FEATURE
cient for diagnosis. However, in the presence of a strong suggestive
history of food allergy, these can confirm the diagnosis without
further need for an oral food challenge. Despite recent advances in
diagnostic testing and food challenges, there is still no correlation
with severity of food allergy reactions. 5
It is not uncommon for patients to seek other non-validated types
of testing to investigate possible food allergy. Unconventional testing
for adverse reactions to foods include tests such as flow cytometry,
measurement of serum IgG or IgG4 antibodies directed against
foods, intradermal provocation-neutralization with food allergens,
hair analysis, electrodermal testing and applied kinesiology. These
tests lack scientific evidence supporting their validity, and there is
potential harm to patients from using such techniques for ruling
in or out food allergy. 7
Currently, there is no FDA approved therapy for food allergy.
However, in the past decade, several routes of immunotherapy have
been evaluated for food allergy. These include oral immunother-
apy (OIT), sublingual immunotherapy (SLIT), and epicutaneous
immunotherapy (EPIT). All approaches to date are successful to
variable degrees in achieving desensitization, defined as increased
threshold for reaction to the food allergen, with regular exposure to
the allergen. None of these experimental therapies have been shown
to lead to permanent tolerance or cure, defined as the absence of
symptoms after ingestion of the food allergen ad libidum (at one’s
pleasure) after prolonged periods of avoidance. Safety is a major
concern, as anaphylaxis has been known to occur while on therapy.
Studies are still ongoing. 9
References
Standard-of-care for food allergy consists of food avoidance and
keeping rescue medications such as epinephrine readily availa ble
for emergency use. Physicians should counsel patients and patient
families on allergen avoidance for a variety of settings including
home, school and travel. At home, care is needed during food
preparation to avoid cross-contact of allergen with safe foods. In-
formation about obtaining safe packaged foods by careful reading
of food labels should be discussed. 5 1. Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pon-
gracic, et al. The prevalence, severity, and distribution of child-
hood food allergy in the United States. Pediatrics 2011;128:e9-17.
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3. Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US
prevalence of self-reported peanut, tree nut, and sesame allergy:
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While food allergen avoidance is the key to prevent a food re-
action, patients should be educated to recognize the symptoms of
food-induced anaphylaxis. Emphasis should be placed on prompt
awareness of anaphylaxis and swift intervention. Epinephrine is the
first-line and only approved therapy for the treatment of anaphylaxis.
Epinephrine autoinjectors (EAI) are the recommended method for
self-administration by patients. Currently, EAIs are available in three
different devices in three different doses. Dosing decisions should be
made by patient weight. Patients greater than or equal to 30 kg (66
lbs) should be prescribed a 0.3 mg EAI, patients 15 to 30 kg (33 to
66 lbs) 0.15 mg EAI, and patients 7.5 to 15 kg (16.5 to 33 lbs) a 0.1
mg EAI. There is NO contraindication for the use of epinephrine in
treating anaphylaxis, even in adult patients with cardiac histories.
The delay of epinephrine administration is known to increase the
risk for severe anaphylaxis and death. 4. Dyer AA, Lau CH, Smith TL, Smith BM, Gupta RS. Pediatric
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Wood, R.A. et al. Guidelines for the diagnosis and management of
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expert panel. (IV)J Allergy Clin Immunol. 2010; 126: S1–S58.
6. Gupta, R., Holdford, D., Bilaver, L., Dyer, A., Holl, J.L., and
Meltzer, D. The economic impact of childhood food allergy in
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Due to the alarming increased incidence of food allergy, studies
have investigated ways to prevent food allergies. Over the past several
decades, there has been an emphasis on delayed introduction of al-
lergic foods. Despite delayed introduction, data suggests an increase
in the rate of clinical food allergy while the rate of sensitization has
remained largely unchanged. In the Learning Early About Peanut
(LEAP) study, where infants were randomized to early or delayed
peanut introduction, rates of IgE sensitization were unchanged
between the groups, despite the nearly 90 percent reduction in true
peanut allergy with early introduction. New guidelines recommend-
ing the introduction of allergenic foods earlier will hopefully reduce
the rate of clinically significant food allergy and may reverse trends
seen over the past few decades. 8 9. Rachid R, Keet C. Current status and unanswered questions for
food allergy treatments. J Allergy Clin Immunol Pract 2018;6:377-
82.
Disclosures:
Dr. Wes Sublett is the Director of Clinical Research at Family Allergy &
Asthma. No funding was received for the writing or publication of this
article. J W Sublett has the following financial relationships which may
be related to this article: Aimmune Therapeutics, DBV Technologies,
Kaleo Pharmaceuticals, Mylan, Novartis, Sanofi.
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