Updated Food Allergy Guidelines Help Allergists Make Informed Patient Decisions

Parents of children who suffer from food allergies often rely a great deal on the expertise and advice of their children’s doctors and allergists. They tend to be the last bastion of knowledge regarding what approach may be best for an individual child’s allergy maintenance and prevention needs. Parents trust that clinicians have kept up with the latest research, studies, scientific journal articles and treatments protocols relating to food allergies, and that knowledge will be applied to the treatment of food allergic children under their care. One such article regarding food allergy treatment protocols, Food Allergy: A Practice Parameter, was published by the American Academy of Allergy, Asthma and Immunology.

What Is the Food Allergy Practice Parameter (FAPP)?

In 1989, the Joint Task Force on Practice Parameters was formed. It’s comprised of members from the Joint Council of Allergy, Asthma & Immunology (JCAAI); the American Academy of Allergy, Asthma & Immunology (AAAAI); and the American College of Allergy, Asthma & Immunology (ACAAI). The intent of the Joint Task Force was to create a set of documents that would:

  • Aid clinicians in providing appropriate diagnosis and treatment of allergic conditions, consistent with the best available scientific evidence and clinical consensus
  • Establish parameters for appropriate patient care that promote consistency in practice while allowing for variable approaches based on individual patient differences.

The FAPP is the result of that effort. Each year, the FAPP is updated to consider the latest advancements in food allergy research. The guide discusses 64 “Summary Statements,” which are general medical advice points for food allergy management or prevention. Each Summary Statement is accompanied by a “strength of recommendation;” Grade A-D. Summary Statement recommendation grades are categorized as follows:

  • Grade A or B: The benefits of the recommended approach clearly exceed the harms, and the quality of the supporting evidence is excellent.
  • Grade B or C: The benefits of the recommended approach exceed the harms, but the quality of supporting evidence is not as strong.
  • Grade D: High quality studies show little clear advantage to one approach versus another or the quality of supporting evidence is “suspect.”
    • In Grade D situations, there may also be a lack of relevant evidence and an imprecise balance between the benefits and harms of a given approach.

Many doctors and allergists study the FAPP and its updates to stay abreast of revised recommendations based on new studies and scientific evidence, and to apply the information to preferences and needs of their individual patients. 

Although the FAPP generally describes accepted practices, it is not intended to define a specific standard of care.

Current Important Updates to FAPP

The AAAAI has established several areas that have significant updates in 2014 including recommendations regarding:

  • Cross Reactivity: Currently, clinicians are advised to inform patients with certain food allergies of the possibility for cross reactivity with other related foods. For example, children allergic to cow’s milk may now be warned about risk of cross reactivity when drinking goat’s milk, meaning both should be avoided. Also, patients with an allergy to latex may experience cross reactivity with bananas, avocados, kiwi, chestnuts, potatoes, green peppers, and/or other fruits and nuts.
  • Maternal Diet Restrictions: Clinicians are now advised against recommending mothers avoid certain food during pregnancy to prevent food allergy. Research has not supported “food avoidance” as an effective approach to allergy prevention.
  • Breastfeeding: Although the exclusive breastfeeding of infants for the first 4-6 months is restated, the update no longer supports food avoidance while breastfeeding. Again, the science does not support it as an effective approach to allergy prevention. This is a departure from the 2006 FAPP.
  • Allergy to Meat: The update notes a correlation between allergies to alpha-gal, a carbohydrate found in red meat, and possible allergy to all Doctors are advised to test patients for alpha-gal allergy if they’ve had a reaction to red meat, particularly if they’ve also had a history of tick bites. Additionally, patients with alpha-gal allergy are further advised to avoid all meat.
  • Indications for Radiocontrast and Seafood Allergies: Traditionally, people with seafood allergies have been advised against using traditional radiocontrast media when undergoing medical scans due to possibility of cross reactivity. Though the 2006 FAPP suggested no evidence supports cross reactivity assertions, clinicians have not informed their patients. The 2014 update advises patients be informed that they do not have an increased risk of reaction.
  • Treatment with Probiotics: Though research is exploring probiotic use as a treatment for allergies, there is insufficient evidence to support probiotic supplements in a mother’s or child’s diet as an approach to allergy prevention.
  • Reactions to Food Additives: Natural food additives have recently been implicated in unexplained anaphylaxis events following ingestion of food that is not implicated in allergy. The updated FAPP recommends patients in this situation be tested for sensitivity or allergy to annatto (derived from achiote seeds) and carmine (derived from “scale insect” bodies).

Although the FAPP is intended for use by doctors, it remains an essential resource for anyone wishing to learn more about current trends in food allergy and immunology. As always, talk with your physician about any medical decisions or interpretations you may make that are based on information contained in the FAPP.

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