Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report

• Published in: Journal of allergy and clinical immunology Vol. 126; no. 6; pp. 1105 - 1118
• Main Authors: Boyce, Joshua A., MD, Assa'ad, Amal, MD, Burks, A. Wesley, MD, Jones, Stacie M., MD, Sampson, Hugh A., MD, Wood, Robert A., MD, Plaut, Marshall, MD, Cooper, Susan F., MSc, Fenton, Matthew J., PhD, Arshad, S. Hasan, MBBS, MRCP, DM, FRCP, Bahna, Sami L., MD, DrPH, Beck, Lisa A., MD, Byrd-Bredbenner, Carol, PhD, RD, FADA, Camargo, Carlos A., MD, DrPH, Eichenfield, Lawrence, MD, Furuta, Glenn T., MD, Hanifin, Jon M., MD, Jones, Carol, RN, AE-C, Kraft, Monica, MD, Levy, Bruce D., MD, Lieberman, Phil, MD, Luccioli, Stefano, MD, McCall, Kathleen M., BSN, RN, Schneider, Lynda C., MD, Simon, Ronald A., MD, Simons, F. Estelle R., MD, Teach, Stephen J., MD, MPH, Yawn, Barbara P., MD, MPH, MSc, Schwaninger, Julie M., MSc
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2010; Elsevier; Elsevier Limited
• Subjects: Allergic diseases; Allergies; Allergy and Immunology; Biological and medical sciences; Celiac disease; Comorbidity; Digestive allergic diseases; Disease; Disease prevention; Drug dosages; Drug therapy; Epidemiology; Expert Testimony; Family medical history; Food; Food allergies; Food Hypersensitivity - diagnosis; Food Hypersensitivity - physiopathology; Food Hypersensitivity - therapy; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Medical sciences; Medicine; National Institute of Allergy and Infectious Diseases (U.S.); Oxygen therapy; Patients; Proteins; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Tropical diseases; United States; United States; North America; America; Food allergy; Immunopathology; Clinical management; Immunology; Digestive diseases; Diagnosis; Recommendation
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2010.10.008

First-line and adjuvant treatment for food-induced anaphylaxis1114 6.3.2. Despite the risk of severe allergic reactions and even death, there is no current treatment for FA: the disease can only be managed by allergen avoidance or treatment of symptoms. [...]the diagnosis of FA may be problematic, given that nonallergic food reactions, such as food intolerance, are frequently confused with FAs. Due to these concerns, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, working with more than 30 professional organizations, federal agencies, and patient advocacy groups, led the development of "best practice" clinical guidelines for the diagnosis and management of FA (henceforth referred to as the Guidelines).1 Based on a comprehensive review and objective evaluation of the recent scientific and clinical literature on FA, the Guidelines were developed by and designed for allergists/immunologists, clinical researchers, and practitioners in the areas of pediatrics, family medicine, internal medicine, dermatology, gastroenterology, emergency medicine, pulmonary and critical care medicine, and others. Bronchodilator (β2-agonist): albuterol MDI (child: 4-8 puffs; adult: 8 puffs) or Nebulized solution (child: 1.5 ml; adult: 3 ml) every 20 minutes or continuously as needed H1 antihistamine: diphenhydramine 1 to 2 mg/kg per dose Maximum dose, 50 mg IV or oral (oral liquid is more readily absorbed than tablets) Alternative dosing may be with a less-sedating second generation antihistamine H2 antihistamine: ranitidine 1 to 2 mg/kg per dose Maximum dose, 75 to 150 mg oral and IV Corticosteroids Prednisone at 1 mg/kg with a maximum dose of 60 to 80 mg oral or Methylprednisolone at 1 mg/kg with a maximum dose of 60 to 80 mg IV Vasopressors (other than epinephrine) for refractory hypotension, titrate to effect Glucagon for refractory hypotension, titrate to effect Child: 20-30 μg/kg Adult: 1-5 mg Dose may be repeated or followed by infusion of 5-15 μg/min Atropine for bradycardia, titrate to effect Supplemental oxygen therapy IV fluids in large volumes if patients present with orthostasis, hypotension, or incomplete response to IM epinephrine Place the patient in recumbent position if tolerated, with the lower extremities elevated Therapy for the patient at discharge First-line treatment: