Friday, December 17, 2010

New Rules for Diagnosing Food Allergies

Last week, as reported in the Wall Street Journal, the National Institute for Allergies and Infectious Diseases issued the first clinical guidelines for diagnosing and treating food allergies stating that blood or skin tests alon aren't sufficient when making a diagnosis.  The recommendation is that a combination approach should be taken including a detailed medical history review, and in some cases, an oral food challenge.

According to the WSJ articule, "the guidelines, published this week in the Journal of Allergy and Clinical Immunology, are aimed at resolving wide discrepancies in diagnosing and treating food allergies among allergists, dermatologists, gastroenterologists, pulmonologists and emergency physicians, as well as pediatricians and internists. More than 30 professional organizations, federal agencies and patient groups were involved in the report, which was in the works for two years."

There has been a great deal of press lately on the topic of whether the many children diagnosed with food allergies over the last couple of years actually have a severe enough allergy to warrant completely removing all possibilities of contact.  In many cases patients or parents of patients have been told to eliminate multiple foods only to later do a food challenge and find the patient can tolerate all but one or two of those foods. These recommendations were based on the results of either or both the RAST blood test or the skin prick test.  According to experts, "having IgE antibodies to specific foods doesn't necessarily mean a person will have an allergic reaction when eating the foods. Skin-prick tests are more predictive, but they, too, measure IgE "sensitization," which may not result in an actual reaction. The report estimates that 50% to 90% of presumed allergies are not, in fact, allergies."  In fact, according to the WSJ, a study published online in the Journal of Pediatrics this fall reviewed 125 children evaluated for food allergies and eczema at National Jewish in 2007 and 2008.  They found that over 90% of the foods the children were avoiding were returned to their diets after food challenges.

Here is a great illustration of the new clinical guidelines for diagnosing food allergies as opposed to what has been happening.

Other significant guidelines from the National Institute for Allergy and Infectious Diseases include:
  • Introducing solid foods to infants should not be delayed beyond 4 to 6 months old.
  • People with an egg allergy need not avoid the measles, mumps, rubella (MMR) vaccine. But they should avoid vaccines for influenza, yellow fever or rabies.
  • Even those at high risk for food allergies, such as family members of those with allergies, may not need routine testing. One exception: siblings of children with severe peanut allergies. 
I'm hoping these guidelines have a very positive impact of the understanding of food allergies.  I simply couldn't imagine living the lifestyle that our family has lived now for seven years only to find out that our child didn't really have a severe enough food allergy to warrant all of the precautions that we've put into place.  What a cruel twist of fate that would be.  Also, maybe if there is less confusion within the allergy community, i.e., different recommendations from different doctors, different requirements for different allergy patients, etc.,  it will make it easier for the general population to better understand the implications of a true, life-threatening allergy, and have a better appreciation.. maybe even a little more tolerance for those with allergies.

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