MONDAY, Dec. 6 (HealthDay News) -- A new set of guidelines
designed to help doctors diagnose and treat food allergies was
released Monday by the U.S. National Institute of Allergy and
Infectious Diseases (NIAID).
In addition to recommending that doctors get a thorough medical
history from a patient when a food allergy is suspected, the
guidelines also try to help physicians distinguish which tests are
the most effective for determining whether someone has a food
Allergy to foods such as peanuts, milk and eggs are a growing
problem, but how many people in the United States actually suffer
from food allergies is unclear, with estimates ranging from 1
percent to 10 percent of children, experts say.
"Many of us feel the number is probably in the neighborhood of 3 to 4 percent," Dr. Hugh A. Sampson, an author of the guidelines, said during a Friday afternoon news conference detailing the guidelines. "There is a lot of concern about food allergy being overdiagnosed, which we believe does happen."
Still, that may still mean that 10 to 12 million people suffer
from these allergies, said Sampson, a professor of pediatrics and
dean for translational biomedical sciences at the Mount Sinai
School of Medicine in New York City.
Another problem is that food allergies can be a moving target,
since many children who develop food allergies at an early age
outgrow them, he noted. "So, we know that children who develop egg
and milk allergy, which are two of the most common allergies, about
80 percent will eventually outgrow these," he said.
However, allergies to peanuts, tree nuts, fish and shellfish are
more persistent, Sampson said. "These are more often than not
lifelong," he said. Among children, only 10 percent to 20 percent
outgrow them, he added.
The 43 recommendations in the guidelines were developed by NIAID
after working jointly with more than 30 professional groups,
advocacy organizations and federal agencies. Rand Corp. was also
commissioned to perform a review of the medical literature on food
allergies. A summary of the guidelines appears in the December
issue of the
Journal of Allergy and Clinical Immunology.
One thing the guidelines try to do is delineate which tests can
distinguish between a food sensitivity and a full-blown food
allergy, Sampson noted. The two most common tests done to diagnose
a food allergy -- the skin prick and measuring the level of
antigens in a person's blood -- only spot sensitivity to a
particular food, not whether there will be a reaction to eating the
To determine whether the results of these two tests indicate a
true allergy, other tests and a food challenge are often needed,
When only the skin prick and blood tests are used, they can lead
to children being put on very restrictive diets, he said. However,
in many cases when these children face a food challenge it is
discovered that they are not truly allergic to many foods.
"Diagnosing a food allergy is not just doing a skin test, or not just doing a blood test, or not even having a report of a food allergy. It takes a combination of good medical history, as well as laboratory tests and in some cases a food challenge, to make the appropriate diagnosis," Sampson said.
The new guidelines also define what foods are common allergens,
what the symptoms of an allergic reaction are and how to manage an
allergy, depending on which food is the allergen.
And the guidelines also note there is no benefit to restricting
a pregnant woman's diet in hope of preventing allergies in her
baby. "There is not sufficient evidence to show that altering the
maternal diet or altering the infant's diet will have any impact on
development of food allergy or allergic disease," Sampson said.
Commenting on the guidelines, Dr. Gary Kleiner, an associate
professor of clinical pediatrics at the University of Miami Miller
School of Medicine, said that "this is a very good document that
hopefully will be helpful to physicians."
Kleiner believes the guideline recommending a skin test rather
than a blood test for initial allergy screening is good. The skin
test is more sensitive and a negative result is very helpful,
because it tells you the patient will be able to tolerate the food,
he said. "Many times the blood test gives false positives," he
Other recommendations, such as not giving infants soy milk
instead of cow's milk, are also a step in the right direction,
In addition, the recommendations about how to treat an severe
allergic reaction will give doctors, especially emergency room
physicians, more confidence in treating them aggressively, he
For more on food allergies, visit the
U.S. National Library of Medicine.
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