push our physicians and specialists to order the test and send it to Biotek. When labs lose the business because of lack of accreditation, they will get accredited and then they too will push the insurance companies to pay for the tests.

The test takes the immunoglobulin and exposes it to the top 100 allergens in the US, the results show a bar graph that shows not only if you are responding, but how severely you are responding to each of the 100 items. There is no fasting, no requisite exposure to the allergen or anything special for the patient to do except get a blood draw at their doctors office. The doctor needs only order the test and have the blood sent to the lab.

The lab does the work and it is crucial that they do it accurately and with every protocol followed to the letter as even a slight deviation can create false readings. It is a tricky business, and that is why only one lab is completely accredited in the US (at least only one that I can find).

Posted by: BLLM | December 8, 2010 12:24 PM    Report this comment

MJL December 7, 2010 skin prick tests show that I am not allergic to anything!!!!! I was diagnosed officially with celiac disease in 2006. I am now 75 and went 71 years undiagnosed.....Dermatitis herpetiformis has been my only symptom for those 70+ years.I have multiple food allergies which I have found on my own because no allergy specialist will order the blood tests to determine my food allergies or sensitivities. Some food sensitivities I know for sure like milk products but others I am not sure. If these guidelines influence how a person is diagnosed I am all for them . If not then they are worthless. I follow a gluten/dairy free diet as strictly as possible and read, read, read about gluten/dairy free lifestyle. When the symptoms are life threatening, attention is paid to person, otherwise you are on your own is my experience. what a shame!!!!!

Posted by: Maryjane l | December 7, 2010 1:06 PM    Report this comment

After nearly 30 years in primary health care, I am continually dismayed but no longer surprised at short-sighted recommendations coming from panels of "experts". These recommendations are usually a couple of decades behind the cutting edge and generally not useful in clinical practice. Note the recent Vitamin D recommendations by the Institute of Medicine. As was pointed out by another commenter, no mention is made of IgA or IgG responses. Some recent studies that measure gluten-related nitric oxide levels in the intestines show and acute response peak in 15 hours, not 15 seconds. In the case of auto-immune triggers, the effects might not be noted for 30 years. It is best to work with a clinician who gets results than listen to a committee.

Posted by: Daniel S | December 7, 2010 11:03 AM    Report this comment

I often see this statement that some allergies aren't really allergies and, anyway, children will "grow out of" them. I think what happens instead is that the reaction becomes less severe. I was told I had outgrown my allergies to egg and dairy and had been consuming them for 40+ years, (years that I was constantly and chronically ill) until at almost 100 pounds (I'm 5'7") I took my health into my own hands and had the prick test. Both egg and dairy (amongst other foods) were shown, again, as something I reacted strongly to. I have been avoiding these foods for almost 9 years and I am now healthy as a horse. Western medicine ignores subtlety and focuses only on extreme reactions. The subtle reactions might not need the epi-pen but chip away at the immune system compromising the very core of ones health and quality of life. There are many foods that contain the nutrients missing in eggs and dairy and other foods so the argument that one's diet becomes too restrictive is nonsense. If our doctors and dietitians would think a bit more outside of the box perhaps this argument of allergy versus sensitivity wouldn't even be an issue.

Posted by: Mary B | December 7, 2010 6:28 AM    Report this comment

I am seconding the comment above about Leaky Gut Syndrome. While still gluten-intolerant/celiac, all of my other food sensitivities have resolved after healing my gut using appropriate supplements. Check it out.

Posted by: pickle | December 6, 2010 6:39 PM    Report this comment

One more metabolic response I'd like to add to the above comment, is Leaky Gut Syndrome, which can be the cause of many food sensitivities. If you heal the gut many of one's food sensitivites will also be healed.

Posted by: Unknown | December 6, 2010 5:13 PM    Report this comment

Allergy Associates of La Crosse (www.lacrosseallergy.com) has been safely and successfully treating patients for more than 40 years with sublingual immunotherapy. Please consider that many studies, both European and US based are showing that success. See the web link above to get reference links to those studies and their treatment approach.

Both my daughters have been successfully treated for inhalent and food allergies at AAOL!

Posted by: sarake | December 6, 2010 5:04 PM    Report this comment

I would have liked to have seen mention of eosinophlic diseases, better testing for (ie blood test instead of endoscopies). A better test to help diagnose foods, since prick and patch test often are inconclusive, especially on little ones would be wonderful. The research on this and help for parents is very limited. Of course I am glad to see progress!!

Posted by: Megan S | December 6, 2010 2:38 PM    Report this comment

I am hopeful that the general public will continue to become more aware of the differences in food reactions and sensitivities many individuals have. Two of our four children suffer from anaphylaxis and other severe symptoms related to several foods. Sadly, people still believe that lactose-free milk is a good substitute for someone with a true, anaphylactic milk allergy, that feeding animal crackers manufactured on the same line with peanut and tree nut products are ok to feed to peanut / tree nut allergic individuals, etc. We need more education and more specific information to be provided by doctors and caregivers to help assay some of the generalities many people cite when discussing food and our bodies' varied reactions to them. I believe this work is designed to help narrow down the definition of a true allergy in the sense of IgE responses such as airway issues, mouth/tongue/lip swelling, wheezing, hives, vomiting and, in severe cases, anaphylactic shock. This can help people better understand how to define / describe their food sensitivity without over-using a term that may not be accurate.

Posted by: SHERYL RIGBY | December 6, 2010 2:08 PM    Report this comment

It would be helpful to mention stress in these remarks as intolerance can lie dormant without it.

It would also be helpful to mention that many food intolerances in one individual has been rising over 10 and 20 years, not just across populations.

Posted by: Lynnette F | December 6, 2010 2:03 PM    Report this comment

None of the key points in the article above mention anything about IgG responses to foods, and that's a shame. Blood testing for these responses would help determine delayed immune reactions to various foods, etc. that wouldn't be found doing skin-prick/IgE testing.

Not everyone has an anaphylactic response to a food, however that doesn't mean people are not indeed having delayed - several days later - immune responses to certain foods. Nor does the article discuss metabolic responses to foods - ie gluten intolerance, lactose intolerance, etc. These can be just as distressing on the body, regardless of whether or not an immune response is present.

These issues should at least be a part of the conversation and something I would think (hope) Living Without would address in response to this latest NIH "research" that just came out.

Posted by: wondermama | December 6, 2010 1:47 PM    Report this comment

Doesn't seem to be anything new in this.

Posted by: Unknown | December 6, 2010 1:37 PM    Report this comment

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