Not only your child but also his friends and their parents should understand how serious the condition is and how important it is to avoid the allergen in any form. Update information regularly at the start of each school year and as new facts become available.

In this regard, it is important to report accurate information, ie, definite food allergies, not minor food sensitivities. US labeling laws require disclosure of peanut, tree nuts eg, almond, hazelnut, walnut , milk, egg, wheat, soy, fish, and crustacean shellfish ingredients in packaged manufactured foods.

When a tree nut, fish, or crustacean shellfish is an ingredient, the type must be disclosed eg, walnut, cod, shrimp. Therefore, to play it safe, these foods are best avoided. If your child is allergic to a food not covered by the law, you have to be extra careful.

In some cases, you may need to contact a manufacturer to get additional information about ingredients. Whenever in doubt, just avoid that food.

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Turn off Animations. Turn on Animations. Our Sponsors Log in Register. Log in Register. Ages and Stages. Healthy Living. Safety and Prevention. Family Life. Systematic reviews to assess the benefit or harm of H1 antihistamines for the treatment of anaphylaxis have been conducted.

Randomized and quasi-randomized controlled trials to compare this therapy with placebo or no intervention have been sought. However, no studies have satisfied inclusion criteria Nurmatov et al. The medications presumably help to relieve cutaneous symptoms but no studies regarding effect on other symptoms of anaphylaxes or progression of reactions have been conducted.

Combination treatment with H1 and H2 antihistamines may have additional efficacy compared to H1 antihistamines alone for cutaneous symptoms Lin et al. Oral in preference to intravenous administration is recommended for relief of cutaneous symptoms Ellis and Brown, ; Muraro et al.

The onset of action of antihistamines e. Studies to determine the benefit or harm of antihistamines in anaphylaxis would be useful. Oral or intravenous glucocorticoids are often used in anaphylaxis to theoretically prevent protracted symptoms or late onset of symptoms and also to address concomitant asthma.

A systematic review was undertaken with the intention to perform a meta-analysis to assess benefits and harms of glucocorticoid treatment during anaphylaxis, but no randomized or quasi-randomized controlled trials comparing glucocorticoids to any control were identified and so no meta-analysis could be undertaken Choo et al.

Therefore, therapy with glucocorticoids, which have a slow onset of action, are used in anaphylaxis without clear evidence and are based on expert opinion Boyce et al. Studies on the utility of glucocorticoids in anaphylaxis could inform therapeutic approaches.

No consensus in the literature exists on the optimal time for observation of the patient who has experienced anaphylaxis, although 4 to 6 hours has been suggested, or longer if the patient experienced hypotension Boyce et al.

Based on current guidelines, discharge planning or long-term management should include a written anaphylaxis emergency action plan, encouraging medical identification jewelry, and having epinephrine auto-injectors typically two always available, a plan for monitoring auto-injector expiration, a plan for arranging further evaluation as needed, printed information about anaphylaxis and its treatment, and consideration for referral to specialist for further evaluation.

It also is recommended to have instructions on the proper use of epinephrine auto-injectors and indications for use, advice about allergen avoidance, and additional information regarding a dietitian consult and support groups Boyce et al.

As reviewed above, discharge and long-term management of patients with food allergy who are at risk for anaphylaxis has some potential pitfalls. Nutritional and psychological concerns are described below.

Adequate nutrition is important for normal child development and growth. When allergen avoidance is the one recommendation to minimize the risk of an allergic reaction, children could end up deficient on specific nutrients or calories if attention to their nutrition is not considered.

The most common allergenic foods contain nutrients whose removal may reduce diet quality i. For example, cow milk has protein, fat, calcium, vitamin D, and riboflavin; wheat in fortified cereals contains carbohydrates, iron, thymine, niacin, riboflavin, and folate; egg includes protein, fat, iron, and riboflavin; and fish and shellfish are sources of protein, fat, and omega-3 fatty acids.

When cow milk is avoided, substitutions are typically needed to account for lost nutrients Fiocchi et al. However, these beverages are not equivalent to cow milk in terms of fat, protein, calories, and other essential nutrients Groetch et al.

Specifically, an infant with a diagnosed cow milk allergy will typically tolerate formulas approved for use in these circumstances, such as extensively hydrolyzed casein—based or amino acid—based formula, or soy formula, as medically necessary following a diagnostic evaluation.

However, partially hydrolyzed milk—based formula is not typically appropriate for an infant with a diagnosed cow milk allergy Lee et al.

