Food Allergy – Guidelines for the Diagnosis and Management of Food Allergy

The Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary for Patients, Families, and Cargivers summarizes the most important information from the Guidelines and provides a starting point for patient-doctor conversations about food allergy. We hope that this information will empower patients, families, and caregivers with the knowledge they need to manage the disorder and, in turn, experience a better quality of life.

Why You Need To Know About the Food Allergy Guidelines

Approximately 1 in 20 children and about one in 25 adults have a food allergy. If you have a food allergy, then the more you know and understand about the disease and its diagnosis and management, the better you will be able to discuss your care with your doctor.

The Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-sponsored Expert Panel is a report developed by a 25-member expert panel to help healthcare professionals, including family practice physicians, medical specialists, and nurses, to better care for their patients with food allergy. The guidelines are based on the most up-to-date scientific and clinical information about food allergy and the consensus expert opinion of the panel members.

Make sure your doctor knows that the guidelines are available so you can work together to manage your food allergy effectively.


The Food Allergy Guidelines—What They Tell Your Doctor

The guidelines were developed for healthcare professionals. In addition to important background information about food allergy, the guidelines contain 43 clinical recommendations that can help your doctor determine whether you have food allergy and if you do, then customize your care.

The guidelines provide the following information:

  • Definitions of food allergy and disorders associated with food allergy
  • Descriptions of the development of food allergy and conditions associated with food allergy
  • Recommendations on
    • How to diagnose food allergy and what tests to use
    • How to manage non-life-threatening allergic reactions
    • How to diagnose and manage potentially life-threatening food-induced anaphylaxis and other acute reactions


Digging Deeper—What’s in the Guidelines for You?


The guidelines define food, food allergy, food allergens, and specific allergic conditions associated with food. The guidelines also provide information to enable your doctor to distinguish food allergy from food intolerance (read about the difference between these two conditions below).


Common food allergens

In the United States, the most common food allergens are egg, milk, peanut, tree nuts, wheat, crustacean shellfish, fish, and soy.


How food allergy develops

Food allergy is more common in children than in adults.

Most children will outgrow allergies to milk, egg, soy, and wheat. Allergies to peanut or tree nuts are often lifelong. A food allergy that starts in adulthood, such as an allergy to shellfish, also tends to be lifelong.

Food allergy often co-exists with other diseases, such as asthma, eczema (atopic dermatitis), and eosinophilic esophagitis. If your family has a history of allergy and you have eczema, then you are at greater risk for having food allergy than someone who does not have these risk factors.

Because the severity of an allergic reaction to food is based on many factors, the severity of any future reaction cannot be accurately predicted by the severity of a past reaction.


Diagnosing food allergy and which tests are used

If you have had an adverse reaction to a food, see a doctor who can evaluate whether you have a food allergy. Although you may think that your reaction is caused by an allergic response to a food, only your doctor can determine whether this is true.

The guidelines recommend that your doctor first takes your detailed medical history and then performs a physical examination. If a diagnosis of food allergy seems likely, there are tests―?such as the skin prick test or a blood test that detects allergen-specific antibodies―?that will help identify the possible allergenic foods. However, these approaches cannot conclusively diagnose a food allergy.

The only test that definitively proves whether you have a food allergy is an oral food challenge. Because having this test can place you at risk for a severe allergic reaction, it must always be performed by a healthcare professional who has the appropriate experience and resources to perform this test.


Ways to manage your food allergy after a diagnosis

Is there a cure for food allergy? Not yet. The only way to prevent a reaction to a food is to avoid the allergenic food.

The guidelines suggest that you read food labels carefully.

If you have a child with food allergy, the guidelines suggest seeking nutritional counseling.

Remember, because some allergies can be outgrown, you should be re-tested periodically to see whether you are still allergic.


Anaphylaxis and foods most likely to cause it

Anaphylaxis is a serious allergic reaction that is rapid in onset and may result in death.

Anaphylaxis can have many symptoms and affect different parts of the body. As a result, it is under-recognized and under-treated.

The most common trigger foods for anaphylaxis are peanut, tree nuts, milk, egg, fish, and crustacean shellfish.

To reduce the risk of anaphylaxis, it is essential that you avoid your specific trigger food.


What to do if you are experiencing anaphylaxis

The guidelines recommend that if you are experiencing anaphylaxis, or even suspect that you are, immediately take epinephrine and seek immediate medical attention by calling 9-1-1. Delaying epinephrine use places you at significantly increased risk for a life-threatening reaction.


Be prepared—have an emergency plan in case you experience anaphylaxis

If a doctor has told you that you have had anaphylaxis, the guidelines recommend that you and your doctor develop an anaphylaxis emergency plan so that you can be prepared in case it happens again. For example, always carry epinephrine with you in a self-injectable form.


Food Allergy

Is it Food Allergy or Food Intolerance?

  • Food allergy is sometimes confused with food intolerance

Lactose intolerance
Lactose is a sugar found in milk and most milk products.Lactase is an enzyme in the lining of the gut that breaks down or digests lactose. Lactose intolerance occurs when lactase is missing. Instead of the enzyme breaking down the sugar, bacteria in the gut break it down, which forms gas, which in turn causes symptoms of bloating, abdominal pain, and sometimes diarrhea.

Lactose intolerance is uncommon in babies and young children under the age of 5 years. Because lactase levels decline as people get older, lactose intolerance becomes more common with age. Lactose intolerance also varies widely based on racial and ethnic background.

Your healthcare professional can use laboratory tests to find out whether your body can digest lactose.

Food additives
Another type of food intolerance is a reaction to certain products that are added to food to enhance taste, add color, or protect against the growth of microbes. Compounds such as monosodium glutamate (MSG) and sulfites are tied to reactions that can be confused with food allergy.

  • MSG is a flavor enhancer. When taken in large amounts, it can cause some of the following:
  • Flushing
    • Sensations of warmth
    • Headache
    • Chest discomfort

      These passing reactions occur rapidly after eating large amounts of food to which MSG has been added.

  • Sulfites are found in food for several reasons:
    • They have been added to increase crispness or prevent mold growth.
    • They occur naturally in the food.
    • They have been generated during the winemaking process.
      Sulfites can cause breathing problems in people with asthma.

      The FDA has banned sulfites as spray-on preservatives for fresh fruits and vegetables. When sulfites are present in foods, they are listed on ingredient labels.

Gluten intolerance
Gluten is a part of wheat, barley, and rye. Gluten intolerance is associated with celiac disease, also called gluten-sensitive enteropathy. This disease develops when the immune system responds abnormally to gluten. This abnormal response does not involve IgE antibody and is not considered a food allergy.

Food poisoning
Some of the symptoms of food allergy, such as abdominal cramping, are common to food poisoning. However, food poisoning is caused by microbes, such as bacteria, and bacterial products, such as toxins, that can contaminate meats and dairy products.

Histamine toxicity
Fish, such as tuna and mackerel that are not refrigerated properly and become contaminated by bacteria, may contain very high levels of histamine. A person who eats such fish may show symptoms that are similar to food allergy. However, this reaction is not a true allergic reaction. Instead, the reaction is called histamine toxicity or scombroid food poisoning.

Other conditions
Several other conditions, such as ulcers and cancers of the gastrointestinal (GI) tract, cause some of the same symptoms as food allergy. These symptoms, which include vomiting, diarrhea, and cramping abdominal pain, become worse when you eat.


Click Here to Download PDF copy of the Guidelines Summary for Patients, Families, and Caregivers

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