Food Allergies Treatment & Management

  • Author: Scott H Sicherer, MD; Chief Editor: Michael A Kaliner, MD   more...
 
Updated: Mar 7, 2012
 

Approach Considerations

The only proven medication therapy against a food allergy is strict elimination of the offending food allergen from the diet and avoidance of any contact with the food by ingestion, skin contact, inhalation, or injection.

In 2010, Guidelines for the Diagnosis and Management of Food Allergy in the United States were published. These provide evidenced-based, expert panel recommendations for the diagnosis and management of food allergies.[65] The guidelines do not cover issues for schools, which are of interest to pediatricians, but a 2010 Clinical Report reviews this topic area.[66]

Injectable epinephrine is the drug of choice for the initial management of a food-induced anaphylactic reaction. Ensure that the patient has self-injectable epinephrine readily available at all times. Advanced medical therapy of food allergen–induced anaphylaxis may include antihistamines, bronchodilators, histamine 2 (H2) blockers, corticosteroids, and administration of intravenous fluids, glucagon, and oxygen. In severe anaphylaxis, ventilatory and circulatory support may be needed.

Next

Diet

A properly managed, well-balanced elimination diet (eg, allergen restriction) can lead to resolution of symptoms and help to avoid nutritional deficiencies.

Educate the patient and family about how to properly read food labels and identify common words used for indicating the presence of the food allergen of concern. US labeling laws now require major allergens (ie, egg, milk, wheat, soy, peanut, tree nuts, fish, crustacean shellfish) to be identified as ingredients on manufactured food products using plain English terms. Note that not all potential allergens are included and that some may be subsumed under terms such as spices or natural flavor. Advisory labels (eg, may contain) are not regulated, are voluntary, and may reflect variable risks.

Meal preparation must consider avoidance of cross contact (eg, through shared utensils or fryers) of allergens with otherwise safe foods.

With elimination diets, exclude only those foods confirmed to provoke allergic reactions. Review obvious and hidden sources of food allergens. Be aware of the potential for exposures by routes other than ingestion, such as skin contact, or inhalation. This concern is particularly problematic for foods while they are being cooked, because proteins are dispersed in the steam (eg, frying fish, boiling milk). Educate patients about the potential for food allergens to be present in medications and cosmetics.

Anticipate potential candidates for food allergen cross-reactivity, such as the following:[26]

  • Eggs and chicken (< 5% of patients have both allergies)
  • Cow milk and beef (10% of patients with milk allergy react to beef)
  • Cow milk and goat milk (>90% allergic to cow milk also react to goat/sheep milk)
  • Fish (>50% allergic to any finned fish are reactive to all types)
  • Peanuts and other legumes (< 10% with a peanut allergy react to other legumes)
  • Soy and other legumes (< 5% with a soy allergy react to other legumes)
  • Wheat and other grains (25% with a wheat allergy react to rye and barley)
  • Tree nuts and other nuts (>50% with an allergy to a tree nut react to others)

Encourage avoidance of high-risk situations (eg, buffets, picnics) where accidental or inadvertent ingestion of food allergens can occur. Instruct patients to discuss their food allergies with restaurant and food establishment personnel.

Previous
Next

Emergency Plan

Despite following stringent avoidance measures for clinically relevant food allergens, accidental or inadvertent ingestions may occur. Therefore, patients must be instructed on actions to take in the event of a reaction. A concise written plan for the treatment of allergic reactions resulting from accidental exposure to a patient’s food allergen should be developed. Have copies of this plan available in appropriate places (eg, daycare, schools, work locations, college dormitory advisors). Examples of such a plan can be downloaded from www.foodallergy.org.

Patients with food allergies should be advised to obtain and wear medical identification jewelry indicating their food allergies.

Ensure that the patient has an emergency contact number available (eg, 911, their physician's office phone number, or a local emergency department) that can be used in the event of a major food-induced allergic reaction.