Infants with food allergy may have nutritional concerns related to their elimination diets or to underlying chronic illness.

For example atopic dermatitis or GI inflammation can interfere with nutrient absorption or result in increased caloric needs Jarvinen et al.

No RCTs have addressed whether food allergen avoidance affects growth and nutritional status of infants and children. Multiple studies, primarily observational and cross-sectional, suggest that food allergy may be associated with impaired growth Cho et al.

It has particularly been noted that growth may be impaired in those avoiding cow milk Hobbs et al. For example, Tiainen et al. Long-term outcomes for those on a childhood milk avoidance diet can include increased risk of reduced bone mineral density and increased risk of early osteoporosis Nachshon et al.

Having multiple food allergies appears to put children at increased risk of decreased growth, due to the reduced food and total energy intake Cho et al. For example, Christie et al. compared children with food allergy to healthy controls and found that children with two or more food allergies were shorter than those with one, and children with cow milk or multiple food allergies were less likely to consume sufficient dietary calcium Christie et al.

Meyer et al. noted that children with food allergies were more underweight than the general UK population, which was linked to the number of foods excluded Meyer et al.

However, they also noted cases of obesity despite dietary elimination. Although data are limited Berni Canani et al. Evidence-based specific dietary guidance for children with food allergy is lacking Groetch et al.

However, the data suggest that by individualizing dietary counseling, dietary intakes and nutritional status can be improved and growth impairment may be prevented. Daily management of food allergy is focused on avoiding trigger foods and recognizing and managing allergic reactions, some of which are life-threatening.

These considerations practically affect the routine of daily living and also carry psychological burdens that can result in anxiety and stress. Measurement of health-related quality of life HRQL helps determine the impact of disease on an individual, which may vary among individuals even if disease severity is similar.

Tools to measure HRQL may be generic or disease specific. Generic instruments allow comparison between disorders, while disease-specific instruments are more sensitive for measuring the burden of disease and identifying changes caused by interventions.

A systematic review was undertaken to identify validated instruments specific to food allergy disease Salvilla et al. Seventeen eligible studies were retrieved and seven disease specific HRQL instruments were subjected to detail quality appraisal.

These seven were found to have robust psychometric properties Cohen et al. The authors also concluded that further work is required to understand clinically important differences in score appraisal of patients with food allergy. Using this systematic review, guidelines were developed for using specific instruments based on the type of food allergy, research or clinical applications, inclusion or exclusion of comorbidities, patient age, language and cultural issues, the preferred respondent, and target population Muraro et al.

This review pointed out that the instruments have been used in research settings only to provide quantitative information on the HRQL of patients with IgE-mediated food allergy and to assess the effect of interventions and determine outcomes.

Studies to recommend use of these instruments at the individual patient level are insufficient. Additionally, the review offered a number of research recommendations, including a need to: determine optimum methods of administration, frequency, and interpretation; identify which instruments, if any, are valid to guide clinical practice of individual patients; determine efficacy of the instruments for evaluating medical and technological advances, patient satisfaction and quality of care, and health and regulatory policy; include these instruments to explain different pathways in the development, expression, and impact of chronic diseases; articulate norms for age, sex, and country or culture; explain the relationship between responses to both proxy and self-report measures; develop optimum methods for evaluating measures in patients with comorbid conditions; and, determine how quality-adjusted life years for food allergy can be developed to help inform policy.

Aside from validated HRQL instruments, the practical emotional concerns of daily management of food allergies can result in distress. Food-specific HRQL instruments generally query on issues such as holiday plans, restaurants, social activities, time for preparing meals or other meal-related events, taking precautions, troubles in having to carry medications, worry about health issues, not being able to get help for a reaction, other's lack of understanding about the allergy, attending school or work activities safely, having a normal life, anxiety, and worry about the allergy or reactions Cohen et al.

The degree of impact on HRQL can vary based on knowledge of food allergies, age, having had experiences such as emergency room visit for anaphylaxis, an injection of epinephrine, or multiple food allergies, or allergies to specific foods e. Various factors may affect the distress, anxiety, and psychological aspects of a food allergy diagnosis and management.

Additionally, the impact may vary based on age, role, and time living with a diagnosis. Compared to mothers of children without chronic illness, mothers of children with food allergy have increased anxiety and stress Lau et al.

For example, a study of families with a child having peanut allergy revealed that mothers compared to fathers reported lower psychological and physical quality of life and more stress and anxiety King et al.

