New recommendations from the National Institute of Allergy and Infectious Diseases sets forth 43 clinical recommendations on the diagnosis and management of food allergy.

To help distinguish between the strengths of particular recommendations in Guidelines for the Diagnosis and Management of Food Allergy in the United States, the expert panel used the verb “recommend” to convey a strong recommendation for or against a particular course of action, or “suggest” if the panel only weakly recommended for or against the strategy.

For example, the panel recommends using medical history, physical examination, and the skin-prick test to help diagnose immunoglobulin (Ig)E-mediated food allergy. However, the panel merely suggests that eliminating specific foods from the diet may be useful in diagnosing food allergy, particularly in identifying foods responsible for non-IgE-mediated food-induced allergic disorders and some mixed IgE- and non-IgE-mediated food-induced allergic disorders, such as eosinophilic esophagitis (EoE).

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According to multiple studies, 50% to 90% of presumed food allergies actually are not allergies. In the guidelines, food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food. The true prevalence of food allergy has been difficult to establish, but many studies have indicated a rise in prevalence over the past 10 to 20 years.

Food allergy may coexist with asthma, atopic dermatitis, EoE, and exercise-induced anaphylaxis. The panel notes that in persons with asthma, the coexistence of food allergy may be a risk factor for severe asthma exacerbations. In addition, food may be a trigger for exercise-induced anaphylaxis.

Boyce JA et al. J Allergy Clin Immunol. 2010;126:1105-1118