Food allergy may pose a significant burden on patients, families, and health care systems, and pediatricians are essential in providing care for these patients, according to a review article.
In a review, published in Frontiers in Pediatrics, investigators summarized the current recommendations for pediatricians in diagnosing, managing, and preventing immunoglobulin E (IgE)-mediated food allergy. The review emphasized the importance of early introduction of allergenic foods, such as peanuts, to infants and the critical role pediatricians play in educating and supporting parents through this process.
The investigators noted that in scenarios where allergist availability is limited—as is often the case in rural, Medicaid, and minority populations—pediatricians can assist in evaluating and managing food allergy by providing action plans, education, and counseling for patients and families.
The review outlined the steps for diagnosing IgE-mediated food allergy, including taking a thorough medical history, documenting comorbidities and family history, and utilizing specific IgE and skin prick testing. A comprehensive medical history should involve documenting all foods eaten prior to the reaction, severity and duration of symptoms, time elapsed between ingestion of the food and the onset of symptoms, and response to medications. An IgE-mediated reaction is suspected when the onset of symptoms is less than 2 hours after ingestion.
The investigators noted that pediatric patients with food allergy often present with comorbidities such as atopic dermatitis, asthma, and/or allergic rhinitis, since these conditions are linked by the "atopic march." The presence of comorbidities may affect symptom severity and treatment response, with uncontrolled asthma being a risk factor for severe anaphylaxis. Atopy in parents can also increase the risk of atopic conditions in pediatric patients, particularly atopic dermatitis and food allergy.
The review emphasized that medical history alone is not sufficient to diagnose food allergy and should be supplemented by testing, including specific IgE and/or skin prick testing. Both tests are highly sensitive but nonspecific, which may lead to false positive results. Therefore, these tests should generally only be undertaken when the patient presents with a history of reaction to a given food.
In some cases, an oral food challenge may be needed to definitively diagnose food allergy. Oral food challenges are considered the most effective available tests to evaluate the presence of allergic reactivity to foods but must be performed by an experienced allergist because of the risk of severe reactions.
Management of food allergy primarily involves strict avoidance of the allergen and having an emergency plan in place, including the use of injectable epinephrine. The investigators highlighted the importance of educating patients and caregivers on the proper use of epinephrine and addressing any hesitancy to use it when needed.
The review further discussed the evolving treatment landscape for food allergy, including the recent U.S. Food and Drug Administration approval of peanut oral immunotherapy and omalizumab for the treatment of food allergy, as well as other investigational therapies such as subcutaneous, sublingual, and epicutaneous immunotherapy.
The authors emphasized the crucial role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy and the importance of a multidisciplinary approach involving allergists, nurses, dieticians, and pharmacists to optimize patient care as new diagnostic tools and therapies become available.
Conflict of interest declarations can be found in the review article.