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Food for Thought

What You Need to Know about the New Food Allergy Guidelines

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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 better care for people 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. 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.

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 allergy from food intolerance.

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

If you have had an adverse reaction to a food, see a doctor who can evaluate whether you have a food allergy.

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, 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. It 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.


Source: National Institute of Allergy and Infectious Diseases,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2011.