Our Take: Food Allergy/Intolerance Guidelines Update

While incredibly conservative and contains gaping holes, the Journal of Allergy and Clinical Immunology's guidelines suggesting pediatricians and internists be thorough in accounting for food allergies is a step in the right direction. Here are the important things to take away from the guidelines:

• There is no cure for food allergies, however, sublingual/oral immunotherapy may be closing in on this.

• The guidelines only focus on the majority of foods observed as mainly responsible for food allergies. However, the report DOES acknowledge that foods elicit non-immunologic adverse reactions (food intolerances). The report offers little guidelines, however, on detecting food intolerance. They state that food intolerance includes metabolic, pharmacologic, and toxic mechanisms, often mimicking reactions typical of allergic/immune-mediated response. The guidelines only mentions non-immunologic mediated toxic reactions to food additives, artificial colors, and various preservatives (such as sulfites), but no actual foods.
  

• The guidelines admit that it is difficult to diagnose non-immunologic food intolerance. Mixed immunologic and non-immunologic reactions should be suspected when symptoms, which generally involve the GI tract, and are more of a chronic nature, do not resolve quickly, and are not closely and immediately associated with the ingestion of an offending food.
  

• For both food allergy and intolerance, the guidelines suggest avoiding the offending foods/substances.
  

• The guidelines suggest using oral food challenges under a controlled environment, considered the gold standard, for diagnosing food allergy.
  

• Whether a patient has food intolerance or food allergy, the guidelines recommend nutritional counseling with a licensed professional for all children to avoid nutritional deficiencies.
  

• There are NO medications currently recommended to prevent food induced allergic reactions from occurring. The current evidence does not support the use of pharmacological therapy for immunologic (IgE) mediated reactions to food because while they have the potential to prevent or lessen the severity of the reaction by altering immune-response, the agents may display significant side effects and predispose an individual to increased risk of infection.
  

• There are NO medications currently recommended to prevent food induced intolerance reactions from occurring. The current evidence does not support the use of pharmacological therapy, corticosteroids in particular, for non-immunologic mediated reactions to food because while they have the potential to prevent or lessen the severity of the reaction, the agents may display significant side effects and predispose an individual to increased risk of infection.
  

• Food allergy and intolerance avoidance is the first line of treatment recommended by these guidelines.

• We are disappointed that the guidelines do not suggest patients at risk for developing food allergies limit exposure to foods that may be cross-reactive with the eight major food allergens: milk, egg, peanut, tree nuts, soy, fish, and crustacean shellfish).
  

• We are also disappointed that the guidelines do not recommend that women during pregnancy or lactation restrict food allergens from their diet.
  

The guidelines make more mention of food intolerance than many guides in the past. However, they do very little to help physicians diagnose them. While food allergies bring more acute risk, food intolerance, when not treated properly, leads to myriad chronic diseases. For this reason, we can only ascertain that the panel did not expound on food intolerance because they know next to nothing about it. Hopefully, this will change quickly. At least there are a few health professionals around the country, like ourselves, that do know how to screen and treat it.