NIAID released its first ever list of guidelines for food allergies. Photo: CC-stephendepolo
Celiac.com 01/06/2011 - The National Institute for Allergy and Infectious Disease (NIAID) released its first ever list of guidelines for food allergies. Developed over two years by a panel of nineteen experts, the guidelines suggested avoiding the ingestion of specific allergens as the best strategy for managing allergies, but made no recommendations for medication.

The panel defined a food allergy as an “adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food." The panel also compiled forty-three recommendations as part of what panel-chair Dr. Joshua A. Boyce called an “important starting point toward a more cogent, evidence-based approach to the diagnosis and management of food allergy.” The NIAID list in intended for use by family practice physicians and other medical experts.

After an extensive review of the most common food allergies in the United States, studies suggest an increase in the prevalence of allergies to egg, milk, wheat, soy, peanuts and tree nuts over the past 10-20 years. The guidelines further children who suffer these allergies are likely to develop a tolerance to egg, milk, wheat and soy, though peanut and tree nut allergies are expected to continue through adulthood.

According to the guidelines, properly diagnosing these food allergies is crucial because studies returned evidence that as much as 90% of presumed allergies are indeed not food allergies. The NIAID reviewed the most common tests for accurately identifying allergies, pointing to their various strengths and weaknesses, and highlighted the oral food test as the best option. Those at the highest risk for developing a food allergy were noted to be those which a biological parent or sibling who suffers from similar confirmed allergies.

While the NIAID has identified those who would be at a higher risk for advancing an allergy, they did not find evidence that would support the delaying exposure to common allergens has a significant effect on the progression of allergy development. Similarly, they do not advocate that nursing mothers restrict their diet to avoid typical allergen triggers during pregnancy and lactation.

In fact, the guidelines recommend breast-feeding through the first 4-6 months as well as proceeding with vaccinations against measles, mumps and rubella which contains small amounts of egg protein. Advances in vaccine development have allowed for decreased levels of egg protein, making them safe to administer.

The guidelines note that eliminating certain food allergens which can worsen conditions like asthma, atopic dermatitis, and eosinophilic esophagitis, can ease symptoms. They also list epinephrine as the best choice of treatment for anaphylaxis, followed by antihistamines and corticosteroids.

Together with the vast information the guidelines provide in the fields of science and medicine, the list also points to areas where more research is needed. The NIAID issue of recommendations marks a striking advance in research and will continue to shape future of food allergies.

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