This study also found that children with food allergy had greater separation anxiety than their siblings. Another study noted that mothers of children with food allergy were more empowered than fathers of children with food allergy, but empowerment was not associated with higher HRQL Warren et al.

One study found that maternal anxiety and a child's attitude toward food allergy were associated with child distress for children ages 8 to 17 years Lebovidge et al.

Another study found that child anxiety and parental stress significantly predicted parental report of their child's HRQL, and that child anxiety, parenting stress, length of diagnosis, and receiving epinephrine predicted self-reported HRQL Roy and Roberts, A study using various scales to determine anxiety and depression found that among parents being evaluated for a first-time allergy clinic appointment for suspected food allergy in their child, 33 percent reported mild to severe anxiety and 18 percent reported depression, with no significant change 1 month after the visit Knibb and Semper, Studies have focused on teens and young adults as well.

A small qualitative study of adolescents and their parents found that having a child with anaphylaxis can have a significant long-term psychological impact on the parents, and in some cases, this anxiety may be transferred to the adolescents Akeson et al.

Over time, adolescents with food allergy experienced increases in generalized anxiety disorder and depression, but having food allergy was not associated with a higher likelihood of having a diagnosed psychiatric disorder Shanahan et al. An online study of 86 food-allergic and healthy adults ages 18 to 22 years evaluated autonomy, anxiety, depression, and perception of parental behavior.

The study indicated that, although food allergic young adults did not differ from healthy ones, those who experienced anaphylaxis described their disease as more severe, were more worried, and indicated their parents as more protective then those who had not experienced anaphylaxis Herbert and Dahlquist, Additionally, for adolescents and young adults, having a food allergy may be associated with dating anxiety, interference with physical intimacy, and fear of a negative evaluation by peers Hullmann et al.

Bullying has been another focus of study among psychosocial aspects of food allergy. Episodes of bullying appear to be more common among children with food allergy compared to peers and can take the form of verbal and physical events Lieberman et al.

Bullying is significantly associated with decreased quality of life and increased distress in parents and children. Parents often may not know about their child being bullied Shemesh et al. When parents were aware of bullying, the child's quality of life was better and distress was reduced.

Food-related bullying often persists over time, although it is less likely to continue if parents intervene Annunziato et al. The AAAAI Guidelines specifically suggests that physicians inquire about behavioral changes because of food allergy—related bullying Sampson et al. Overall, the relationship of a chronic disease such as food allergy and psychosocial problems is complex.

A systematic review and meta-analysis of 43 studies suggested a positive association between psychosocial factors and future atopic disorders and current atopic disorders and future poor mental health, but studies of food allergy were insufficient to comment on this disease separately Chida et al.

Determinants of food allergy—related cognition, emotion, and behavior are complex and understudied DunnGalvin et al. Interventions pertaining to reducing the psychosocial impact of food allergy are few. It appears that food allergy interventions themselves can result in improvement.

For example, measures of food-specific HRQOL showed improvement for those on desensitization therapy in small or uncontrolled studies Arasi et al.

Also, anxiety may decrease and HRQL may improve following a diagnostic OFC, whether the outcome confirms an allergy or not Franxman et al.

However, no comprehensive, evidence-based protocols exist for the clinical management of psychosocial concerns related to food allergy, and studies are few. Availability of a hour helpline for expert management improved quality of life for participants randomized to this intervention Kelleher et al.

A pilot study of a telephone-based intervention teaching parents self-regulation for chronic disease management resulted in improvement in some components of HRQL Baptist et al. Data to understand the value of support groups for food allergy are limited Sharma et al.

Referral to a mental health professional would presumably be of value, if indicated, to improve psychosocial health concerns. Unfortunately, one study of mental health screening of families with food allergy failed to result in a greater consultation rate with a mental health professional compared to a referral by the patient's allergist Shemesh et al.

An expert review on the topic of addressing the psychosocial aspect of food allergy on a patient-level basis suggested that medical providers can validate feelings, normalize the challenge of balancing management with participation in daily activities, and provide education about food allergy and its psychosocial impact, with referral to a mental health expert when indicated Herbert et al.

In conclusion, food allergy may affect different aspects of mental health and HRQL. Health professionals should address these issues. However, more information is needed to refine understanding about identification, prevention, and management of these issues.

The following summarizes approaches under investigation to treat food allergy. This is not meant to be a comprehensive review of risks and benefits of these approaches, nor a compendium of all approaches under study, but rather an overview with summaries of expert reports and suggested additional references.

