AAAAI Releases Updated Food Allergy Guidelines for Doctors
The American Academy of Allergy, Asthma and Immunology has released an update to its Food Allergy Practice Parameter. These guidelines are intended to help allergists make informed decisions with their patients, and take into account recent developments in an evolving field.
The 2014 update, developed by top allergists from AAAAI as well as the American College of Allergy, Asthma and Immunology, considers the latest in food allergy research to add to the original 2006 Practice Parameter for food allergy.
Some significant updates include:
• Warnings of cross-reactivity: Allergists are now advised to warn those with specific food allergies of the risk of cross-reaction with related foods. Examples include alerting those with one tree nut allergy of the risk of reaction with other nuts; warning those with (or with children with) cow’s milk allergy to also avoid goat’s and sheep’s milk.
The guidelines also now recommend that patients with latex allergy be warned of the possibility of cross-reactions with banana, avocado, kiwi, chestnut, potato, green pepper, and other fruits and nuts.
• Alpha-gal allergy: Patients should be tested for alpha-gal allergy if they’ve had a delayed systemic reaction to red meat, especially if they have a history of tick bites. Any patient with alpha-gal allergy should avoid all mammalian meat.
• Seafood allergy & X-rays: Patients with seafood allergy should be informed that they do not have an increased risk to react to radiocontrast media used in medical scans. The 2006 Practice Parameter mentioned there is no evidence for this link, but stopped short of recommending allergists tell their patients this.
• Maternal diet: The new Parameter advises that physicians should not recommend avoiding certain allergenic foods during pregnancy, as this practice of avoidance hasn’t proven effective in preventing allergies.
• Breastfeeding: The update recommends exclusive breastfeeding for the first four to six months of life, and does not recommend that mothers avoid certain foods while breastfeeding (as with the maternal diet, there’s no evidence this prevents allergies). The 2006 Parameter had included the older recommendation (which the experts no longer support) that “breastfeeding mothers should avoid highly allergenic foods if familial allergic susceptibility is present.” (For more on the maternal diet and breastfeeding, see: NIAID Guidelines, page 23.)
• Probiotics: It’s also not recommended to use probiotics as supplement for the mother’s or child’s diet as a way to prevent allergies, due to insufficient supporting evidence.
• Food Additives: There are revised recommendations on considering natural food additives in evaluating unexplained anaphylactic reactions that follow eating (in cases where other food triggers are not implicated). When food additives are the suspected cause of an adverse reaction, the new Parameter recommends in particular that the patient be evaluated for sensitivity to annatto and carmine.
While the document is intended for doctors, it is still a strong resource for anybody looking to learn more about the current state of food allergy and immunology. Of course, any medical decisions should be discussed with an allergist, and not be based solely on interpretation of this document.
See all AAAAI Practice Parameters here.