Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report - 07/08/11

Doi : 10.1016/j.jaci.2010.10.008

Joshua A. Boyce, MD ^a : Primary Author, Amal Assa’ad, MD ^d : Primary Author, A. Wesley Burks, MD ^e : Primary Author, Stacie M. Jones, MD ^g : Primary Author, Hugh A. Sampson, MD ^h : Primary Author, Robert A. Wood, MD ⁱ : Primary Author, Marshall Plaut, MD ^j : Primary Author, Susan F. Cooper, MSc ^j : Primary Author, Matthew J. Fenton, PhD ^j,^⁎ : Primary Author, S. Hasan Arshad, MBBS, MRCP, DM, FRCP ^k,^l,^m : NIAID-Sponsored Expert Panel Author, Sami L. Bahna, MD, DrPH ⁿ : NIAID-Sponsored Expert Panel Author, Lisa A. Beck, MD ^o : NIAID-Sponsored Expert Panel Author, Carol Byrd-Bredbenner, PhD, RD, FADA ^p : NIAID-Sponsored Expert Panel Author, Carlos A. Camargo, MD, DrPH ^b : NIAID-Sponsored Expert Panel Author, Lawrence Eichenfield, MD ^q,^r : NIAID-Sponsored Expert Panel Author, Glenn T. Furuta, MD ^s,^t,^u : NIAID-Sponsored Expert Panel Author, Jon M. Hanifin, MD ^v : NIAID-Sponsored Expert Panel Author, Carol Jones, RN, AE-C ^w : NIAID-Sponsored Expert Panel Author, Monica Kraft, MD ^f : NIAID-Sponsored Expert Panel Author, Bruce D. Levy, MD ^c : NIAID-Sponsored Expert Panel Author, Phil Lieberman, MD ^x : NIAID-Sponsored Expert Panel Author, Stefano Luccioli, MD ^y : NIAID-Sponsored Expert Panel Author, Kathleen M. McCall, BSN, RN ^z : NIAID-Sponsored Expert Panel Author, Lynda C. Schneider, MD ^aa : NIAID-Sponsored Expert Panel Author, Ronald A. Simon, MD ^bb : NIAID-Sponsored Expert Panel Author, F. Estelle R. Simons, MD ^cc : NIAID-Sponsored Expert Panel Author, Stephen J. Teach, MD, MPH ^dd : NIAID-Sponsored Expert Panel Author, Barbara P. Yawn, MD, MPH, MSc ^ee,^ff : NIAID-Sponsored Expert Panel Author, Julie M. Schwaninger, MSc ^j : Contributing Author
^a Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
^b Department of Emergency Medicine, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
^c Partners Asthma Center, Pulmonary and Critical Medicine Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass
^d Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
^e Division of Allergy and Immunology, Department of Pediatrics, Duke University Medical Center, Durham, NC
^f Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC
^g Division of Allergy and Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Ark
^h Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY
ⁱ Division of Allergy and Immunology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
^j Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
^k School of Medicine, University of Southampton, Southampton, United Kingdom
^l The David Hide Asthma and Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, United Kingdom
^m Southampton University Hospital NHS Trust, Southampton, United Kingdom
ⁿ Department of Pediatrics, Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, La
^o Department of Dermatology, University of Rochester Medical Center, Rochester, NY
^p Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ
^q Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, Calif
^r Departments of Pediatrics and Medicine, University of California, San Diego, Calif
^s Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Digestive Health Institute, Children’s Hospital Denver, Aurora, Colo
^t Department of Pediatrics, National Jewish Health, Denver, Colo
^u Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colo
^v Department of Dermatology, Oregon Health and Science University, Portland, Ore
^w Allergy and Asthma Network Mothers of Asthmatics, McLean, Va
^x Division of Allergy and Immunology, Department of Medicine, University of Tennessee College of Medicine, Memphis, Tenn
^y Office of Food Additive Safety, US Food and Drug Administration, College Park, Md
^z Children’s Hospital of Orange County, Orange, Calif
^aa Division of Immunology, Children’s Hospital Boston, Boston, Mass
^bb Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
^cc Departments of Pediatrics and Child Health and Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
^dd Division of Emergency Medicine, Children’s National Medical Center, Washington, DC
^ee Department of Research, Olmsted Medical Center, Rochester, Minn
^ff Department of Family and Community Health, University of Minnesota School of Medicine, Minneapolis, Minn

Corresponding author: Matthew J. Fenton, PhD, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 6610 Rockledge Drive, Room 3105, Bethesda, MD 20892.