Anticipatory guidance measures cannot be overemphasized; for example, educate the patient about potential sources of accidental exposure to relevant food allergens (eg, daycare, school, travel, picnics, dining out).

Previous
Next

Emergency Medications

Injectable epinephrine is the drug of choice for the initial management of a food-induced anaphylactic reaction. Ensure that the patient has self-injectable epinephrine readily available at all times. Also ensure that the patient receives proper training regarding when and how to use the injection device. An antihistamine should also be available. Patients with food allergies and asthma should always have access to a rapid-acting bronchodilator.

Self-injectable epinephrine is typically available by prescription (ie, EpiPen, EpiPen Jr, Twinject 0.3mg, Twinject 0.15mg). These devices should be stored properly (avoiding extremes of temperature) and replaced before the expiration date.

Previous
Next

Future Therapeutics

There are currently no curative therapies for food allergy. Injection immunotherapy is an accepted treatment for anaphylactic allergy to insect venoms and for environmental allergies, but it poses a high risk for food allergies (anaphylaxis to injected native food proteins).[73, 74]

Studies are underway to determine if oral or sublingual immunotherapy is safe and effective for food allergies, with some promising results.[75, 76] However, additional studies are needed to define the safety profile and side effects (short term and long term) and to determine whether treatment affects resolution of the allergy (tolerance without repeated dosing of the allergen) or desensitization (an increased threshold while undergoing dosing).[77, 78]

Studies are underway to determine whether therapies with modified food proteins are safe and effective. Additional therapeutics may in the future be derived from investigations of anti-IgE antibodies and cytokine and anti-cytokine therapies, as well as from the evaluation of traditional Chinese medicine.

Previous
Next

Consultations

Consultation with a board-certified allergist/immunologist should be considered when food allergy is suspected or confirmed.

Consultation with a nutritionist or nutrition service is invaluable in the overall management of food allergies. The elimination diet can be reviewed and appropriate substitutions can be recommended. Dietary deficiencies can be anticipated and prevented.

Consultation with a gastroenterologist is also useful in the evaluation of selected patients. For example, patients who present with possible anatomic gastrointestinal abnormalities, eosinophilic esophagitis or gastroenteritis, failure to thrive, and malabsorption syndromes may benefit from consultation with an allergist and a gastroenterologist.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Scott H Sicherer, MD  Professor of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine of New York University

Scott H Sicherer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD  Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy

Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians

Disclosure: Alcon Consulting fee Consulting; Teva Consulting fee Consulting; Meda Honoraria Speaking and teaching; Ista Consulting fee Consulting; sunovian Consulting fee Consulting; dey Honoraria Review panel membership

Additional Contributors

Dan Atkins, MD Assistant Professor, Department of Pediatrics, University of Colorado Health Sciences Center; Head, Division of Ambulatory Pediatrics, Department of Pediatrics, Director, Pediatric Day Program, National Jewish Medical and Research Center

Dan Atkins, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American Thoracic Society

Disclosure: Nothing to disclose.

Stephen C Dreskin, MD, PhD Professor of Medicine, Departments of Internal Medicine, Director of Allergy, Asthma, and Immunology Practice, University of Colorado Health Sciences Center

Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American Association of Immunologists, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, and Joint Council of Allergy, Asthma and Immunology

Disclosure: Genentech Consulting fee Consulting; American Health Insurance Plans Consulting fee Consulting; Johns Hopkins School of Public Health Consulting fee Consulting; Array BioPharma Consulting fee Consulting

John M James, MD Consulting Staff, Department of Pediatrics, Department of Allergy and Immunology, Colorado Allergy and Asthma Centers, PC

John M James, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, American Medical Association, Colorado Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. May 2004;113(5):832-6. [Medline].

  2. Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. Apr 2007;119(4):1016-8. [Medline].

  3. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol. Sep 1999;104(3 Pt 2):S114-22. [Medline].

  4. Burks AW, James JM, Hiegel A, et al. Atopic dermatitis and food hypersensitivity reactions. J Pediatr. Jan 1998;132(1):132-6. [Medline].

