Journal of food allergy最新文献

Background: Military and civilian allergists can be consulted for their expertise in food allergy to guide medical evaluations for military service applicants. Military accession (acceptance) standards with regard to food allergy can be daunting, with added complexity when considering service-specific broadening of guidelines and waiver tolerance. The allergist plays a critical role in evaluating patients with food-related concerns who are interested in military service.

Objective: The purpose of this short communication is to aid in understanding of current military medical standards and diagnostic protocols related to food allergies in recruitment and enlistment, identification of food reactions that may impact candidacy for military accession, and provide strategies to address the food-related condition and help navigate the military medical evaluation process.

Methods: We conducted a thorough review of current applicable military standard guidelines for accession pertinent to food allergies. Through review of Department of Defense medical standard guidelines as well as some service-specific initiatives to expand accessions, allergists can systematically steer through the evaluation process to support military applicants, clearing the path for accession.

Results: We provide case-based recommendations to guide allergists in the evaluation of patients with possible food allergy who are interested in application for military service.

Conclusion: Through appropriate use of published medical standards and evidence-based practice with strategic stepwise evaluation, the allergist can help clear the path for military applicants in the accessions process.

Food allergy impacts are far-reaching, across individuals, families, and societies, and affect both nutrition and psychological health. Understanding risk in context as well as thresholds of reactivity can help to improve food allergy management. These strategies can provide empowerment and improve quality of life. Food allergy thresholds and reaction severity can vary but both tend toward stability, at least in the short-term. An understanding of food allergen thresholds may better leverage active food allergy management as well as better tailor the most appropriate avoidance in selected individuals. Shared decision-making is central to operationalizing food allergen thresholds.

Background: Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and may cause death.

Methods: The true prevalence of infant anaphylaxis is unknown, but such cases may be increasing in presentation of these patients to emergency departments, with studies that evaluate health-care utilization after implementation of early introduction guidelines that report an increase in the use of emergency department for food-related visits as well as an increase in epinephrine prescriptions for infants.

Results: Reasons for these increases may include early food introduction as well as therapeutic interventions such as early life or preschool oral immunotherapy.

Conclusion: Infant anaphylaxis presents many diagnostic challenges, including poor recognition attributable to confusing signs and symptoms that may be age specific, and risk for inadequate acute management.

This article examines the intricate interplay between food allergy and asthma by focusing on the challenges of managing food allergy in patients with asthma. Although asthma is a prevalent comorbidity in food allergy, often > 50% among older children, its impact on food allergy outcomes remains not fully understood. Studies indicate a higher prevalence of asthma among individuals experiencing fatal anaphylaxis, yet there is no consistent evidence that supports a direct causal link between food allergy and the development of asthma. Clinicians and patients often overestimate asthma control, which leads to underestimated risks associated with severe food allergy reactions. This article underscores the critical need for optimal asthma control before and during oral food challenges and dietary advancement therapies, highlighting the heightened risk of severe reactions in individuals with poorly controlled asthma. Whereas biologics such as omalizumab show promise in enhancing asthma control and increasing food allergy thresholds, a comprehensive, multifaceted approach that involves diligent asthma management, patient education, and appropriate treatment strategies is essential for ensuring safe and effective management of food allergy in individuals with asthma. Integrated management, which addresses both conditions concurrently, is vital for improving patient safety and quality of life.

Background: Food allergies pose a significant burden on the daily life of individuals with food allergy, including dietary, psychosocial, and economic impact. The management of food allergy has shifted recently from previous passive avoidance approaches to current active therapeutic interventions.

Objective: This article aims to discuss selection of patients with food allergies for different therapies.

Methods: Published literature on risks and benefits of various therapies as well as articles on shared decision-making were reviewed for this article. Key papers are included.