The committee did not make an assessment in regard to which treatment modalities have more promise in the future nor where the research gaps exist.

A number of food allergy treatment strategies are under investigation. Examples that are furthest along in study and are allergen-specific include oral, sublingual, and epicutaneous immunotherapy. Oral immunotherapy OIT involves ingesting the food allergen in gradually increasing amounts.

Sublingual immunotherapy SLIT takes a similar approach but the allergen is retained for a period under the tongue and much lower doses are used compared to OIT. Epicutaneous immunotherapy EPIT involves placement of a membrane impregnated with allergen on the skin.

That is, these treatment approaches may raise the threshold of reactivity while the therapy is in progress, while cessation of therapy may result in loss of protection.

A curative therapy would not depend upon daily treatments to maintain a threshold where the food can be ingested without concerns for dose ingested or other factors that may alter the safe ingestion of the food e. Approaches that are not allergen-specific also have been suggested.

For example, omalizumab is a humanized monoclonal antibody against IgE that is approved for use in recalcitrant allergic asthma and for chronic hives. It may increase the threshold of reactivity to allergens and may, in co-administration with OIT, allow more rapid dosing with fewer symptoms Begin et al.

Studies with a similar agent suggested an increased threshold to peanut during oral food challenges Leung et al. The EAACI Guidelines concluded that allergen-specific immunotherapy is promising, but is associated with risks, including anaphylaxis and is not recommended for routine clinical use Muraro et al.

These Guidelines p. although it represents a promising treatment modality. The AAAAI Guidelines similarly concluded that immunotherapeutic approaches such as OIT show promise, but are not ready for implementation in clinical practice because of inadequate evidence of therapeutic benefit over risks Sampson et al.

The field of allergen-specific immunotherapy is rapidly progressing. A number of systematic reviews and meta-analyses have addressed the utility of immunotherapy primarily OIT and SLIT for food allergy.

A meta-analysis of milk OIT identified five trials. The authors noted the poor quality of the trials and concluded that treatment could lead to desensitization in a majority of individuals.

Although most were mild, a major drawback was the frequency of side effects Yeung et al. A systematic review and meta-analysis of milk oral OIT identified six qualifying articles and concluded that it was effective for treating IgE-mediated cow milk allergy because significantly more patients were desensitized on treatment compared to those on an avoidance diet.

The treatment was considered reasonably safe because side effects were mild to moderate and intramuscular epinephrine was rarely required Martorell Calatayud et al. A review and meta-analysis of peanut OIT Sheikh et al. Although most were minor, some were potentially life-threatening.

They concluded that the treatment was promising for short- or medium-term management of carefully selected patients, but that more robust studies were needed and that OIT should not be administered outside of carefully designed clinical trials.

A meta-analysis Sun et al. These immunotherapies were determined to have a positive effect on peanut allergy OR: The authors cautioned that the findings were based on a small number of trials and larger, well-designed and double-blind RCTs are needed.

A review of pediatric SLIT Larenas-Linnemann et al. A meta-analysis Nurmatov et al. The meta-analysis revealed a lower risk of reactions on treatment risk ratio [RR]: 0. Additionally, SPT responses significantly decreased mean difference: —2. Safety data showed an increased risk of local oral-pharyngeal and gastrointestinal adverse reactions with treatment RR: 1.

Also, a non-significant increased average risk of systemic adverse reactions occurred with treatment RR: 1. The authors concluded that OIT can induce immunomodulatory changes and thereby promote desensitization. However, based on limited evidence on long-term efficacy and safety, as well as cost-effectiveness, they concluded that the treatment should not currently be used outside of experimental conditions.

Overall, these reviews and meta-analyses are in agreement with the guidelines noted above. However, OIT is being used clinically by a number of practice settings with various motivations Greenhawt and Vickery, ; Pajno et al.

Phase 3 studies are currently under way for OIT and EPIT. Numerous other approaches have been tried or are in development, such as a panoply of biologics, immune adjuvants, modified protein vaccines, traditional Chinese medicine practices, probiotics, and many others Bauer et al.

Clearly, many strategies can be pursued to address treatment of food allergy. Management in the health care setting involves education about the daily strategies that patients need to follow to avoid allergen ingestion and to recognize and treat reactions promptly. Although these management approaches begin in the health care setting, success often requires involvement at the community level see Chapter 8.

Allergen avoidance, usually strict avoidance even of trace amounts of allergen, is the primary means of management. This requires significant education and caution throughout the day.