  5. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics. Mar 1998;101(3):E8. [Medline].

  6. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr. Nov 1985;107(5):669-75. [Medline].

  7. Sampson HA, Scanlon SM. Natural history of food hypersensitivity in children with atopic dermatitis. J Pediatr. Jul 1989;115(1):23-7. [Medline].

  8. David TJ, Waddington E, Stanton RH. Nutritional hazards of elimination diets in children with atopic eczema. Arch Dis Child. Apr 1984;59(4):323-5. [Medline].

  9. Lever R, MacDonald C, Waugh P, Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol. Feb 1998;9(1):13-9. [Medline].

  10. Ortolani C, Ispano M, Pastorello E, et al. The oral allergy syndrome. Ann Allergy. Dec 1988;61(6 Pt 2):47-52. [Medline].

  11. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. Oct 2007;133(4):1342-63. [Medline].

  12. Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol. Jul 2011;128(1):3-20.e6. [Medline].

  13. Powell GK. Food protein-induced enterocolitis of infancy: differential diagnosis and management. Compr Ther. Feb 1986;12(2):28-37. [Medline].

  14. Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics. Apr 2003;111(4 Pt 1):829-35. [Medline].

  15. Odze RD, Wershil BK, Leichtner AM, Antonioli DA. Allergic colitis in infants. J Pediatr. Feb 1995;126(2):163-70. [Medline].

  16. James JM. Respiratory manifestations of food allergy. Pediatrics. Jun 2003;111(6 Pt 3):1625-30. [Medline].

  17. Bock SA. Respiratory reactions induced by food challenges in children with pulmonary disease. Pediatr Allergy Immunol. 1992;3:82.

  18. James JM, Eigenmann PA, Eggleston PA, Sampson HA. Airway reactivity changes in asthmatic patients undergoing blinded food challenges. Am J Respir Crit Care Med. Feb 1996;153(2):597-603. [Medline].

  19. Roberts G, Patel N, Levi-Schaffer F, et al. Food allergy as a risk factor for life-threatening asthma in childhood: a case-controlled study. J Allergy Clin Immunol. Jul 2003;112(1):168-74.

  20. Weber RW. Food additives and allergy. Ann Allergy. Mar 1993;70(3):183-90. [Medline].

  21. Chehade M, Mayer L. Oral tolerance and its relation to food hypersensitivities. J Allergy Clin Immunol. Jan 2005;115(1):3-12; quiz 13. [Medline].

  22. Vickery BP, Scurlock AM, Jones SM, Burks AW. Mechanisms of immune tolerance relevant to food allergy. J Allergy Clin Immunol. Mar 2011;127(3):576-84. [Medline].

  23. Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol. Jun 2008;121(6):1331-6. [Medline].

  24. Sicherer SH, Eigenmann PA, Sampson HA. Clinical features of food protein-induced enterocolitis syndrome. J Pediatr. Aug 1998;133(2):214-9. [Medline].

  25. Abernathy-Carver KJ, Sampson HA, Picker LJ, Leung DY. Milk-induced eczema is associated with the expansion of T cells expressing cutaneous lymphocyte antigen. J Clin Invest. Feb 1995;95(2):913-8. [Medline].

  26. Sicherer SH. Clinical implications of cross-reactive food allergens. J Allergy Clin Immunol. Dec 2001;108(6):881-90. [Medline].

  27. Commins SP, Satinover SM, Hosen J, Mozena J, Borish L, Lewis BD, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. Feb 2009;123(2):426-33. [Medline].

  28. Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. Jan 2001;107(1):191-3. [Medline].

  29. Sloan AE, Powers ME. A perspective on popular perceptions of adverse reactions to foods. J Allergy Clin Immunol. Jul 1986;78(1 Pt 2):127-33. [Medline].

  30. Altman DR, Chiaramonte LT. Public perception of food allergy. J Allergy Clin Immunol. Jun 1996;97(6):1247-51. [Medline].

