Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary for Patients, Families and Caregivers

Guidelines for the Diagnosis and Management of Food Allergy in the United States:
Summary for Patients, Families, and Caregivers.

A publication by the National Institute of Allergy and Infectious Diseases
This publication was developed for patients, families and caregivers based from, The Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID Sponsored Expert Panel, released in December, 2010 and written to provide medical professionals with the most up-to-date clinical advice on how to care for patients with food allergy.    A panel of experts developed the Guidelines based on recent scientific publications of food allergy.   An outline of this document was covered in a previous post here: https://www.facebook.com/home.php?sk=group_152247234817293&view=doc&id=209191925789490#!/note.php?note_id=188609647818519
One of the most important pieces taken from The Summary for Patients, Families and Caregivers coincides with the PIC Foundation mission.   Found in the introduction (page 5) “summarizes the most important information from The Guidelines and provides a starting point for patient-doctor conversation about food allergy….to empower patients, families, and caregivers with the knowledge they need to manage the disorder and, in turn, experience a better quality of life”.
Key points from this publication specific to Non-IgE- mediated food allergy are:
Introduction:

• The Guidelines include definitions of food allergy and related disorders, with recommendations for diagnosis and management.

Food Allergy Prevalence and Associated Disorders:

• Defines Food Allergy “an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.”
• Definition of Food Allergen, “parts of a food or ingredients within a food (usually protein) that are recognized by immune cells”.  It goes on to clarify that most food allergens cause reactions even after they have been cooked or digested but that some allergens (most often fruits and vegetables) can cause allergic reactions only when eaten raw.  And oils (such as soy, corn, peanut, and sesame) may or may not cause an allergic reaction, depending on how it is processed.
• Defines IgE and Non-IgE.  “Non-IgE mediated- the symptoms are the result of interaction of the allergen with the immune system, but the interaction does not involve an IgE antibody”.
• Conditions that can occur with food allergy: “if someone has food allergy, he or she is more likely to have asthma, eczema, eosinophilic esophagitis (EoE), or exercise-induced anaphylaxis”.

Diagnosis of Food Allergy:

• Food allergic reactions may be IgE-mediated or Non-IgE-mediated, or both.  The chapter, on page 9 gives some guidelines for when your healthcare provider should consider food allergy diagnosis.
• Table A: Symptoms of Allergic reactions caused by food is on page 10.  You may notice similar language to the PIC article written for Non-IgE Food Allergy as The Guidelines are keys in our references for that information and table provided.
• “How should your healthcare professional diagnosis Non-IgE-mediated food allergy?” is covered on page 16.  Examples given: Eosinophilic GI diseases (EGID)- clarifying that EoE is a mixed IgE/Non-IgE-mediated disorder; Food Protein Induced Enterocolitis Syndrome (FPIES); Food Protein-Induced Allergic Proctocolitis (AP); Allergic contact dermatitis (ACD); and Systemic contact dermatitis.  The coinciding guidelines, within The Guidelines, is given with brief descriptions of these disorders here.
• Table C, on page 17, gives tests to diagnosis Non-IgE-mediated food allergy.

Management of Nonacute Allergic Reactions and Prevention of Food Allergy:

• Avoidance of the food allergen following diagnosis of IgE, Non-IgE, or food allergy in combination with eczema, allergy, or EoE, is the safest way for management of food allergy at this time.
• EoE, eczema, asthma may have influences not related to food allergy.
• Children diagnosed with food allergy should receive nutritional counseling, growth monitoring, and training on understanding ingredient lists.
• Know that there is a law, the U.S Food Allergen Labeling and Consumer Protection Act of 2004 that “requires food labels to list which of the eight major food allergens (milk, egg, peanut, tree nut, soy, wheat, fish, and crustacean shellfish) are present as ingredients in prepared foods.  However the law does not require or suggest wording for warning labels, such as “may contain trace amounts of nuts” or “may be prepared in a facility that also uses nuts”.  The inclusion of these warning labels is voluntary.
• There are currently no medications available to prevent and treat allergic reactions caused by foods.   Oral immunotherapy is currently being studied.  There are active clinical trials: http://www.clinicaltrials.gov
• Recommendations, including a helpful table, for vaccines and egg allergy on page 20-21.
• Discussions on prevention of food allergy on pages 22-24.

 Diagnosis and Management of Anaphylaxis Caused by Food

• Symptoms and treatment of anaphylaxis (IgE) allergy, including a Sample Anaphylaxis Emergency Action Plan

Glossary

• Listed on page 30 gives a glossary for the many terms used in this summary that may be new to the reader.

It should be noted that the Guidelines for medical professionals are “a resource to guide clinical practice and to help develop educational materials for patients, their families, caregivers and the public.  They do not override your doctor’s responsibility to make decisions appropriate to your circumstances”.
  
The Summary for Patients, Families and Caregivers can be viewed at the website below, and printed or you can request a copy to be mailed from NIAID.  I strongly suggest you read it and incorporate its goals of empowering you with the knowledge you need to manage food allergy for your family, in your doctor’s office, and in your home.   It is great progress to see these key points of Non-IgE allergy being recognized and discussed as important in the diagnosis of food allergy for our children.
The Guidelines for the Diagnosis and Management of Food Allergy in the United States can be found at: http://www.niaid.nih.gov/topics/foodallergy/clinical
The Summary for Patients, Families and Caregivers can be found at:  http://www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAguidelinesPatient.pdf