In addition, it relies upon others in the community to provide safety, seriously affects quality of life, and increases anxiety. Counseling about avoidance involves emphasizing key concerns, such as cross-contact and hidden ingredients and discussing foods related to the diagnosed allergens, which may need to be avoided upon a full food allergy evaluation.

Counseling is directed to managing food allergies at home, reading labels and knowing about products that are not included in mandatory labeling laws , asking questions when eating in restaurants and during travel, and, for children, avoiding food allergens when away from home e.

Such counseling should address common pitfalls that have been identified in a variety of studies. However, data to be able to provide individualized risk assessments upon which to base instructions regarding avoidance and emergency management are limited.

Also, limited programs exist for educating patients, caregivers, and other stakeholders, with few evidence-based programs to ensure effectiveness, and limited information exists on implementation.

Adolescents and young adults appear to be at increased risk for fatal anaphylaxis, and their risk-taking behavior has been identified as a possible cause.

Emergency management depends upon recognizing a reaction and promptly instituting therapy. Epinephrine is the primary treatment for anaphylaxis, with auto-injectors having fixed doses used for first-aid care.

However, dosing of epinephrine has not been extensively studied and current auto-injectors may not provide appropriate doses for infants or individuals with obesity. Anaphylaxis is often underrecognized and undertreated. A number of risk factors have been identified for anaphylaxis, but there are no means to reliably predict severity of anaphylaxis.

Medications used as primary and adjunctive therapy for anaphylaxis have not been studied. Post-anaphylaxis care includes observation in the medical setting to ensure resolution of symptoms, prescription of medications, education on avoidance and management, and possibly referral for additional testing and management.

However, numerous pitfalls to these strategies have been identified. Avoidance diets, particularly ones involving milk or multiple foods, can affect nutrition and growth and dietitian intervention is warranted. However, data on best practices are limited. Considering the significant impact of food allergy on quality of life and emotional status, information on how best to approach these issues is severely lacking.

In addition, data on aspects of management for adults are sparse. Emerging studies show promising results for desensitizing specific allergens but more information is needed about the safest and most effective approaches and how they may be individualized based on patients allergies and needs.

The committee did not wish to repeat all reasonable management recommendations that are already noted in professional guidelines, committee reports, and practice parameters.

However, the committee emphasizes some key research recommendations in alignment with such reports where the study findings suggest areas of high need and frequent deficits in management. Numerous clinical guidelines and parameters provide advice for health care providers and patients and their caregivers on diagnosing, preventing, and managing food allergy.

The committee generally supports current guidelines and U. practice parameters for food allergy management and the committee emphasizes those areas where improvements would lead to significant changes in the quality of life of patients and their caregivers, such as training and education of the general public and all stakeholders.

The committee recommends that the Centers for Disease Control and Prevention work with other public health authorities to plan and initiate a public health campaign for the general public, individuals with food allergy, and all relevant stakeholders to increase awareness and empathy as well as to dispel misconceptions about food allergy and its management.

For example, as part of that campaign and taking advantage of the popularity of digital media among the public, particularly children and adolescents, public health authorities could develop effective media engagement programs. To plan for this campaign and develop media programs, public health authorities could conduct formative research with all potential audiences.

For example, current evidence is insufficient to associate any of the following behaviors with prevention of food allergy: food allergen avoidance diets for pregnant or lactating women, prolonged allergen avoidance in infancy, vaginal delivery, breastfeeding, infant formulas containing extensively or partially hydrolyzed protein, and supplementation with specific nutrients e.

The committee recommends that medical schools as well as residency and fellowship programs and other relevant schools include training for health care providers in the management of food allergy and anaphylaxis.

Health care providers, including dietitians and mental health professionals, also should receive training on approaches to counseling patients and their caregivers. Counseling training is envisioned to be provided, in part, by professional organizations through various means, including the Internet.

The following elements of food allergy training are appropriate for all health care providers, including emergency medical technicians, emergency room staff, nurses, dietitians, and others:. As appropriate, physicians and other health care providers also may receive training to provide the following:.

The committee recommends that health care providers counsel patients and their caregivers on food allergies following the most recent food allergy guidelines and emphasizing the need to take age-appropriate responsibility for managing their food allergy.

Counseling is particularly important for those at high risk of food allergy and severe food allergy reactions, such as adolescents, young adults, and those with both food allergy and asthma. The committee recommends that health care providers and others use intramuscular epinephrine adrenaline in all infants, children, and adults as a first line of emergency management for episodes of food allergy anaphylaxis.