  31. Bock SA, Atkins FM. Patterns of food hypersensitivity during sixteen years of double-blind, placebo-controlled food challenges. J Pediatr. Oct 1990;117(4):561-7. [Medline].

  32. Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics. May 1987;79(5):683-8. [Medline].

  33. Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. Sep 2007;120(3):638-46. [Medline].

  34. Zuidmeer L, Goldhahn K, Rona RJ, Gislason D, Madsen C, Summers C, et al. The prevalence of plant food allergies: a systematic review. J Allergy Clin Immunol. May 2008;121(5):1210-1218.e4. [Medline].

  35. Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol. Dec 2003;112(6):1203-7. [Medline].

  36. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. Feb 2010;125(2 Suppl 2):S116-25.

  37. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol. Mar 2011;127(3):594-602. [Medline].

  38. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. Jul 2011;128(1):e9-e17. [Medline].

  39. Grundy J, Matthews S, Bateman B, Dean T, Arshad SH. Rising prevalence of allergy to peanut in children: Data from 2 sequential cohorts. J Allergy Clin Immunol. Nov 2002;110(5):784-9. [Medline].

  40. Kagan RS, Joseph L, Dufresne C, Gray-Donald K, Turnbull E, Pierre YS, et al. Prevalence of peanut allergy in primary-school children in Montreal, Canada. J Allergy Clin Immunol. Dec 2003;112(6):1223-8. [Medline].

  41. Hourihane JO, Aiken R, Briggs R, Gudgeon LA, Grimshaw KE, DunnGalvin A, et al. The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanut allergy in United Kingdom children at school entry. J Allergy Clin Immunol. May 2007;119(5):1197-202. [Medline].

  42. Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. Dec 2009;124(6):1549-55. [Medline].

  43. Wood RA. The natural history of food allergy. Pediatrics. Jun 2003;111(6 Pt 3):1631-7. [Medline].

  44. Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol. Nov 2007;120(5):1172-7. [Medline].

  45. Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol. Dec 2007;120(6):1413-7. [Medline].

  46. Savage JH, Kaeding AJ, Matsui EC, Wood RA. The natural history of soy allergy. J Allergy Clin Immunol. Mar 2010;125(3):683-6. [Medline].

  47. Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. Mar 2009;123(3):e459-64. [Medline].

  48. Assa'ad AH, Putnam PE, Collins MH, Akers RM, Jameson SC, Kirby CL, et al. Pediatric patients with eosinophilic esophagitis: an 8-year follow-up. J Allergy Clin Immunol. Mar 2007;119(3):731-8. [Medline].

  49. Romano A, Di Fonso M, Giuffreda F, et al. Diagnostic work-up for food-dependent, exercise-induced anaphylaxis. Allergy. Oct 1995;50(10):817-24. [Medline].

  50. Horan RF, Sheffer AL. Food-dependent exercise-induced anaphylaxis. Immunol Allergy Clin North Am. 1991;757.

  51. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. May 2001;107(5):891-6. [Medline].

  52. Maloney JM, Rudengren M, Ahlstedt S, Bock SA, Sampson HA. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol. Jul 2008;122(1):145-51. [Medline].

  53. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol. Oct 1997;100(4):444-51. [Medline].

  54. Wang J, Godbold JH, Sampson HA. Correlation of serum allergy (IgE) tests performed by different assay systems. J Allergy Clin Immunol. May 2008;121(5):1219-24. [Medline].

  55. Dang TD, Tang M, Choo S, Licciardi PV, Koplin JJ, Martin PE, et al. Increasing the accuracy of peanut allergy diagnosis by using Ara h 2. J Allergy Clin Immunol. Feb 29 2012;[Medline].

  56. Eigenmann PA, Sampson HA. Interpreting skin prick tests in the evaluation of food allergy in children. Pediatr Allergy Immunol. Nov 1998;9(4):186-91. [Medline].

  57. Bock SA, Lee WY, Remigio L, et al. Appraisal of skin tests with food extracts for diagnosis of food hypersensitivity. Clin Allergy. Nov 1978;8(6):559-64. [Medline].