Results and conclusion: In addition to the two U.S. Food and Drug Administration approved therapies currently available (for oral peanut immunotherapy and for treatment of single and/or multiple food allergies), many novel treatments are on the horizon. Alternative forms of food immunotherapy, such as epicutaneous and sublingual, as well as a variety of new biologics are under development. When selecting patients for therapy, it is important to consider multiple factors, including eligibility, age, type of food, history of life-threatening reactions, baseline quality of life, and the presence of atopic comorbidities. As the food allergy landscape becomes enriched with novel treatment modalities, choice of the appropriate therapy for each individual is more challenging. Avoidance also remains an acceptable strategy for those who prefer this approach.

Omalizumab is approved for the management of immunoglobulin E-mediated food allergy in individuals ages ≥ 1 year. Approval for food allergy followed the Omalizumab as Monotherapy and as Adjunct Therapy to Multi-Allergen OIT in Food Allergic Participants (OUtMATCH) study, which demonstrated that omalizumab increases the threshold dose of multiple food allergens needed to elicit an allergic reaction. Despite the demonstrated efficacy in food allergy and favorable safety profile, many questions remain. This review addresses the efficacy of omalizumab for the management of food allergy, as monotherapy, and in conjunction with oral immunotherapy. Safety in children is paramount, and this review addresses noted adverse events of anaphylaxis and malignancy. There is minimal knowledge with regard to the real-world impact on food allergy-related quality of life. Many questions still remain, including identifying who is the ideal patient for omalizumab, determining the role of oral food challenges before and during therapy with omalizumab, evaluating food allergy tolerance while on treatment, and optimizing the cost-effectiveness of this efficacious and well-tolerated management option for food allergy.

Current food allergy management universally treats all patients with food allergy as being at risk for anaphylaxis (with the exception perhaps of pollen food allergy syndrome). Thus, patients are told to avoid the allergenic food in all potentially allergic forms and amounts. However, research over the past 2 decades has shown that many patients will tolerate small amounts of the allergen without any allergic reaction. Thus, if one were able to identify the threshold of reactivity, this could change management. At the population level, establishing levels at which the vast majority of patients (e.g., 95%) do not react could have public health ramifications, such as altering labeling laws. At the individual patient level, personal threshold levels could determine avoidance strategies, affect quality of life, and alter treatment decisions, e.g., oral immunotherapy starting doses. In this review, threshold data for various allergens and their potential effect on the management of the patient with food allergy are examined.

Food allergy prevention has undergone a significant transformation over the past 3 decades. This review provides an overview of the evolution of food allergy prevention, highlighting changes in guidance, cost-effectiveness of prevention, the role of shared decision-making, and the emergence of oral immunotherapy for those in whom primary prevention fails. Changes to food allergy prevention over recent decades can be conceptualized into five epochs, which have followed a general trend of loosening restrictions on the allergen introduction timeline. These epochs are characterized by significant maternal and infant dietary restrictions in the "universal avoidance epoch"(-1990), loosened maternal diet restrictions in the "infant avoidance epoch" (1990-2000), a time-bound allergen introduction schedule in the "stratified avoidance epoch" (2000-2010), retraction of recommendations in the "corrective retraction epoch" (2010-2015), and endorsement of early allergen introduction in the "early introduction epoch" (2015-present), the start of which is marked by the 2015 Learning Early About Peanut study. In hindsight, it is clear that certain recommendations from previous decades were not the best course of action. A no-screening early introduction approach to food allergy prevention is both cost-effective and beneficial to patient quality of life.

A food reaction history is the basis of food allergy diagnoses. Several levels of food allergy diagnostic testing can confirm or refute the presence of food allergy. The choice of food allergy testing modality should be informed by the reaction history and determined by the testing goals. Testing modalities include skin-prick testing, in vitro specific immunoglobulin E testing, component-resolved testing, epitope threshold testing, and basophil activation testing. The goal of food allergy testing may be merely to confirm the diagnosis of food allergy or may be used to guide passive (avoidance) or active (allergen immunotherapy) management. The most appropriate diagnostic path should consider testing predictive value, the goal of the evaluation, patient and family food allergy anxiety, and cost. Peanut allergy testing provides an algorithm for testing pathways.