The Food and Drug Administration should evaluate the need for, and, if indicated, industry should develop an auto-injector with 0. Current auto-injectors have 0. Consensus is currently lacking on first aid management using available auto-injectors when managing infants.

A dose of 0. Labeling the auto-injectors in a standard manner to differentiate doses also could be beneficial. The committee recommends that organizations, such as the American Red Cross or the National Safety Council, who provide emergency training e. Food allergy management primarily requires avoiding the trigger allergen s , but this approach requires extreme care; knowledge of cross-contact, hidden ingredients, and the effect of processing; and knowledge of ingredients through label reading and other methods.

It is prone to accidents resulting in allergic reactions. Numerous obstacles arise for food-allergic consumers attempting to obtain safe meals outside the home. Surveys among individuals with food allergy, caregivers, and health care providers reveal deficiencies in food allergy knowledge and concerns about accidents, especially among adolescents and young adults.

Only limited programs are available for educating individuals, caregivers, and health care providers on strategies to obtain and provide safe meals outside the home, with few validated programs and limited information on implementation.

In addition, validated, evidence-based dietary guidance is lacking for those avoiding allergens, such as milk or multiple foods. Knowledge about potential interventions that health professionals could use to improve individual psychosocial status, such as to improve quality of life or alleviate anxiety, also is lacking.

In regard to management, some areas of research need further study. For example, no means are currently available to reliably predict severity of anaphylaxis, which would be valuable for health care providers, individuals with food allergy, and their caregivers.

In terms of managing anaphylaxis, underuse of epinephrine, the primary treatment for anaphylaxis, is common but the reasons are unknown. In addition, the fixed doses of epinephrine in auto-injectors may not be appropriate for infants or for individuals with obesity.

Also, medications used as primary and adjunctive therapy for anaphylaxis e. Standardized emergency plans for individuals that can be used by caregivers at home or school also do not exist.

To address those gaps in knowledge, the following research areas should be pursued on all affected populations ages, sexes, ethnicities, comorbidities, socioeconomic strata , especially on underrepresented populations:. The section on packaged foods below describes the current regulatory frameworks for food labeling of packaged foods that attempt to inform consumers of the presence of an allergen in a food.

Aerosolizing is the process or act of converting some physical substance into the form of particles small and light enough to be carried on the air. Homology between proteins is defined in terms of shared ancestry and is typically inferred from the similarity of their amino acid sequence.

Case series design studies are considered to be vulnerable to selection bias because they, for example, might draw their patients from a particular population and might not represent the wider population.

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Show details National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Food Allergies: Global Burden, Causes, Treatment, Prevention, and Public Policy; Oria MP, Stallings VA, editors.

Contents Hardcopy Version at National Academies Press. Search term. EDUCATING PATIENTS ABOUT ALLERGEN AVOIDANCE This section presents several topics where health care providers should provide advice to their patients with food allergy.

Strictness of Allergen Avoidance Typically persons with a food allergy are advised to strictly avoid the trigger food Boyce et al. Allergen Avoidance and Relationship to Comorbid Asthma, Atopic Dermatitis, and Allergic Rhinitis Food allergen avoidance is generally not recommended as a primary means to address treatment of asthma, atopic dermatitis, or allergic rhinitis.

Concerns About Cross-Reactive Foods Food with proteins that are homologous 3 to a food protein to which an individual is allergic may present a reaction risk Boyce et al.

ADVICE ON ALLERGEN AVOIDANCE IN VARIOUS SETTINGS OF CONCERN Packaged Foods Laws governing the labeling of allergens in packaged foods vary by country Akiyama et al. Management at Home Management of food allergen avoidance in the home requires constant vigilance regarding cross contact, label reading, and hidden ingredients.

Management in Food Service Settings and During Travel People who are food allergic must navigate multiple issues when dining away from home, including avoiding cross-contact and hidden ingredients in foods served at food service establishments such as restaurants, ice cream parlors, bakeries, grocery stores with prepared foods, and food carts see also Chapter 8.

Management in Schools and Child Care Centers Supervision of children and procedures to provide safe foods in early care and education settings, schools, and summer camp settings is required to avoid allergen exposure and to recognize and promptly treat allergic or anaphylactic reactions.

Educational Needs Although it is incumbent upon health care providers to educate patients and families, these providers have noted deficits in understanding food allergy and anaphylaxis management, as described in Chapter 2.