  58. Knight AK, Shreffler WG, Sampson HA, Sicherer SH, Noone S, Mofidi S, et al. Skin prick test to egg white provides additional diagnostic utility to serum egg white-specific IgE antibody concentration in children. J Allergy Clin Immunol. Apr 2006;117(4):842-7. [Medline].

  59. Roberts G, Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol. Jun 2005;115(6):1291-6. [Medline].

  60. Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Work Group report: oral food challenge testing. J Allergy Clin Immunol. Jun 2009;123(6 Suppl):S365-83. [Medline].

  61. Bock SA, Sampson HA, Atkins FM, et al. Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual. J Allergy Clin Immunol. Dec 1988;82(6):986-97. [Medline].

  62. Spergel JM, Brown-Whitehorn T, Beausoleil JL, Shuker M, Liacouras CA. Predictive values for skin prick test and atopy patch test for eosinophilic esophagitis. J Allergy Clin Immunol. Feb 2007;119(2):509-11. [Medline].

  63. Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol. Aug 2006;17(5):351-5. [Medline].

  64. Mehl A, Rolinck-Werninghaus C, Staden U, Verstege A, Wahn U, Beyer K, et al. The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol. Oct 2006;118(4):923-9. [Medline].

  65. Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Allergy Clin Immunol. Dec 2010;126(6):1105-18. [Medline].

  66. Sicherer SH, Mahr T. Management of Food Allergy in the School Setting. Pediatrics. Dec 2010;126(6):1232-1239. [Medline].

  67. Pastorello EA, Stocchi L, Pravettoni V, et al. Role of the elimination diet in adults with food allergy. J Allergy Clin Immunol. Oct 1989;84(4 Pt 1):475-83. [Medline].

  68. Lemon-Mule H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. Nov 2008;122(5):977-983.e1. [Medline].

  69. Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. Jan 2008;121(1):183-91. [Medline].

  70. James JM, Burks AW, Roberson PK, Sampson HA. Safe administration of the measles vaccine to children allergic to eggs. N Engl J Med. May 11 1995;332(19):1262-6. [Medline].

  71. Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. Aug 26 2011;60(33):1128-32. [Medline].

  72. National Institute of Allergy and Infectious Diseases. Updated recommendations on influenza vaccine and people with egg allergy. Available at http://www.niaid.nih.gov/topics/vaccines/research/Pages/eggAllergy.aspx. Accessed September 20, 2011.

  73. Sicherer SH, Sampson HA. Food Allergy: Recent Advances in Pathophysiology and Treatment. Annu Rev Med. Aug 19 2008;[Medline].

  74. Nowak-Wegrzyn A, Sampson HA. Future therapies for food allergies. J Allergy Clin Immunol. Mar 2011;127(3):558-73. [Medline].

  75. Varshney P, Jones SM, Scurlock AM, et al. A randomized controlled study of peanut oral immunotherapy: Clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol. Mar 2011;127(3):654-60. [Medline].

  76. Kim EH, Bird JA, Kulis M, Laubach S, Pons L, Shreffler W. Sublingual immunotherapy for peanut allergy: Clinical and immunologic evidence of desensitization. J Allergy Clin Immunol. Mar 2011;127(3):640-646.e1. [Medline].

  77. Thyagarajan A, Varshney P, Jones SM, et al. Peanut oral immunotherapy is not ready for clinical use. J Allergy Clin Immunol. Jul 2010;126(1):31-2. [Medline]. [Full Text].

  78. Fisher HR, du Toit G, Lack G. Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?: a meta-analysis of published RCTs. Arch Dis Child. Mar 2011;96(3):259-64. [Medline].

  79. Simons FE. First-aid treatment of anaphylaxis to food: focus on epinephrine. J Allergy Clin Immunol. May 2004;113(5):837-44. [Medline].

  80. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. Mar 2005;115(3 Suppl 2):S483-523. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.