Acute and long-term management of food allergy: systematic review

Authors

  • D. de Silva,

    1. The Evidence Centre, London
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  • M. Geromi,

    1. The Evidence Centre, London
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  • S. S. Panesar,

    1. Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
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  • A. Muraro,

    1. Department of Pediatrics, Center for Food Allergy Diagnosis and Treatment, Veneto Region, University of Padua, Padua, Italy
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  • T. Werfel,

    1. Hanover Medical School, Hanover, Germany
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  • K. Hoffmann-Sommergruber,

    1. Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
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  • G. Roberts,

    1. David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport
    2. NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton
    3. Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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  • V. Cardona,

    1. Hospital Vall d'Hebron, Barcelona, Spain
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  • A. E. J. Dubois,

    1. Division of Paediatric Pulmonology and Paediatric Allergy, Department of Paediatrics, University Medical, Centre Groningen, University of Groningen, Groningen, the Netherlands
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  • S. Halken,

    1. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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  • A. Host,

    1. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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  • L. K. Poulsen,

    1. Laboratory of Medical Allergology, Allergy Clinic, Copenhagen University Hospital, Gentofte, Denmark
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  • R. Van Ree,

    1. Departments of Experimental Immunology and Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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  • B. J. Vlieg-Boerstra,

    1. Department of Pediatric Respiratory Medicine and Allergy, Academic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
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  • I. Agache,

    1. Transylvania University, Brasov, Romania
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  • A. Sheikh,

    Corresponding author
    1. Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
    2. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
    • Correspondence

      Aziz Sheikh, MD, FRCGP, FRCP, FRCPE, Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom

      Tel.: +44 (0)131 651 4151

      Fax: +44 (0)131 650 9119

      E-mail: Aziz.Sheikh@ed.ac.uk

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  • and on behalf of the EAACI Food Allergy and Anaphylaxis Guidelines Group

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    • EAACI Food Allergy and Anaphylaxis Guidelines Group: C. A. Akdis, R. Alvarez, K. Beyer, C. Bindslev-Jensen, P. Demoly, P. Eigenmann, M. Fernandez Rivas, G. Lack, M. J. Marchisotto, B. Niggemann, C. Nilsson, N. Papadopoulos, I. Skypala, M. Worm.

  • Review registration: PROSPERO registration number CRD42013003708.
  • Edited by: Pascal Demoly

Abstract

Background

Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts.

Methods

Seven bibliographic databases were searched from their inception to September 30, 2012, for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-and-after and interrupted time series studies. Experts were consulted for additional studies. There was no language or geographic restrictions. Two reviewers critically appraised the studies using the appropriate tools. Data were not suitable for meta-analysis due to heterogeneity so were narratively synthesized.

Results

Eighty-four studies were included, but two-thirds were at high risk of potential bias. There was little evidence about acute management for non-life-threatening reactions. H1-antihistamines may be of benefit, but this evidence was in part derived from studies on those with cross-reactive birch pollen allergy. Regarding long-term management, avoiding the allergenic food or substituting an alternative was commonly recommended, but apart from for infants with cow's milk allergy, there was little high-quality research on this management approach. To reduce symptoms in children with cow's milk allergy, there was evidence to recommend alternatives such as extensively hydrolyzed formula. Supplements such as probiotics have not proved helpful, but allergen-specific immunotherapy may be disease modifying and therefore warrants further exploration.

Conclusions

Food allergy can be debilitating and affects a significant number of people. However, the evidence base about acute and longer-term management is weak and needs to be strengthened as a matter of priority.

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