High-Risk Groups Several guidelines e. Advice on Allergens in Nonfood Items and Alcoholic Beverages Allergens in Pet Foods, Cosmetics, and Topical Products A variety of noningested products include allergens, which requires caution on the part of consumers when allergen disclosures may not be included.

Allergens in Vaccines, Medications, and Dietary Supplements Physicians and patients with food allergy must consider potential food allergen exposures in vaccines, medications, and dietary supplement products e.

Allergens in Alcoholic Beverages Allergic or allergic-like reactions can occur from alcoholic beverages. Definition of Anaphylaxis, Diagnosis, and Differential Diagnosis Anaphylaxis has been described as a severe, life-threatening, generalized or systemic hypersensitivity reaction Muraro et al.

Nature of Anaphylaxis Anaphylaxis involves more than one organ system e. Risk Factors Asthma, Certain Foods, Cofactors and Risk Assessment A number of comorbid diseases may affect the severity and treatment response of anaphylaxis Boyce et al.

Medical Treatment of Anaphylaxis Epinephrine, typically prescribed as auto-injectors for self-injection for first aid management, is first-line therapy for food-induced anaphylaxis and is recommended to be injected intramuscularly anterolateral thigh into the vastus lateralis muscle Boyce et al.

Post-Anaphylaxis Long-Term Management Based on current guidelines, discharge planning or long-term management should include a written anaphylaxis emergency action plan, encouraging medical identification jewelry, and having epinephrine auto-injectors typically two always available, a plan for monitoring auto-injector expiration, a plan for arranging further evaluation as needed, printed information about anaphylaxis and its treatment, and consideration for referral to specialist for further evaluation.

Public Health Authorities, Health Care Providers, and Their Patients and Caregivers The committee recommends that the Centers for Disease Control and Prevention work with other public health authorities to plan and initiate a public health campaign for the general public, individuals with food allergy, and all relevant stakeholders to increase awareness and empathy as well as to dispel misconceptions about food allergy and its management.

The following elements of food allergy training are appropriate for all health care providers, including emergency medical technicians, emergency room staff, nurses, dietitians, and others: Emergency management. This includes training to recognize and manage an anaphylaxis emergency, such as the use of intramuscular epinephrine as a first line of emergency management for episodes of anaphylaxis.

Counseling on food allergy management and anaphylaxis. This includes identifying food allergies as well as managing and treating them in various settings e. Nutrition counseling. This includes discussion of safe and nutritionally adequate avoidance diets to individuals with food allergies, particularly children and their caregivers.

The training also could include offering referral to a dietitian when needed and as part of reimbursable care. In addition, dietitians may receive training in providing individualized dietary advice to people with food allergies and their caregivers.

Psychosocial counseling. This includes identifying and discussing with patients and caregivers psychosocial concerns e. Training also could include offering referral to a mental health professional when needed and as part of reimbursable care.

In addition, mental health professionals may receive training in counseling individuals with food allergy and their caregivers. Training First Responders and First Aiders The committee recommends that organizations, such as the American Red Cross or the National Safety Council, who provide emergency training e.

RESEARCH NEEDS Health Care Settings Food allergy management primarily requires avoiding the trigger allergen s , but this approach requires extreme care; knowledge of cross-contact, hidden ingredients, and the effect of processing; and knowledge of ingredients through label reading and other methods.

To address those gaps in knowledge, the following research areas should be pursued on all affected populations ages, sexes, ethnicities, comorbidities, socioeconomic strata , especially on underrepresented populations: Determine the effectiveness of evidence-based guidelines and evidence-based educational programs on food allergy management, including avoidance of allergens and emergency management of allergic reactions and anaphylaxis, for health care providers and for patients, particularly for high-risk groups.

the identification of means to recognize clinically relevant versus nonrelevant allergen cross-reactivity. Identify risk factors and biomarkers of food-induced anaphylaxis, particularly to identify individuals at high risk of severe reactions. Assess the safety and efficacy of adjunctive therapies for anaphylaxis, especially bronchodilators, antihistamines, and corticosteroids.

Devise safe and effective therapies for food allergy, including those that can induce long-term desensitization and tolerance i. Evaluate whether consulting with a dietitian or a mental health professional improves quality of life and understand barriers to referring patients to dietitians or mental health professionals.

Explore the best means to identify and intervene about psychosocial concerns associated with managing food allergy. Identify best practices for providing a uniform written emergency action plan for anaphylaxis. Consider using the recent American Academy of Pediatrics guidelines as the reference for a best practice study.

