Food Allergy Treatments
- Education is of paramount importance for patients with food allergies.
- Patients can obtain useful resource information by contacting the Food Allergy and Anaphylaxis Network (toll-free phone number is 800-929-4040) and the International Food Information Council (phone number is 202-296-6540 and email address is firstname.lastname@example.org).
- Remember that appropriate restriction and complete avoidance of the relevant food allergen(s) is the only current effective therapy.
- Elimination of food allergen
- Once a food allergy is diagnosed, strict elimination of the offending food allergen from the diet and avoidance of any contact with the food either by ingestion, skin contact, inhalation, or injection is necessary.
- Elimination and strict avoidance is the only proven medical therapy for this allergic disease.
- Recognize the early signs and symptoms of an allergic reaction. Keep in mind that cutaneous, gastrointestinal, and respiratory symptoms are the most common clinical manifestations of food allergy.
- Consultation with a nutritionist or nutrition service is invaluable in the overall management. The elimination diet can be reviewed and appropriate substitutions can be recommended. Dietary deficiencies can be anticipated and prevented.
- Consultation with a gastroenterologist is also useful in the evaluation of selected patients. For example, patients presenting with possible anatomic gastrointestinal abnormalities, eosinophilic esophagitis or gastroenteritis, failure to thrive, and malabsorption syndromes may benefit from consultation with both an allergist and a gastroenterologist.
- A properly managed well-balanced elimination diet (eg, allergen restriction) can lead to resolution of symptoms and help avoid nutritional deficiencies.
- Educate the patient and family about how to properly read food labels and identify common words used for indicating the presence of the food allergen of concern (eg, casein and whey for milk).
- With elimination diets, only exclude those foods confirmed to provoke allergic reactions.
- Review obvious and hidden sources of food allergens. Be aware of the potential for exposures by routes other than ingestion, such as skin contact, inhalation, or injection.
- Anticipate potential candidates for food allergen cross-reactivity, such as the following:
- Eggs and chicken (<5%)
- Cow milk and beef (10%)
- Cow milk and goat milk (>90%)
- Fish (>50%)
- Peanuts and related legumes (<10%)
- Soy and related legumes (<5%)
- Wheat and other grains (25%)
- Tree nuts and other nuts (>50%)
- Encourage avoidance of high-risk situations (eg, buffets, picnics), where accidental or inadvertent ingestion of food allergens can occur.
Despite following stringent avoidance measures for clinically relevant food allergens, accidental or inadvertent ingestions occur all too often. Therefore, a concise written plan for the treatment of allergic reactions resulting from accidental exposure to the food must be available to the patient. For patients with a history of a mild reaction, such as urticaria and pruritus following the ingestion of a food allergen, treatment may be limited to an oral antihistamine. However, the potential for a more severe reaction on subsequent exposures must be taken into consideration because of the possibility of the ingestion of a larger dose than previously ingested or an unexpected or unrecognized increase in the patient’s degree of sensitivity.
If the patient has significant systemic symptoms, the treatment of choice is epinephrine administered by intramuscular injection in the lateral thigh. Examples of systemic manifestations of food allergy include generalized urticaria, laryngeal edema, lower respiratory symptoms (eg, chest tightness, dyspnea, wheezing), and hypotension. Administer epinephrine to any patient with history of a severe allergic reaction as soon as ingestion of the food allergen is discovered and the first symptoms appear.
For the medical therapy of food allergen–induced allergic reactions, the use of antianaphylactic agents, antihistamines, bronchodilators, and corticosteroids in combination with the administration of intravenous fluids and oxygen (when indicated), is suggested.