New Guidelines for Diagnosis, Treatment and Prevention of Food Allergies

The NIAID (National Institute of Allergy and Infectious Diseases) announced new guidelines and recommendations for the diagnosis, treatment and prevention of food allergies. You can find a summary of their guidelines here.

I read through the summary, and for the most part, it did not depart from the usual practice, at least as far as I have experienced it. They recommend medical history (history of immediate allergic response to food) combined with oral food challenge as necessary as the gold standard for diagnosis of food allergy, and the use of skin tests and blood tests to determine specific allergens.

One recommendation strikes me as particularly useful, and that is that the skin tests and blood tests should not be used to make the initial diagnosis of food allergy. Those tests are known for potential false positives or negatives, so it is important to combine them with the patient’s history of reactions (and/or use of an elimination diet) to be sure of the diagnosis.

I will admit, though, that I am grateful my pediatrician chose to start with a blood test to diagnose my Certain Little Someone’s allergies. Unfortunately, with a breastfeeding infant, it’s difficult to determine exactly what the specific food allergens are, especially if there are multiple ones. Trying an elimination diet via breastfeeding would be incredibly time-consuming, and his eczema was so bad that time was of the essence.  I can see, though, where the initial blood test has created some issues: in particular, peanut showed up as a slight positive, but his allergist is convinced he’s not truly allergic to peanut. However, because of his age, his propensity to allergies, and the severity of a peanut allergy, we continue to avoid peanuts and peanut products until a future blood test and/or oral food challenge can prove otherwise.

One recommendation in the guidelines I found interesting, and was glad to see: they do not advise pregnant or nursing women to eliminate allergenic foods from their diet as a preventative measure for infant food allergies. Furthermore, and what is perhaps even more surprising, they do not at all recommend avoiding potentially allergenic foods from infants even as young as 4-6 months of age. Finally the recommendations are catching up with the research! There has been some confusion within the medical community and society at large about this issue, and hopefully these recommendations will start clearing that up. It is my firm belief that if you are allergic, you will be allergic no matter when you are exposed to the food in question. In some ways, the earlier you discover the allergen, the better!

Have you read the new guidelines? What do you think about them? Agree? Disagree?


One Comment on “New Guidelines for Diagnosis, Treatment and Prevention of Food Allergies”

  1. Lisa says:

    This was very interesting to me. My son has moderate to severe eczema that we are keeping under control with steroid cream (I resisted that for a long time!). He has true allergies to a lot of foods. I know, because when he comes in contact with them he will have a reaction almost instantly. Things like wheat, milk, kiwis (of all things!), and nuts/seeds. He does well on hemp milk; not sure about coconut. We have not done official skin testing, though I have done some home skin tests (especially for nuts), and at times when he comes in contact with an allergen by accident, which has helped us narrow things down. The IgE test we did showed him highly allergic to almost everything they tested for! His IgG was also showing reactions to almost all foods.

    His doctors (except for the allergist) suspect that there is an internal problem that is causing such severe reactions, and we’re working on pinpointing the cause. In the mean time, he eats a very limited rotation diet, and he is a happy little boy about to turn two!

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