Determine the proper dose of epinephrine in infants less than 10 kg and in individuals with obesity. Characterize risks associated with non-oral allergen exposures e. The use of epinephrine in the treatment of anaphylaxis. AAAI Board of Directors. J Allergy Clin Immunol.

AAAAI BOD. Anaphylaxis in schools and other childcare settings. AAAAI Board of Directors. American Academy of Allergy, Asthma and Immunology.

Abdurrahman ZB, Kastner M, Wurman C, Harada L, Bantock L, Cruickshank H, Waserman S. Experiencing a first food allergic reaction: A survey of parent and caregiver perspectives.

Allergy Asthma Clin Immunol. Agata H, Kondo N, Fukutomi O, Shinoda S, Orii T. Effect of elimination diets on food-specific IgE antibodies and lymphocyte proliferative responses to food antigens in atopic dermatitis patients exhibiting sensitivity to food allergens.

Ahuja R, Sicherer SH. Food-allergy management from the perspective of restaurant and food establishment personnel. Ann Allergy Asthma Immunol. Akeson N, Worth A, Sheikh A.

The psychosocial impact of anaphylaxis on young people and their parents. Clin Exp Allergy. Akiyama H, Imai T, Ebisawa M. Japan food allergen labeling regulation—History and evaluation. Take them while also avoiding allergens. If you are at risk for anaphylaxis , keep your epinephrine auto-injectors with you at all times.

Epinephrine is the only treatment for a severe allergic reaction. It is only available through a prescription from your doctor. Each prescription comes with two auto-injectors in a set. Keep a diary. Track what you do, what you eat, when symptoms occur and what seems to help. This may help you and your doctor find what causes or worsens your symptoms.

Wear a medical alert bracelet or necklace. If you have ever had a severe allergic reaction, please wear a medical alert bracelet. This bracelet lets others know that you have a serious allergy.

It can be critical if you have a reaction and you are unable to communicate. Know what to do during an allergic reaction. Have a written anaphylaxis emergency action plan. It tells you and others what to do in case you have allergic symptoms or a severe allergic reaction.

Minus Related Pages. We wanted to learn more about what restaurant staff knew and believed about food allergies. We interviewed and watched restaurant managers, food workers, and servers, and we looked at related records at restaurants to find out how many restaurants train their staff on food allergies, have ingredient lists available for customers, and provide special equipment and areas for making food for customers with food allergies or require that staff wipe down work surfaces and wash equipment before making said food.

Staff knew more about food allergies if they Worked in restaurants with a plan for serving customers with food allergies. Had more experience in their restaurant. Staff may not be prepared to serve customers with food allergies.

Training often did not cover important information such as what to do if a customer has an allergic reaction. Some managers and staff incorrectly believed someone with a food allergy could safely eat a small amount of that allergen.

Some staff thought others in their restaurant might not know what to do if a customer had an allergic reaction. Restaurants can take key steps to serve allergen-free food to customers. Scientific articles this plain language summary is based on: Restaurant Food Allergy Practices — Six Selected Sites, United States, Food Allergy Knowledge and Attitudes of Restaurant Managers and Staff: An EHS-Net Study [PDF — KB] Food Allergens Study study information Preventing Food Allergies in Restaurants blog More EHS-Net publications by Study Topic More Food Safety Study Findings in Plain Language.

What Is EHS-Net? Page last reviewed: July 7, Content source: National Center for Environmental Health , Division of Environmental Health Science and Practice. home EHS. EHS Resources. About EHS EHS Publications EHS Training EHS A — Z Index EHS Listserv EHS News and Features.

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You will be subject to the destination website's privacy policy when you follow the link. An Anaphylaxis Emergency Plan can be shared with extended family, housemates, babysitters or anyone else who comes into your home.

Quick Facts Home is the perfect place for you and your family to learn how to manage food allergy, because so much more is under your control.

You decide which foods enter your home. You can set up household rules to prevent cross-contamination when storing, preparing and serving food. You have more time to read food labels and, for parents of children with food allergy, teach your child this skill in a relaxed setting.

Always have an Anaphylaxis Emergency Plan and an auto-injector at home. Ideally you should keep at least two auto-injectors on hand, in case you need a second dose during an allergic reaction. Download an Anaphylaxis Emergency Plan. Remember The kitchen refrigerator is a great place to post a copy of your emergency plan.