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Acute and long-term management of food allergy: systematic review

Acute and long-term management of food allergy: systematic review
Acute and long-term management of food allergy: systematic review
BACKGROUND: Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts.

METHODS: Seven bibliographic databases were searched from their inception to September 30, 2012, for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-and-after and interrupted time series studies. Experts were consulted for additional studies. There was no language or geographic restrictions. Two reviewers critically appraised the studies using the appropriate tools. Data were not suitable for meta-analysis due to heterogeneity so were narratively synthesized.

RESULTS: Eighty-four studies were included, but two-thirds were at high risk of potential bias. There was little evidence about acute management for non-life-threatening reactions. H1-antihistamines may be of benefit, but this evidence was in part derived from studies on those with cross-reactive birch pollen allergy. Regarding long-term management, avoiding the allergenic food or substituting an alternative was commonly recommended, but apart from for infants with cow's milk allergy, there was little high-quality research on this management approach. To reduce symptoms in children with cow's milk allergy, there was evidence to recommend alternatives such as extensively hydrolyzed formula. Supplements such as probiotics have not proved helpful, but allergen-specific immunotherapy may be disease modifying and therefore warrants further exploration.

CONCLUSIONS: Food allergy can be debilitating and affects a significant number of people. However, the evidence base about acute and longer-term management is weak and needs to be strengthened as a matter of priority.
acute management, food allergy, long-term management, systematic review
0105-4538
159-167
de Silva, D.
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Geromi, M.
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Panesar, S.S.
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Muraro, A.
31a2d167-86e1-4e11-87ad-6ffb7e32cd47
Werfel, T.
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Hoffmann-Sommergruber, K.
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Roberts, G.
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Cardona, V.
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Dubois, A.E.J.
bf063b50-7bd4-4bdf-9d31-16a6e743762e
Halken, S.
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Host, A.
1b863d1d-cd23-438e-8a37-a20e2dea0e73
Poulsen, L.K.
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Van Ree, R.
4100f8ce-ece6-4ab0-9a4f-e0e862ef078d
Vlieg-Boerstra, B.J.
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Agache, I.
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Sheikh, A.
f34621ac-f425-42fd-81e3-2057b1c9ce2f
de Silva, D.
aef581f3-ada5-4cba-8c6c-84ae0b2f2b17
Geromi, M.
af9fa604-5d5a-4265-8213-d69212cf1edf
Panesar, S.S.
2a52528f-b993-4fd0-9c4b-8d48716d262c
Muraro, A.
31a2d167-86e1-4e11-87ad-6ffb7e32cd47
Werfel, T.
257ddb96-94d9-4ed3-8fbf-7b490e3f9efa
Hoffmann-Sommergruber, K.
7b282387-19b5-4d07-bac8-1679f25197b7
Roberts, G.
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Cardona, V.
32f38d87-4966-4042-85d2-cb6548dc50ed
Dubois, A.E.J.
bf063b50-7bd4-4bdf-9d31-16a6e743762e
Halken, S.
6204ce6f-7b6e-4041-9da2-a5f250467fbb
Host, A.
1b863d1d-cd23-438e-8a37-a20e2dea0e73
Poulsen, L.K.
aa64f94a-6059-4bb3-aab0-6103612ebfeb
Van Ree, R.
4100f8ce-ece6-4ab0-9a4f-e0e862ef078d
Vlieg-Boerstra, B.J.
dc35ae65-880f-4788-b193-d4001acd1446
Agache, I.
2c1d12ef-a70a-4395-a5d7-fe3a657044bb
Sheikh, A.
f34621ac-f425-42fd-81e3-2057b1c9ce2f

de Silva, D., Geromi, M., Panesar, S.S., Muraro, A., Werfel, T., Hoffmann-Sommergruber, K., Roberts, G., Cardona, V., Dubois, A.E.J., Halken, S., Host, A., Poulsen, L.K., Van Ree, R., Vlieg-Boerstra, B.J., Agache, I. and Sheikh, A. (2014) Acute and long-term management of food allergy: systematic review. Allergy, 69 (2), 159-167. (doi:10.1111/all.12314). (PMID:24215577)

Record type: Article

Abstract

BACKGROUND: Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts.

METHODS: Seven bibliographic databases were searched from their inception to September 30, 2012, for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-and-after and interrupted time series studies. Experts were consulted for additional studies. There was no language or geographic restrictions. Two reviewers critically appraised the studies using the appropriate tools. Data were not suitable for meta-analysis due to heterogeneity so were narratively synthesized.

RESULTS: Eighty-four studies were included, but two-thirds were at high risk of potential bias. There was little evidence about acute management for non-life-threatening reactions. H1-antihistamines may be of benefit, but this evidence was in part derived from studies on those with cross-reactive birch pollen allergy. Regarding long-term management, avoiding the allergenic food or substituting an alternative was commonly recommended, but apart from for infants with cow's milk allergy, there was little high-quality research on this management approach. To reduce symptoms in children with cow's milk allergy, there was evidence to recommend alternatives such as extensively hydrolyzed formula. Supplements such as probiotics have not proved helpful, but allergen-specific immunotherapy may be disease modifying and therefore warrants further exploration.

CONCLUSIONS: Food allergy can be debilitating and affects a significant number of people. However, the evidence base about acute and longer-term management is weak and needs to be strengthened as a matter of priority.

Full text not available from this repository.

More information

Accepted/In Press date: 1 October 2013
e-pub ahead of print date: 12 November 2013
Published date: February 2014
Keywords: acute management, food allergy, long-term management, systematic review
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 360133
URI: https://eprints.soton.ac.uk/id/eprint/360133
ISSN: 0105-4538
PURE UUID: 71d0d9c5-3110-4345-a6aa-8875b2102175

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Date deposited: 27 Nov 2013 13:15
Last modified: 18 Jul 2017 03:15

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Contributors

Author: D. de Silva
Author: M. Geromi
Author: S.S. Panesar
Author: A. Muraro
Author: T. Werfel
Author: K. Hoffmann-Sommergruber
Author: G. Roberts
Author: V. Cardona
Author: A.E.J. Dubois
Author: S. Halken
Author: A. Host
Author: L.K. Poulsen
Author: R. Van Ree
Author: B.J. Vlieg-Boerstra
Author: I. Agache
Author: A. Sheikh

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