Food allergy—A holistic approach to dietary management. A joint EAACI Research & Outreach Committee and INDANA review

Abstract

Following a diagnosis of IgE‐mediated food allergy, to secure the best outcome, the patient should receive individualized advice tailored to their specific needs, which considers the type and presentation of the food involved, level of exclusion required, risk of cross‐contamination and any variance required for age, ethnicity, financial issues, and lifestyle. Issues such as food labels “may contain” statements, and variation in the threshold of reaction and impact of cofactors should also be considered. Most important is the need to ensure that the diagnosis is robust, especially given the nutritional, psychological, and socioeconomic issues that can affect an individual with a diagnosis of food allergy. Unnecessary exclusion of one or more foods that have not triggered allergic reactions, especially in individuals with allergic comorbidities, can result in severe IgE‐mediated reactions on re‐exposure. Given that food allergies may change over time, the diagnosis should be reviewed, to determine whether resolution is likely, or new‐food triggers are reported. Regular assessment is vital, especially during childhood, to ensure reintroduction occurs at an appropriate time, thus enabling increased diversity of the diet and improvement in the quality of life. For some, an IgE‐mediated food allergy may necessitate the life‐long exclusion of foods, and for others, a food habitually eaten suddenly triggers an allergic reaction in adult life. People of all ages, ethnicities, and socioeconomic backgrounds deserve individual advice on the management of their food allergy to support a healthy diet and improve quality of life.

Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO

“…Dietary interventions and exercise may improve asthma control in these children 92 . In addition, asthmatic children with multiple food allergies have increased risk for severe exacerbations, 93,94 and elimination diets may result in inadequate nutrient intake and impaired growth 95,96 . Hence, early dietary input may facilitate the overall management of the patient.…”

Nutritional and Psychosocial Impact of Food Allergy in Pediatric Age

“…Noncompliance with dietary and medical recommendations for food allergies is prevalent despite the potentially life-threatening consequences [ 65 ]. Among adolescents and young individuals, full adherence to exclusion diets and carrying adrenaline autoinjectors may be as minimal as 17–21% [ 66 ].…”

“…Among adolescents and young individuals, full adherence to exclusion diets and carrying adrenaline autoinjectors may be as minimal as 17–21% [ 66 ]. Factors influencing adherence encompass age, race, social networks, financial status, challenges with food labeling comprehension, bullying, mental health assistance, and smoking habits [ 65 ]. Globally, access to allergy services varies significantly, often resulting in prolonged wait times to consult a healthcare provider or even a complete lack of support [ 65 ].…”

“…Factors influencing adherence encompass age, race, social networks, financial status, challenges with food labeling comprehension, bullying, mental health assistance, and smoking habits [ 65 ]. Globally, access to allergy services varies significantly, often resulting in prolonged wait times to consult a healthcare provider or even a complete lack of support [ 65 ]. Specifically, there is a shortage of specialized psychologists to aid individuals with food allergies [ 67 ].…”

“…Managing food allergies, particularly egg and milk allergies and peanut and tree nut allergies, highlights the importance of personalized approaches. While complete avoidance of allergenic foods may not always be necessary, partial avoidance coupled with the introduction of baked forms has shown promise in expanding dietary options and improving the quality of life of affected individuals [ 65 , 70 ]. For egg and milk allergies, completely avoiding all forms may not always be necessary [ 70 ].…”