The National Institute of Allergy and Infectious Diseases (NIAID) in 2010 released the first comprehensive food allergy guidelines for allergists, general practitioners and emergency physicians. The guidelines offer expert recommendations on how to diagnose, treat and manage food allergies, including anaphylaxis.
On a media call in December 2010, two experts discussed how the need for the food allergy guidelines arose out of evidence that not all children and adults are being diagnosed using the same protocols.
The allergy guidelines aim to clear up confusion on several issues, such as what medications to use during an anaphylactic reaction. While antihistamines are still often used as the first line of defence, the experts stress that epinephrine should be the first medication administered.
The guidelines discuss the efficacy of different food allergy testing such as the skin prick test, blood test and the gold standard: the oral food challenge.
Allergy Guidelines: Avoid Over-Avoidance
Dr. Hugh Sampson of Mount Sinai’s School of Medicine, one of two experts on the media call, stressed that he and other allergists are seeing too many children “who are put on very highly restrictive diets” and then, when tested or challenged, these children are often found not to be allergic.
Sampson explains there has been a lot of confusion between sensitization – meaning a person may produce some IgE allergy antibodies to a food – and clinical reactivity. The latter indicates a person is truly allergic.
The new allergy guidelines show that diagnosis of food allergy is not just about one skin or blood test. A history of symptoms is also important and, in some cases an oral challenge, may be done. (This involves having the patient eat the food in question, starting with a tiny amount.)
Oral challenges do carry the risk of anaphylaxis for the patient and are time-consuming for the doctor and the patient. However, Dr. Sampson and his colleague Dr. Matthew Fenton of NIAID expressed hope that the guidelines would result in more of these definitive tests. The guidelines, of course, explain the circumstances under which a doctor should be recommending an oral challenge.