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Managing food allergy: GA2LEN guideline 2022

Managing food allergy: GA2LEN guideline 2022
Managing food allergy: GA2LEN guideline 2022

Food allergy affects approximately 2–4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA2LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy.

Adolescent, Adults, Children, Food allergy, Food hypersensitivity
1939-4551
100687
Muraro, Antonella
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de Silva, Debra
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Halken, Susanne
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Worm, Margitta
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Khaleva, Ekaterina
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Arasi, Stefania
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Dunn-Galvin, Audrey
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Nwaru, Bright I.
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De Jong, Nicolette W.
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Rodríguez Del Río, Pablo
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Begin, Philippe
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Angier, Elizabeth
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Demoulin, Céline
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Deschildre, Antoine
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Fiocchi, Alessandro
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Flokstra-de Blok, Bertine
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Gerdts, Jennifer
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Gradman, Josefine
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Grimshaw, Kate
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Jones, Carla
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Lau, Susanne
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Loh, Richard
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Alvaro Lozano, Montserrat
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Makela, Mika
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Meyer, Rosan
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Mills, Clare
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Nilsson, Caroline
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Nowak-Wegrzyn, Anna
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Pajno, Giovanni
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Podestà, Marcia
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Poulsen, Lars K.
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Sampson, Hugh A.
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Sanchez, Angel
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Schnadt, Sabine
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Szajewska, Hania
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Van Ree, Ronald
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Venter, Carina
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Wood, Robert
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Roberts, Graham
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GALEN Food Allergy Guideline Group
Muraro, Antonella
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de Silva, Debra
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Halken, Susanne
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Worm, Margitta
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Khaleva, Ekaterina
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Arasi, Stefania
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Dunn-Galvin, Audrey
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Nwaru, Bright I.
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De Jong, Nicolette W.
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Rodríguez Del Río, Pablo
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Turner, Paul J.
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Smith, Pete
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Begin, Philippe
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Angier, Elizabeth
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Arshad, Hasan
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Ballmer-Weber, Barbara
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Beyer, Kirsten
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Bindslev-Jensen, Carsten
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Cianferoni, Antonella
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Demoulin, Céline
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Deschildre, Antoine
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Ebisawa, Motohiro
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Fernandez-Rivas, Maria Montserrat
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Fiocchi, Alessandro
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Flokstra-de Blok, Bertine
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Gerdts, Jennifer
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Gradman, Josefine
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Grimshaw, Kate
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Jones, Carla
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Lau, Susanne
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Loh, Richard
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Alvaro Lozano, Montserrat
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Makela, Mika
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Marchisotto, Mary Jane
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Meyer, Rosan
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Mills, Clare
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Nilsson, Caroline
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Nowak-Wegrzyn, Anna
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Nurmatov, Ulugbek
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Pajno, Giovanni
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Podestà, Marcia
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Poulsen, Lars K.
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Sampson, Hugh A.
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Sanchez, Angel
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Schnadt, Sabine
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Szajewska, Hania
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Van Ree, Ronald
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Venter, Carina
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Wood, Robert
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Roberts, Graham
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GALEN Food Allergy Guideline Group (2022) Managing food allergy: GA2LEN guideline 2022. World Allergy Organization Journal, 15 (9), 100687, [100687]. (doi:10.1016/j.waojou.2022.100687).

Record type: Review

Abstract

Food allergy affects approximately 2–4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA2LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy.

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Accepted/In Press date: 1 August 2022
e-pub ahead of print date: 7 September 2022
Published date: September 2022
Additional Information: Funding Information: Graham Roberts: grant: UK Food Standards Agency, Natasha Allergy Research Foundation; consulting: DBV; leadership: BSACI. Funding Information: Paul J Turner: personal fees: from Aimmune Therapeutics, DBV Technologies, Allergenis, UK Food Standards Agency; grants: National Institute for Health Research (NIHR)/Imperial Biomedical Research Centre, UK Medical Research Council, UK Food Standards Agency, End Allergies Together, Jon Moulton Charity Trust. Funding Information: Antoine Deschildre: personal fees from Novartis, ALK, GSK, Sanofi, Aimmune Therapeutics, DBV Technologies, Nestlé Health Science, Boehringer Ingelheim, Stallergenes Greer, DBV Technologies, Nutricia. Grant from Fondation du Souffle, Conseil Régional Hauts-de-France Research Program 2014–2018. Funding Information: Elizabeth Angier: grant: Natasha Allergy Research Foundation; expert testimony UK Medicines and Healthcare Regulatory Authority; leadership BSACI, EAACI, WONCA. Publisher Copyright: © 2022
Keywords: Adolescent, Adults, Children, Food allergy, Food hypersensitivity

Identifiers

Local EPrints ID: 470660
URI: http://eprints.soton.ac.uk/id/eprint/470660
ISSN: 1939-4551
PURE UUID: 4e17f93e-3be8-401a-aa8a-92f6414752ac
ORCID for Ekaterina Khaleva: ORCID iD orcid.org/0000-0002-2220-7745
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

Catalogue record

Date deposited: 17 Oct 2022 16:52
Last modified: 18 Mar 2024 03:57

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Contributors

Author: Antonella Muraro
Author: Debra de Silva
Author: Susanne Halken
Author: Margitta Worm
Author: Ekaterina Khaleva ORCID iD
Author: Stefania Arasi
Author: Audrey Dunn-Galvin
Author: Bright I. Nwaru
Author: Nicolette W. De Jong
Author: Pablo Rodríguez Del Río
Author: Paul J. Turner
Author: Pete Smith
Author: Philippe Begin
Author: Elizabeth Angier
Author: Hasan Arshad
Author: Barbara Ballmer-Weber
Author: Kirsten Beyer
Author: Carsten Bindslev-Jensen
Author: Antonella Cianferoni
Author: Céline Demoulin
Author: Antoine Deschildre
Author: Motohiro Ebisawa
Author: Maria Montserrat Fernandez-Rivas
Author: Alessandro Fiocchi
Author: Bertine Flokstra-de Blok
Author: Jennifer Gerdts
Author: Josefine Gradman
Author: Kate Grimshaw
Author: Carla Jones
Author: Susanne Lau
Author: Richard Loh
Author: Montserrat Alvaro Lozano
Author: Mika Makela
Author: Mary Jane Marchisotto
Author: Rosan Meyer
Author: Clare Mills
Author: Caroline Nilsson
Author: Anna Nowak-Wegrzyn
Author: Ulugbek Nurmatov
Author: Giovanni Pajno
Author: Marcia Podestà
Author: Lars K. Poulsen
Author: Hugh A. Sampson
Author: Angel Sanchez
Author: Sabine Schnadt
Author: Hania Szajewska
Author: Ronald Van Ree
Author: Carina Venter
Author: Robert Wood
Author: Graham Roberts ORCID iD
Corporate Author: GALEN Food Allergy Guideline Group

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