Kirsi M. Järvinen

Disclosures

Curr Opin Allergy Clin Immunol. 2011;11(3):255-261. 

In This Article

What is the Natural History and Long-term Management?

The persistence of food allergy is variable and depends on the specific food allergen. Cow's milk allergy will be outgrown in 64% by age 12 years,[66] egg allergy in 37% by age 10 years,[67] and wheat allergy in 65% by 12 years.[68] In contrast, only 20% of children with peanut allergy and 9% with tree nut allergy will develop tolerance.[69,70] The rate of decrease in food-specific IgE levels over time has been shown to have predictive value.[71]

All patients with food allergy, and especially food-induced anaphylaxis, should be educated about the signs and symptoms of anaphylaxis and the correct use of an epinephrine auto-injector together with written instructions on its proper administration into the lateral thigh intramuscularly and an anaphylaxis treatment plan. Otherwise healthy young children who weigh 10–25 kg (22–55 lb) should be prescribed auto-injectors with 0.15 mg of epinephrine and those who weigh approximately 25 kg (55 lb) or more should be prescribed auto-injectors with 0.30 mg of epinephrine.[72] For children who weigh less than 10 kg (22 lb), the risks and benefits of delay in dosing and dosing errors when an ampule/syringe/needle is used against accepting nonideal auto-injector doses should be weighed. Prospective studies are needed to establish rational guidelines for prescribing one or more doses for a growing number of food-allergic patients.

Currently, the only treatment for food-induced anaphylaxis is strict dietary avoidance. Educating the patient regarding dietary avoidance of the food allergen(s) includes stressing the importance of constant reading of package labels and advisory labeling, and asking questions regarding the food to be consumed. Effective care also requires a comprehensive management approach involving schools, camps, and other youth organizations, and education of supervising adults with regard to recognition and treatment of anaphylaxis. A medical identification bracelet or necklace is also recommended.

Development of therapies to prevent the food-induced anaphylaxis is a vigorous research area. Promising therapies under investigation are both allergen specific and nonspecific, including humanized monoclonal anti-IgE antibodies and Chinese herbal medications, as well as oral, sublingual, and cutaneous immunotherapy (desensitization). They also include use of mutated recombinant proteins, co-administered with heat-killed Escherichia coli and peptide immunotherapy.[73••]

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