Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-Sponsored Expert Panel report

Section 1. Introduction1.1. Overview1.2. Relationship of the US Guidelines to other guidelines1.3. How the Guidelines were developed1.3.1. The Coordinating Committee1.3.2. The Expert Panel1.3.3. The independent, systematic literature review and report1.3.4. Assessing the quality of the body of evidence1.3.5. Preparation of the draft Guidelines and Expert Panel deliberations1.3.6. Public comment period and draft Guidelines revision1.4. Defining the strength of each clinical guideline1.5. SummarySection 2. Definitions, prevalence, and epidemiology of food allergy2.1. Definitions2.1.1. Definitions of food allergy, food, and food allergens2.1.2. Definitions of related terms2.1.3. Definitions of specific food-induced allergic conditions2.2. Prevalence and epidemiology of food allergy2.2.1. Systematic reviews of the prevalence of food allergy2.2.2. Prevalence of allergy to specific foods, food-induced anaphylaxis, and food allergy with comorbid conditionsSection 3. Natural history of food allergy and associated disorders3.1. Natural history of food allergy in children3.2. Natural history of levels of allergen-specific IgE to foods in children3.3. Natural history of food allergy in adults3.4. Natural history of conditions that coexist with food allergy3.4.1. Asthma3.4.2. Atopic dermatitis3.4.3. Eosinophilic esophagitis3.4.4. Exercise-induced anaphylaxis3.5. Risk factors for the development of food allergy3.6. Risk factors for severity of allergic reactions to foods3.7. Incidence, prevalence, and consequences of unintentional exposure to food allergensSection 4. Diagnosis of food allergy4.1. When should food allergy be suspected?4.2. Diagnosis of IgE-mediated food allergy4.2.1. Medical history and physical examination4.2.2. Methods to identify the causative food4.2.2.1. Skin prick test4.2.2.2. Intradermal tests4.2.2.3. Total serum IgE4.2.2.4. Allergen-specific serum IgE4.2.2.5. Atopy patch test4.2.2.6. Use of skin prick tests, sIgE tests, and atopy patch tests in combination4.2.2.7. Food elimination diets4.2.2.8. Oral food challenges4.2.2.9. Nonstandardized and unproven procedures4.3. Diagnosis of non-IgE-mediated immunologic adverse reactions to food4.3.1. Eosinophilic gastrointestinal diseases4.3.2. Food protein-induced enterocolitis syndrome4.3.3. Food protein-induced allergic proctocolitis4.3.4. Food protein-induced enteropathy syndrome4.3.5. Allergic contact dermatitis4.3.6. Systemic contact dermatitis4.4. Diagnosis of IgE-mediated contact urticariaSection 5. Management of nonacute allergic reactions and prevention of food allergy5.1. Management of individuals with food allergy5.1.1. Dietary avoidance of specific allergens in IgE-mediated food allergy5.1.2. Dietary avoidance of specific allergens in non-IgE-mediated food allergy5.1.3. Effects of dietary avoidance on associated and comorbid conditions, such as atopic dermatitis, asthma, and eosinophilic esophagitis5.1.4. Food avoidance and nutritional status5.1.5. Food labeling in food allergy management5.1.6. When to re-evaluate patients with food allergy5.1.7. Pharmacologic intervention for the prevention of food-induced allergic reactions5.1.7.1. IgE-mediated reactions5.1.7.2. Non-IgE-mediated reactions5.1.8. Pharmacologic intervention for the treatment of food-induced allergic reactions5.1.9. Immunotherapy for food allergy management5.1.9.1. Allergen-specific immunotherapy5.1.9.2. Immunotherapy with cross-reactive allergens5.1.10. Quality-of-life issues associated with food allergy5.1.11. Vaccinations in patients with egg allergy5.1.11.1. Measles, mumps, rubella, and varicella vaccine5.1.11.2. Influenza vaccine5.1.11.3. Yellow fever vaccine5.1.11.4. Rabies vaccines5.2. Management of individuals at risk for food allergy5.2.1. Nonfood allergen avoidance in at-risk patients5.2.2. Dietary avoidance of foods with cross-reactivities in at-risk patients5.2.3. Testing of allergenic foods in patients at high risk prior to introduction5.2.4. Testing in infants and children with persistent atopic dermatitis5.3. Prevention of food allergy5.3.1. Maternal diet during pregnancy and lactation5.3.2. Breast-feeding5.3.3. Special diets in infants and young children5.3.3.1. Soy infant formula versus cow's milk formula5.3.3.2. Hydrolyzed infant formulas versus cow's milk formula or breast-feeding5.3.4. Timing of introduction of allergenic foods to infantsSection 6. Diagnosis and management of food-induced anaphylaxis and other acute allergic reactions to foods6.1. Definition of anaphylaxis6.2. Diagnosis of acute, life-threatening, food-induced allergic reactions6.3. Treatment of acute, life-threatening, food-induced allergic reactions6.3.1. First-line and adjuvant treatment for food-induced anaphylaxis6.3.2. Treatment of refractory anaphylaxis6.3.3. Possible risks of acute therapy for anaphylaxis6.3.4. Treatment to prevent biphasic or protracted food-induced allergic reactions6.3.5. Management of milder, acute food-induced allergic reactions in health care settings6.4. Management of food-induced anaphylaxisAppendix A. Primary author affiliations and acknowledgmentsAppendix B. List of abbreviationsReference