Plan

Contents

Introduction

Overview

Relationship of the US Guidelines to other guidelines

How the Guidelines were developed

Defining the strength of each clinical guideline

Summary

Definitions, prevalence, and epidemiology of food allergy

Definitions

Prevalence and epidemiology of food allergy

Natural history of food allergy and associated disorders

Natural history of food allergy in children

Natural history of levels of allergen-specific IgE to foods in children

Natural history of food allergy in adults

Natural history of conditions that coexist with food allergy

Risk factors for the development of food allergy

Risk factors for severity of allergic reactions to foods

Incidence, prevalence, and consequences of unintentional exposure to food allergens

Diagnosis of food allergy

When should food allergy be suspected?

Diagnosis of IgE-mediated food allergy

Diagnosis of IgE-mediated contact urticaria

Management of nonacute allergic reactions and prevention of food allergy

Management of individuals with food allergy

Management of individuals at risk for food allergy

Prevention of food allergy

Diagnosis and management of food-induced anaphylaxis and other acute allergic reactions to foods

Definition of anaphylaxis

Diagnosis of acute, life-threatening, food-induced allergic reactions

Treatment of acute, life-threatening, food-induced allergic reactions

Management of food-induced anaphylaxis

	J. A. Boyce has served on the Advisory Board of GlaxoSmithKline. He has served as a consultant and/or speaker for Altana, GlaxoSmithKline, and Merck. He has received funding/grant support from the National Institutes of Health.
	A. Assa’ad holds, or is listed as an inventor on, US patent application #10/566903, entitled “Genetic markers of food allergy.” She has served as a consultant for GlaxoSmithKline and as a speaker for the American College of Allergy, Asthma, and Immunology, the North East Allergy Society, the Virginia Allergy Society, the New England Allergy Society, and the American Academy of Pediatrics. Dr Assa’ad has received funding/grant support from GlaxoSmithKline.
	A. W. Burks holds, or is listed as an inventor on, multiple US patents related to food allergy. He owns stock in Allertein and MastCell, Inc, and is a minority stockholder in Dannon Co Probiotics. He has served as a consultant for ActoGeniX NV, McNeil Nutritionals, Mead Johnson, and Novartis. He has served on the speaker’s bureau for EpiPen/Dey, LP, and has served on the data monitoring committee for Genentech. He has served on an expert panel for Nutricia. Dr Burks has received funding/grant support from the Food Allergy and Anaphylaxis Network, Gerber, Mead Johnson, and the National Institutes of Health.
	S. M. Jones has served as a speaker and grant reviewer and has served on the medical advisory committee for the Food Allergy and Anaphylaxis Network. She has received funding/grant support from Dyax Corp, the Food Allergy and Anaphylaxis Network, Mead Johnson, the National Peanut Board, and the National Institutes of Health.
	H. A. Sampson holds, or is listed as an inventor on, multiple US patents related to food allergy. He owns stock in Allertein Therapeutics. He is the immediate past president of the American Academy of Allergy, Asthma, and Immunology. He has served as a consultant for Allertein Therapeutics, the American Academy of Allergy, Asthma, and Immunology, the Food Allergy Initiative, and Schering Plough. He has received funding/grant support for research projects from the Food Allergy Initiative, the National Institutes of Health (Division of Receipt and Referral, National Institute of Allergy and Infectious Diseases, National Center for Complementary and Alternative Medicine), and Phadia AB. He is a co-owner of Herbal Spring, LLC.
	R. A. Wood has served as a speaker/advisory board member for GlaxoSmithKline, Merck, and Dey. He has received funding/grant support from Genentech and the National Institutes of Health (National Institute of Allergy and Infectious Diseases).
	S. H. Arshad has received funding/grant support from the National Institutes of Health and the National Institute of Health Research, UK.
	S. L. Bahna has received funding/grant support from Genentech.
	L. A. Beck has received funding/grant support from the American Academy of Allergy, Asthma, and Immunology, the National Eczema Association, and the National Institutes of Health.
