February 16, 2011 Dr. Carla Davis, Allergy & Immunology Specialist

Guidelines For The Diagnosis And Treatment Of Food Allergies

In December 2010, the National Institute of Allergy and Infectious Diseases published guidelines for the diagnosis and treatment of food allergies. This report was developed by a 25-member expert panel to help health care professionals provide better care for patients with food allergy. It is important that patients work with their physicians to accurately diagnose and treat their food allergies according to these guidelines.
The key points from these guidelines are as follows:

1. Food allergies are not the same as food intolerance. Food intolerance includes celiac disease and other diseases, like lactose intolerance and food poisoning, which are not mediated by the immune system.
2. A small number of foods cause most allergies. In the United States, the most common food allergens include egg, milk, peanuts, tree nuts, wheat, crustacean shellfish, fish and soy.
3. Food allergies are more common in patients with other allergic diseases. Asthma, eczema and eosinophilic esophagitis can coexist in food allergic patients. 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 diseases.
4. Tests alone cannot accurately diagnose food allergy. It is important that your doctor take a medical history and perform a physical exam first before diagnosing food allergy. If the diagnosis is likely, blood or skin tests can be performed to help determine the likelihood of food allergy. These tests cannot conclusively diagnose food allergy, however. The most accurate way to diagnose food allergy is by giving the food very slowly and carefully in a doctor’s office setting prepared to treat an allergic reaction. This is called an oral challenge and should only be done in an experienced health care professional’s office with the resources to perform this test.
5. Anaphylaxis, a serious allergic reaction that is rapid in onset and may result in death, is under-diagnosed and under-treated. If you experience anaphylaxis, or even suspect that you are, immediately take epinephrine and seek medical attention by calling 9-1-1. Delaying epinephrine use significantly increases the risk of a life-threatening reaction.
6. There is no cure for food allergy. Food avoidance and use of an emergency medical plan is the best treatment for food allergy. You should work with your physician to develop an emergency medical plan which includes self-injectable epinephrine in the event of an accidental exposure. Food avoidance is best achieved by careful vigilance and knowing how to read food labels.

The above information is general in nature and not to be used as medical advice for specific cases. If you have a specific question, I recommend discussing this with your personal physician.