reference of food allergy of two pages
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Food Allergy Guidelines
Diagnosis and management of food allergy can vary between clinical practice settings. To promote the best clinical practices, the National Institute of Allergy and Infectious Diseases (NIAID) sponsored clinical guidelines for the diagnosis and management of food allergy in the United States.6 The 43 guidelines were based on an independent literature review and expert clinical opinion and provide concise recommendations on how to diagnose, manage, and treat food allergy. They also identify gaps in the current scientific knowledge and provide guidance on points of controversy in patient management (Table 79.10). The NIAID Food Allergy Guidelines are available online (http://www.niaid.nih.gov/topics/foodallergy) in a full format, an executive summary, and a lay-language summary for patients, families, and caregivers. The guidelines have been updated in 2017 to recommend early peanut introduction into the diet of infants with severe atopic dermatitis or egg allergy, considered to be at high risk for peanut allergy.150
The diagnostic approach to food allergy begins with the medical history and physical examination. These assessments guide the selection of the laboratory tests (Fig. 79.1). The value of the medical history largely depends on the patient's recollection of symptoms and the examiner's ability to differentiate between disorders provoked by food hypersensitivity and other causes (Table 79.1). In some cases, it may be useful in diagnosing food allergy (e.g., acute events such as systemic anaphylaxis after isolated ingestion of shrimp), but history alone should never be used to make a diagnosis.5
In several series, less than 50% of reported food-allergic reactions could be verified by DBPCFCs. Information required to establish that a food-allergic reaction occurred and to construct an appropriate blinded challenge at a later date include the following: the food presumed to have provoked the reaction, the quantity of the suspected food ingested, the length of time between ingestion and development of symptoms, whether similar symptoms developed on other occasions when the food was eaten, whether other factors (e.g., exercise, alcohol, drugs) are necessary, and how long since the last reaction to the food occurred. In chronic disorders (e.g., atopic dermatitis, asthma, chronic urticaria), the history is often an unreliable indicator of the offending allergen.
Diet diaries are frequently discussed as an adjunct to history. Patients are instructed to keep a chronologic record of all foods ingested over a specified period, including items placed in the mouth but not swallowed, such as chewing gum. Any symptoms experienced by the patient are also recorded. The diary is then reviewed to determine whether there are any relationships between foods ingested and symptoms experienced. Occasionally, this method detects an unrecognized association between a food and a patient's symptoms. Unlike the medical history, it collects information on a prospective basis and does not depend on a patient's memory. This approach should be used selectively, because it often causes patients and families to focus obsessively on foods instead of other potential triggers of their reactions.