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Food Allergy

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Why the Need for Guidelines?

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What Is a Clinical Practice Guideline?

Definition

"Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Institute of Medicine, 1990). Guidelines define the role of specific diagnostic and treatment methods in the diagnosis and management of patients. The statements contain recommendations that are based on evidence from a rigorous systematic evaluation of the published medical literature and may also rely on clinical expert opinion.

Purpose

The purpose of guidelines is to help clinicians and patients make appropriate decisions about healthcare. Guidelines attempt to do this in the following ways:

  • Describing a range of generally accepted approaches for the diagnosis, management, treatment, or prevention of specific diseases or conditions
  • Defining practices that meet the needs of most patients in most circumstances

The recommendations are not fixed protocols that must be followed. Responsible clinicians’ judgment on the management of patients remains paramount. Clinicians and patients need to develop individual treatment plans that are tailored to the specific needs and circumstances of the patient.

Intended Users

Guidelines are primarily intended for use by

  • Clinicians
  • Physicians
  • Nurses
  • Managed care organizations and other groups that define benefit plans for patients or handle healthcare resources
  • Other health professionals

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Background

Food allergy is a major public health concern

Food allergy affects adults and children in the United States and appears to be increasing in prevalence. Food allergy is associated with severe allergic reactions and is the most common cause of emergency room visits for anaphylaxis. Even though persons with food allergies attempt to avoid known allergens, reactions from unintentional exposure are relatively common.

Despite the risk of severe, potentially life-threatening allergic reactions, there is no current treatment other than allergen avoidance and treating the symptoms associated with severe reactions. Moreover, the diagnosis of food allergy may be problematic given that non-allergic food reactions, such as food intolerance, are frequently misclassified as food allergies.

NIH addresses the food allergy issue

On March 13-14, 2006, at the request of Congress, an expert panel of national and international food allergy experts was convened by NIH on behalf of the HHS Secretary to address issues in food allergy research. In its report, the panel examined the current state of NIH-funded food allergy research and developed and prioritized a list of recommendations to the HHS Secretary on key opportunities and research directions.

View the Report of the NIH Expert Panel on Food Allergy Research.

“Guidelines for the Diagnosis and Management of Food Allergy” Workshop

The decision to develop the guidelines came from a one-day workshop entitled “Guidelines for the Diagnosis and Management of Food Allergy,” co-organized by NIAID, the American Academy of Allergy, Asthma & Immunology, and the Food Allergy & Anaphylaxis Network. Held in July 2007, this workshop brought together representatives from more than 20 professional organizations, patient advocacy groups, and several NIH Institutes.

The primary purpose of the workshop was to determine the need for clinical guidelines on the diagnosis and management of food allergy and acute food allergy reactions that could be used in a variety of healthcare settings. The participants agreed that there was a significant need for such guidelines, and recommended a process to bring this concept to fruition. In addition, the participants recommended that a coordinating committee be established to provide oversight, to review the draft guidelines, and to approve the final version of the guidelines. The coordinating committee would also develop a plan for disseminating the final guidelines.

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Scope

The guidelines focus on both immunoglobulin E (IgE)-mediated reactions to food and some non-IgE-mediated reactions to food. The guidelines do not discuss celiac disease, which is an immunologic non-IgE-mediated reaction to certain foods.

In summary, the guidelines do the following:

  • Provide 43 concise recommendations to a wide variety of healthcare professionals on how to diagnose food allergy, manage ongoing food allergy, and treat acute food allergy reactions
  • Identify gaps in the current scientific knowledge to be addressed through future research
  • Identify and provide guidance to help standardize patient management

These guidelines do not address the management of patients with food allergy outside of clinical care settings (e.g., schools and restaurants) or the related public health policy issues. These issues are beyond the scope of the guidelines.

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Last Updated February 23, 2012

Last Reviewed February 17, 2012