	C. Byrd-Bredbenner owns stock in Johnson & Johnson. She has received funding/grant support from the US Department of Agriculture, the Canned Food Alliance, and the New Jersey Department of Health and Senior Services.
	C. A. Camargo Jr has consulted for Dey and Novartis. He has received funding/grant support from a variety of government agencies and not-for-profit research foundations, as well as Dey and Novartis.
	L. Eichenfield has received funding/grant support from a variety of not-for-profit foundations, as well as Astellas, Ferndale, Johnson & Johnson, Novartis, Sinclair, Stiefel, and Therapeutics Inc.
	G. T. Furuta has served as a consultant and/or speaker to Ception Therapeutics and TAP. He has received funding/grant support from the American Gastrointestinal Association and the National Institutes of Health.
	J. M. Hanifin has served as served as a consultant for ALZA, Anesiva, Inc, Barrier Therapeutics, Inc, Milliken & Company, Nordic Biotech, Novartis Pharmaceuticals Corporation, Shionogi USA, Taisho Pharmaceutical R&D, Inc, Teikoku Pharma USA, Inc, UCB, York Pharma, ZARS, Inc, and ZymoGenetics. He has served as an investigator or received research funding from ALZA, Astellas Pharma US, Inc, Asubio Pharmaceuticals, Inc, Centocor, Inc, Corgentech, Novartis, Nucryst Pharmaceuticals, Seattle Genetics, and Shionogi USA.
	M. Kraft has served as a consultant and/or speaker for Astra-Zeneca, Genentech, GlaxoSmithKline, Merck, Novartis, and Sepracor. She has received funding/grant support from Genentech, GlaxoSmithKline, the National Institutes of Health and Novartis.
	B. D. Levy holds, or is listed as an inventor on, US patent applications #20080064746 entitled “Lipoxins and aspirin-triggered lipoxins and their stable analogs in the treatment of asthma and inflammatory airway diseases” and #20080096961 entitled “Use of docosatrienes, resolvins and their stable analogs in the treatment of airway diseases and asthma.” He owns stock in Resolvyx Pharmaceuticals. He has served as a consultant for Bayer Healthcare and Resolvyx Pharmaceuticals. Dr Levy has received funding/grant support from the National Institutes of Health.
	P. Lieberman has served as a consultant and/or speaker to Dey Laboratories, Novartis, Schering-Plough, AstraZenica, Merck, TEVA, Pfizer, MEDA, Alcon, Genentech, Intelliject, and the Food Allergy and Anaphylaxis Network. He is past president of the American Academy of Allergy, Asthma, and Immunology.
	L. C. Schneider has served as a consultant/clinical advisor for the Food Allergy Initiative. She has received funding/grant support from a variety of not-for-profit research foundations, as well as Novartis and the National Institutes of Health.
	R. A. Simon has served as a speaker for Dey Laboratories, Genentech, GlaxoSmithKline, Merck, Novartis, and the US Food and Drug Administration.
	F. E. R. Simons holds a patent on “Fast-disintegrating epinephrine tablets for sublingual administration.” She is a past-president of the American Academy of Allergy, Asthma, and Immunology and of the Canadian Society of Allergy and Clinical Immunology. She is a member of the advisory boards of Dey, Intelliject, and ALK-Abello. She has received funding/grant support from AllerGen, the Canadian Allergy, Asthma and Immunology Foundation/Anaphylaxis Canada, and the Canadian Institutes of Health Research.
	S. J. Teach has served as a speaker for AstraZeneca. He has received funding/grant support from the AstraZeneca Foundation, Aventis, the Child Health Center Board, the CNMC Research Advisory Council, the National Association of Chain Drug Stores Foundation, the National Institutes of Health (National Institute of Allergy and Infectious Diseases; National Heart, Lung, and Blood Institute), Novartis/Genentech, the Robert Woods Johnson Foundation, the US Centers for Disease Control and Prevention, the US Public Health Service, and the Washington, DC, Department of Health.
	The other authors have declared that they have no conflict of interest.

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Vol 126 - N° 6

P. 1105-1118 - décembre 2010 Retour au numéro

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Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report - 07/08/11

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