An official set of recommendations on the diagnosis, treatment, and management of food allergy—a common medical condition believed to affect three of every 100 Americans—has been formulated by a panel convened by the National Institute of Allergy and Infectious Diseases (J Allergy Clin Immunol. 2010;126:S1-S58).

The comprehensive guidelines are designed for use by primary-care providers, specialists, and other health-care personnel. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel presents 43 concise clinical recommendations and additional guidance on controversial areas of patient management. The document includes:

  • Clear-cut definitions of food allergy vs. food intolerance
  • Information on the proper tests to use to diagnose a food allergy
  • Advice on how to manage non-life-threatening and life-threatening allergic reactions, including anaphylaxis
  • Explanations of how various types of food allergy develop and progress.

The authors note that many food reactions are not allergic in origin. A meta-analysis found that 35% of individuals who reported having a reaction to food believed that they had a food allergy, but results of oral food challenges suggest a much lower prevalence of approximately 3.5%.

The patient’s medical history is a key element to consider when evaluating differential diagnosis of food allergy. For example, food allergens may be blamed for eczematous flares in children when in fact humidity, fluctuating temperatures or bacterial infections of the skin (e.g., Staphylococcus aureus) may be the real culprits. Chronic GI symptoms could be the work not of a food allergy but of reflux, infection, anatomical disorders, such metabolic abnormalities as lactose intolerance or other causes. Acute allergic reactions initially attributed to a food may be triggered by medications, insect stings or other allergens.

Nevertheless, patients who are at risk for developing food allergy (those with a biological parent or sibling with past or present food allergy, asthma, atopic dermatitis or allergic rhinitis) should not limit their exposure to such potential nonfood allergens as dust mites, pollen, or pet dander. As guideline 32 states, “Insufficient evidence exists to suggest that avoidance of allergens that are not food allergens has any effect on the natural history of [food allergy].”