Closing the Knowledge Gap: New food allergy guidelines provide clarity to some otolaryngologists

In a departure from past recommendations, the panel concluded that there was insufficient evidence to suggest that women should restrict their diet while pregnant or nursing (Guideline 36). “I think that takes a big load off the minds of parents, particularly those who have food allergy in the family,” Dr. Reisacher said.

Perhaps even more noteworthy to many otolaryngologists was the recommendation that “introduction of solid foods should not be delayed beyond 4 to 6 months of age,” including the introduction of potentially allergenic foods (Guideline 40). “The prior thinking was that you had to withhold milk for a year, eggs for two years, and nuts and seafood for three years, and now they’re saying that there’s really no reason to withhold anything beyond four to six months,” Dr. Reisacher said.

“That’s a very big change in what was advised previously,” said Dr. Mahoney, who noted that the new recommendations are in agreement with the American Academy of Pediatrics’ (AAP) own recently revised guidelines (Pediatrics. 2008;121(1):183-91).

Dr. Simon said the major revision has come as the result of some surprising new research. “There’s some data suggesting that we may have completely missed the boat on this one, and that potentially earlier introduction of food may actually be a good idea,” he said. “At that point, the infant’s immune system is very, very underdeveloped, and it may accept the food and get tolerant to it, whereas if you wait longer, when the immune system has really matured, that’s when it’s going to see it as something foreign and then develop the allergy. So we may have had this really backwards.”

Vaccines

The guidelines include another change in the recommendations on which vaccines grown in chick embryos can be safely administered to patients with a history of severe reactions to egg protein (Guideline 31). The recommendation on administering flu vaccine is less clear-cut than that of other vaccines, reflecting both a lack of firm evidence and the observation that “egg allergy is relatively common among the very patients who would highly benefit from influenza vaccination,” according to the document.

“A huge problem that we have, particularly with the flu epidemic and H1N1, is people coming in who have had sensitivities and reactions to egg not knowing whether or not they should receive a flu shot,” Dr. Reisacher said. In issuing some guidance, he said the latest recommendations by the NIAID are somewhat less conservative than previous advice from the American Academy of Pediatrics.”