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From:
Pamela Morrison <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 7 Dec 2010 21:25:17 +0000
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Of interest to many of us, I think?

Pamela Morrison IBCLC
Rustington, England
-----------------
Medscape

NIAID Releases First Guidelines for Managing Food Allergies
Emma Hitt, PhD

December 6, 2010 — The first food allergy 
guidelines were issued today by the National 
Institutes of Health's National Institute of 
Allergy and Infectious Diseases (NIAID).

According to the new guidelines, avoiding the 
ingestion of specific allergens is the main 
strategy suggested for managing food allergies, 
and no medications are currently recommended.

Developed over 2 years, the guidelines are 
intended for use by both family practice 
physicians and medical specialists and were 
published online today by the Journal of Allergy 
and Clinical Immunology. The full text of the 
guidelines are now available on the NIAID Web site.

Joshua A. Boyce, MD, from the Division of 
Rheumatology, Immunology and Allergy at Brigham 
and Women's Hospital in Boston, Massachusetts, 
chaired the 19-member panel of experts that 
devised the new guidelines. The NIAID also 
established a coordinating committee with members 
from 34 professional organizations, advocacy groups, and federal agencies.

"These guidelines are an important starting point 
toward a goal of a more cogent, evidence-based 
approach to the diagnosis and management of food 
allergy," Dr. Boyce said in an NIAID news 
release. "We believe that they provide healthcare 
professionals with a clear-cut definition of what 
constitutes a food allergy and a logical 
framework for the appropriate use of diagnostic 
testing and accurate interpretation of the results."

The guidelines, which include 43 clinical 
recommendations, discuss both IgE-mediated 
reactions to food and some non-IgE-mediated 
reactions. The panel defines food allergy as "an 
adverse health effect arising from a specific 
immune response that occurs reproducibly on exposure to a given food."

Food Allergies Increasing in US

The natural history of the most common food 
allergens in the United States — including egg, 
milk, peanut, tree nuts, wheat, crustacean 
shellfish, and soy — was reviewed and summarized. 
The incidence and prevalence of food allergies 
were found to have possibly changed over time, 
with many studies suggesting a true increase in 
prevalence over the last 10 to 20 years.

According to the literature summary in the new 
guidelines, most children with allergies to milk, 
egg, soy, and wheat will eventually be able to 
tolerate these allergens, while tree nut and 
peanut allergies are less likely to resolve with 
time. Likewise, food allergies that begin in adulthood are likely to persist.

The guidelines also note that food allergies tend 
to coexist with asthma, atopic dermatitis, 
eosinophilic esophagitis, and exercise-induced 
asthma. Eliminating food allergens can improve 
symptoms of some of these comorbid conditions.

Guidelines Recommend Confirmation of Allergies

The guidelines also describe conditions that 
should raise clinical suspicion of food 
allergies. In addition, they suggest that food 
allergies should be confirmed, because studies 
indicate that 50% to 90% of presumed food 
allergies are, in fact, not allergies.

The new guidelines will help physicians to know 
which tests have been scientifically evaluated to 
diagnose food allergy. Matthew Fenton, PhD, with 
the NIAID, explained at a press conference held 
Friday regarding the new guidelines.

"The guidelines have indicated what the strengths 
and weaknesses are of the different tests that 
can be used for the diagnosis," said Hugh 
Sampson, MD, with the Mount Sinai School of 
Medicine in New York City. After a patient 
history, skin and blood tests, "the oral food 
challenge is the only way to get to the answer," he added.

Vaccines in Egg-Allergic Populations

The guidelines also suggest that patients 
allergic to eggs should receive the measles, 
mumps, and rubella vaccine despite it being 
egg-based. Administering the egg-based yellow 
fever and rabies vaccines to these patients was 
not supported by a summary of the literature, and 
insufficient evidence was found to recommend the 
egg-based influenza vaccine for these patients.

"These vaccines can be quite safe in egg-allergic 
populations," Dr. Fenton said, "probably in part 
due to a continued lowering of the amount of 
contaminating egg protein in the vaccine, as 
manufacturing methods continue to improve over time."

The panel defines patients at risk for developing 
food allergies as "those with a biological parent 
or sibling with existing, or history of, allergic 
rhinitis, asthma, atopic dermatitis, or food 
allergy." However, these patients do not need to 
limit exposure to foods that may be 
cross-reactive with the most common food allergens.

Delaying of Foods Not Warranted

The guidelines do not recommend restricting 
maternal diet during pregnancy or lactation to 
prevent the development or clinical course of 
food allergies, but they do recommend exclusive 
breast-feeding of all infants until age 4 to 6 
months, unless medical reasons contraindicate breast-feeding.

According to Dr. Sampson, the guidelines concur 
with current American Academy of Pediatrics 
guidelines. "There is no evidence that delaying 
certain foods, even foods that are considered 
allergenic, (is) going to have any significant 
effect on the development of allergy," he said.

Epinephrine the First Choice for Anaphylaxis

The recommended therapy for anaphylaxis is 
described in the guidelines. Dr. Sampson stressed 
that "epinephrine is the first choice for the 
treatment of anaphylaxis and many of the other 
drugs, such as antihistamines, corticosteroids, 
and such, are secondary medications."

"The food allergy guidelines provide a rigorous 
assessment of the state of the science, and 
clearly identify the areas where evidence is 
lacking and where research needs to be pursued," 
Daniel Rotrosen, MD, director of the Division of 
Allergy, Immunology and Transplantation at NIAID, 
said in the news release. "This information will 
help shape our research agenda for the near future."

Dr. Boyce serves on the advisory board of 
GlaxoSmithKline, has served as a consultant 
and/or speaker for Altana, GlaxoSmithKline, and 
Merck, and has received funding and grant support 
from the National Institutes of Health.

             ***********************************************

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