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Allergy “CliffsNotes” – Guidelines for Diagnosis and Management

Published in last December’s issue of The Journal of Allergy and Clinical Immunology are the revised guidelines for the diagnosis and management of food allergy in the United States. In a press call, Dr. Hugh Sampson of Mount Sinai School of Medicine, New York, and Dr. Matthew Fenton of the National Institutes of Health, Bethesda, discussed three important points brought out in the Guidelines.

First, there is a fairly wide consensus that the prevalence of food allergies shows a remarkable upswing over the past 10 to 20 years across all ages. It is estimated that about 3-4% of the U.S. population or a staggering 10 to 12 million people are affected by food allergies. Interestingly, although allergen specific-IgE antibodies generally appear within the first two years of life, adults can develop de novo sensitization to food allergens encountered after childhood. Untreated, allergies may be a risk factor for life-threatening asthma exacerbations and anaphylaxis.

Second, food allergy represents a moving target in children. About 80% of those who develop food allergies at a young age will outgrow them. However, the loss of childhood allergies is a variable process and depends on the individual child and the type of allergen. High initial levels of allergic antibody in the child are associated with a lower rate of symptom resolution over time. Egg and milk allergy, two of the most common food allergies seen in very young children, are frequently outgrown by the teenage years. However, peanut, tree nut and seafood allergies seem to be more persistent and are often life-long. Children with these allergies tend to outgrown them in less than 10-20% of cases.

Third, Dr. Sampson considers the confusion between allergic sensitization and clinical reactivity to be one of the most common issues faced by physicians in patient allergy work-up. Although an increasingly higher serum concentration of the allergic antibody, or a larger skin response size from prick/puncture testing, correlate with increasing risk of clinical reaction, a positive test to any particular food item merely indicates sensitization. Sensitization indicates that the patient has an increased probability above normal that he/she will react, but there is no guarantee and no prediction on the severity of the reaction. This, according to Dr. Sampson, requires test interpretation by the physician based on the history of the patient and often times oral food challenge to determine whether or not the sensitization translates into clinical reactivity. The Guidelines recommends allergen-specific serum IgE as one method to assist in the identification of food-induced allergic reactions.

US BioTek Laboratories offers serum specific-IgE for common food and inhalant allergens through semi-quantitative ELISA. Our ELISA utilizes standard curve traceable to World Health Organization (WHO) IgE standards for enhanced immunoassay performance. For full test panel information on our allergen-specific IgE, please click here.

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