Food Allergy

Meeting Summary

Developing Guidelines for the Diagnosis and Management of Food Allergy

National Institute of Allergy and Infectious Diseases (NIAID)
6610 Rockledge Drive, Room 6021
Bethesda, Maryland 20892

July 19, 2007

Objective

The primary objective of the meeting will be to determine the need for, and value of, developing guidelines that can be used by allergists, dermatologists, gastroenterologists, pulmonologists, emergency physicians, pediatricians, family practitioners, internists and other professional and lay organizations, to assist in the diagnosis, prevention and treatment of food allergy and related diseases.

Co-sponsors

National Institute of Allergy and Infectious Diseases (NIAID)
American Academy of Allergy, Asthma, and Immunology (AAAAI)
The Food Allergy & Anaphylaxis Network (FAAN)

Attendees

Hugh A. Sampson, M.D.	American Academy of Allergy, Asthma & Immunology (AAAAI)
Lawrence F. Eichenfield, M.D.	American Academy of Dermatology (AAD)
Michael E. Winters, M.D. FAAEM	American Academy of Emergency Medicine (AAEM)
Doug Campos-Outcalt, M.D., MPA	American Academy of Family Physicians (AAFP)
Scott H. Sicherer, M.D.	American Academy of Pediatrics (AAP)
Sami Bahna, M.D., Dr PH	American College of Allergy, Asthma & Immunology (ACAAI)
Wyatt W. Decker, M.D., FACEP	American College of Emergency Physicians (ACEP)
Mark B. Pochapin, M.D.	American College of Gastroenterology (ACG)
Raymond J. Dattwyler, M.D.	American College of Physicians (ACP)
David B. Corry, M.D.	American Thoracic Society
Michael Schatz, M.D., MS	Kaiser Permanente Medical Center
Barry K. Wershil, M.D.	North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)
Lawrence M. Lewis, M.D.	Society for Academic Emergency Medicine (SAEM)
Lisa A. Beck, M.D.	Society for Investigative Dermatology (SID)
Robert A. Silverman, M.D.	Society for Pediatric Dermatology (SPD)
Claire Constantikes	American Partnership for Eosinophilic Disorders (APFED)
David Bunning	The Food Allergy Project, Inc.
Robert M. Pacenza	Food Allergy Initiative (FAI)
LaDonna Williams	Inflammatory Skin Disease Institute
Matthew Fenton, Ph.D.	National Institute of Allergy and Infectious Diseases, NIH Division of Allergy, Immunology, and Transplantation
Charles Hackett, Ph.D.	National Institute of Allergy and Infectious Diseases, NIH
Marshall Plaut, M.D.	National Institute of Allergy and Infectious Diseases, NIH Division of Allergy, Immunology, and Transplantation
Daniel Rotrosen, M.D.	National Institute of Allergy and Infectious Diseases, NIH
Daniel J. Raiten, PhD.	National Institute of Child Health and Human Development, NIH Office of Prevention Research and International Programs
Gilman D. Grave, M.D.	National Institute of Child Health and Human Development, NIH
Carl C. Baker, M.D., PhD.	National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH
Madeline K. Turkeltaub, R.N., PhD.	National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH
Cheryl Lapham, Ph.D.	National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH
Alkis Togias, M.D.	National Institute of Allergy and Infectious Diseases, NIH Division of Allergy, Immunology, and Transplantation
Julie Schwaninger, M.S.	National Institute of Allergy and Infectious Diseases, NIH Division of Allergy, Immunology, and Transplantation
Virginia Taggart, M.P.H.	National Heart, Lung, and Blood Institute, NIH
Anne Muñoz-Furlong	The Food Allergy & Anaphylaxis Network (FAAN)
Regla Armengol	FAAN
Cara Schmitt	FAAN
Erin Hubbard	FAAN
Terry Furlong	FAAN

Key Discussion Points

• Representatives from each organization agreed that Guidelines for the Diagnosis & Management of Food Allergy were appropriate and necessary, and all agreed to participate in the development of these guidelines.
• Representatives agreed that:
• NIH should be an active partner in the process of developing Guidelines. NIH adds credibility and its procedures assure that the documents are unbiased, and that conflicts of interest are identified and appropriately managed.
• the Guidelines should be evidence-based, user-friendly, and relevant to the practicing clinician. Each specialty needs a subset of the guidelines focused on that specialty.
• the Guidelines should include a definition of food allergy, approaches to diagnosis of food allergy , and current knowledge of approaches to prevent and treat food allergy. (See Considerations for Guidelines below)
• the methods to develop evidence-based guidelines should be similar to the process described by several Representatives which includes a literature review, evaluating and ranking the evidence, and having a system of linking recommendations with the strength of the evidence.
• wide dissemination of the Guidelines is important, and each representative will facilitate dissemination to members of their organization Representatives will assist in developing an executive summary of the Guidelines that focuses on issues particularly relevant to each specialty represented, with the objective of publishing the executive summary in each professional society’s journal.
• the Guidelines should be a tool to drive the research agenda.
• the Guidelines should include discussion of eosinophilic gastroenteritis, but not celiac disease.

Next Steps

• Representatives requested that the NIAID send a letter to their organization acknowledging their participation in the July 19 meeting. (The letter is attached)
• Representatives will send a letter to the attention of Matthew Fenton, from their professional society, stating their interest in and support of developing food allergy guidelines. (Sample letter attached.) A copy of the letter will be sent to the NIH Institutes each society works closely with and to FAAN.
• Establish a Coordinating Committee/Steering Committee, which will include a representative from each of the organizations present. Other members of the Coordinating Committee to be considered are a Nutritionists, School Nurses, Pediatric Nurse Practitioners, Physician Assistants, otolaryngologists, and representatives from the FDA, USDA, and CDC, as well as an additional NIH Institute (NIDDK).
• The costs for developing the Guidelines will be assessed as the Guidelines are better defined, and funding considerations will be discussed in the future.
• Representatives agreed to schedule a conference call in mid-September.

Considerations for Guidelines

1. Defining what is food allergy
1. Intolerance vs. Allergy
2. Mechanisms
3. Types of reactions
2. What is the prevalence of food allergy?
1. IgE vs. non-IgE
2. pediatric vs. adults
3. demographic differences
3. What is the natural history of food allergy?
1. IgE vs. non-IgE
2. pediatric vs. adults
4. How is food allergy diagnosed?
1. history
2. skin testing
3. in vitro testing: serum specific IgE, basophil histamine release
4. elimination diets
5. food challenges; what kind?
6. what roles should the primary care physician and specialists play in the diagnosis
5. Once the diagnosis of food allergy is made, what should the patient be told?
1. dietary avoidance
1. how strictly should the allergen be avoided
2. how to interpret ingredient labels
3. what about related foods, i. should peanut-allergic patients avoid legumes
4. should peanut-allergic patients avoid tree nuts
5. in young children, should other major allergens be avoided initially
6. in young infants, should solids be delayed
2. emergency management instructions
1. who should receive epinephrine auto injectors
2. what medications should be given for particular symptoms
3. who should administer the medications
4. when should medical help be sought
6. What is the best method of treatment for acute food allergic reaction?
1. What are the most appropriate medications
2. When should epinephrine be used
3. How long should a patient be observed
4. What is the risk of a fatal reaction

back to top