Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report

Boyce, Joshua A., Assa'ad, Amal, Burks, A Wesley, Jones, Stacie M., Sampson, Hugh A., Wood, Robert A., Plaut, Marshall, Cooper, Susan F., Fenton, Matthew J., Arshad, S Hasan, Bahna, Sami L., Beck, Lisa A., Byrd-Bredbenner, Carol, Camargo, Carlos A., Eichenfield, Lawrence, Furuta, Glenn T., Hanifin, Jon M., Jones, Carol, Kraft, Monica, Levy, Bruce D., Lieberman, Phil, Luccioli, Stefano, McCall, Kathleen M., Schneider, Lynda C., Simon, Ronald A., Simons, F. Estelle R., Teach, Stephen J., Yawn, Barbara P. and Schwaninger, Julie M. (2011) Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report. Nutrition Research, 31 (1), 61-75. (doi:10.1016/j.nutres.2011.01.001). (PMID:21310308)

Abstract

1. Introduction

1.1. Overview
1.2. Relationship of the US Guidelines to other guidelines
1.3. How the Guidelines were developed

1.3.1. The Coordinating Committee
1.3.2. The Expert Panel
1.3.3. The independent, systematic literature review and report
1.3.4. Assessing the quality of the body of evidence
1.3.5. Preparation of the draft Guidelines and Expert Panel deliberations
1.3.6. Public comment period and draft Guidelines revision
1.4. Defining the strength of each clinical guideline
1.5. Summary
2. Definitions, prevalence, and epidemiology of food allergy

2.1. Definitions

2.1.1. Definitions of food allergy, food, and food allergens
2.1.2. Definitions of related terms
2.1.3. Definitions of specific food-induced allergic conditions
2.2. Prevalence and epidemiology of food allergy

2.2.1. Systematic reviews of the prevalence of food allergy
2.2.2. Prevalence of allergy to specific foods, food-induced anaphylaxis, and food allergy with comorbid conditions
3. Natural history of food allergy and associated disorders

3.1. Natural history of food allergy in children
3.2. Natural history of levels of allergen-specific IgE to foods in children
3.3. Natural history of food allergy in adults
3.4. Natural history of conditions that coexist with food allergy

3.4.1. Asthma
3.4.2. Atopic dermatitis
3.4.3. Eosinophilic esophagitis
3.4.4. Exercise-induced anaphylaxis
3.5. Risk factors for the development of food allergy
3.6. Risk factors for severity of allergic reactions to foods
3.7. Incidence, prevalence, and consequences of unintentional exposure to food allergens
4. Diagnosis of food allergy

4.1. When should food allergy be suspected?
4.2. Diagnosis of IgE-mediated food allergy

4.2.1. Medical history and physical examination
4.2.2. Methods to identify the causative food

4.2.2.1. Skin prick test
4.2.2.2. Intradermal tests
4.2.2.3. Total serum IgE
4.2.2.4. Allergen-specific serum IgE
4.2.2.5. Atopy patch test
4.2.2.6. Use of skin prick tests, sIgE tests, and atopy patch tests in combination
4.2.2.7. Food elimination diets
4.2.2.8. Oral food challenges
4.2.2.9. Nonstandardized and unproven procedures
4.3. Diagnosis of non-IgE-mediated immunologic adverse reactions to food

4.3.1. Eosinophilic gastrointestinal diseases
4.3.2. Food protein-induced enterocolitis syndrome
4.3.3. Food protein-induced allergic proctocolitis
4.3.4. Food protein-induced enteropathy syndrome
4.3.5. Allergic contact dermatitis
4.3.6. Systemic contact dermatitis
4.4. Diagnosis of IgE-mediated contact urticaria
5. Management of nonacute allergic reactions and prevention of food allergy

5.1. Management of individuals with food allergy

5.1.1. Dietary avoidance of specific allergens in IgE-mediated food allergy
5.1.2. Dietary avoidance of specific allergens in non-IgE-mediated food allergy
5.1.3. Effects of dietary avoidance on associated and comorbid conditions, such as atopic dermatitis, asthma, and eosinophilic esophagitis
5.1.4. Food avoidance and nutritional status
5.1.5. Food labeling in food allergy management
5.1.6. When to re-evaluate patients with food allergy
5.1.7. Pharmacologic intervention for the prevention of food-induced allergic reactions

5.1.7.1. IgE-mediated reactions
5.1.7.2. Non-IgE-mediated reactions
5.1.8. Pharmacologic intervention for the treatment of food-induced allergic reactions
5.1.9. Immunotherapy for food allergy management

5.1.9.1. Allergen-specific immunotherapy
5.1.9.2. Immunotherapy with cross-reactive allergens
5.1.10. Quality-of-life issues associated with food allergy
5.1.11. Vaccinations in patients with egg allergy

5.1.11.1. Measles, mumps, rubella, and varicella vaccine
5.1.11.2. Influenza vaccine
5.1.11.3. Yellow fever vaccine
5.1.11.4. Rabies vaccines
5.2. Management of individuals at risk for food allergy

5.2.1. Nonfood allergen avoidance in at-risk patients
5.2.2. Dietary avoidance of foods with cross-reactivities in at-risk patients
5.2.3. Testing of allergenic foods in patients at high risk prior to introduction
5.2.4. Testing in infants and children with persistent atopic dermatitis
5.3. Prevention of food allergy

5.3.1. Maternal diet during pregnancy and lactation
5.3.2. Breast-feeding
5.3.3. Special diets in infants and young children

5.3.3.1. Soy infant formula versus cow's milk formula
5.3.3.2. Hydrolyzed infant formulas versus cow's milk formula or breast-feeding
5.3.4. Timing of introduction of allergenic foods to infants
6. Diagnosis and management of food-induced anaphylaxis and other acute allergic reactions to foods

6.1. Definition of anaphylaxis
6.2. Diagnosis of acute, life-threatening, food-induced allergic reactions
6.3. Treatment of acute, life-threatening, food-induced allergic reactions

6.3.1. First-line and adjuvant treatment for food-induced anaphylaxis
6.3.2. Treatment of refractory anaphylaxis
6.3.3. Possible risks of acute therapy for anaphylaxis
6.3.4. Treatment to prevent biphasic or protracted food-induced allergic reactions
6.3.5. Management of milder, acute food-induced allergic reactions in health care settings
6.4. Management of food-induced anaphylaxis
Appendix A. Primary author affiliations and acknowledgments
Appendix B. List of abbreviations

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