Finding A Path To Safety In Food Allergy- a Summation of a review

Critical Issues in Food Allergy- Summarizing a review.

Recently, the National Academies of Sciences, Engineering, and Medicine hosted an effort to look at key issues surrounding the public health problem of food allergy. A report, ‘Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy’ was created.

A very nice summation of this work appeared in the journal Pediatrics written by Scott Sicherer, Katrina Allen, Gideon Lack, Steve Taylor, Sharon Donovan, and Maria Oria.

Key points from the review;

  1. Food Allergy involves an immune response and is one of many ways a food can cause a problem.
  2. The true prevalence of food allergy is not known. Best estimates are 1-10% of the population.
  3. Many foods can cause an allergic reaction however the most common responsible for the most serious reactions are cow’s milk, hen’s egg, peanut, tree nuts, and seafood.
  4. It was recommended that physicians use evidence-based standardized procedures as the basis for food allergy diagnosis and avoid Nonstandardized and unproven procedures.
  5. When food allergy is suspected, the patient should be evaluated by someone who has the training and experience to select and interpret appropriate diagnostic tests.
  6. Note the misconception and misunderstanding of widely available tests for food allergy- do not equate a positive skin test or blood test result as having an allergy to the food. These tests ONLY detect IgE antibody. These tests are not intrinsically diagnostic of a food allergy.
  7. The medical history is the key to the diagnosis. Food allergy should be considered when allergic symptoms occur within minutes to hours after the ingestion of a specific food, especially when they have occurred more than once.
  8. Large skin test response or elevated specific IgE levels correlate with higher risks of allergy, but sensitivity and specificity of these tests are often inadequate to confirm a diagnosis.
  9. The oral food challenge, especially when done in a double-blind fashion, is the gold standard for the diagnosis.
  10. Additional tests were not recommended and were considered unproven or non-standardized tests for food allergy include;
    • Allergen specific IgG, IgG4, or IgA
    • Provocation neutralization
    • Immune complexes
    • Human leukocyte antigen screening
    • Lymphocyte stimulation
    • Facial thermography
    • Gastric juice analysis
    • Endoscopic allergen provocation
    • Hair analysis
    • Applied kinesiology
    • Cytotoxic assays
    • Electrodermal testing
    • Mediator release assays
    • Bioresonance
    • Iridology
  11. Since sensitization alone is not diagnostic of allergy, panels of food tests should not be ordered without a rationale.
  12. Early introduction may help prevent the development of food allergy.
  13. There is limited evidence to support or discourage eliminating allergenic foods from the diet of pregnant or lactating women.
  14. Studies on the effects of partially or extensively hydrolyzed infant formulas for preventing food allergy are inconsistent and have flaws in the methods with which they were performed.
  15. Studies on the use of pre or pro biotics also have limits due to the methods used leading to the conclusion that there is no evidence to their use to decrease the risk of a food allergy.
  16. Emergency management focuses on recognition of a situation and the prompt use of epinephrine.
  17. Nutritional monitoring for children with food allergy is a major emphasis.
  18. Attention to the psychosocial part of food allergy is a major emphasis.
  19. The needs to be a major awareness campaign to dispel the myths and misconceptions regarding food allergy.
  20. Food labels need to more helpful and definitive.
  21. Schools and early child care facilities need to be included in efforts to better manage food allergy.
  22. Research needs
    • Determine the actual prevalence of food allergy
    • What is the cost of food allergy?
    • Diagnosis and prognosis
    • Risk factors
    • Prevention
    • Management in health care settings, food establishments, schools, and travel
    • Curative therapies
    • Best modalities for family and physician education about management.
    • Look to barriers to proper testing
    • Educational approaches
  23. Six Major Actions to Achieve Food Allergy Safety
    • Better information on prevalence which in turn is critical to knowing the scope of the problem
    • Improve the quality of diagnosis and provide evidence-based care
    • Evidence-based prevention strategies
    • Improved education and training to recognize, manage, and prevent reactions
    • Develop policies and related practices to help prevent and treat severe reactions
    • Most critical- address research priorities regarding diagnosis, mechanisms, risk determinants,and management. Identifying safe and effective therapies as the ultimate goal.

 

The original work was very detailed. The Consensus report whittles the details down to key learning points. My summary of the summary is intended for the reader to look further into this.

We have a FARE Center of Clinical Excellence and we have an active FARE Community Engagement Council. There are many action points here wanting for solutions. We are looking for help to make a difference.

FEL 7/25/2017

July 27, 2017 · fleickly · No Comments
Posted in: Uncategorized

Leave a Reply

You must be logged in to post a comment.