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

by Bryn Nelson •

Testing

Several otolaryngologists agreed that other guidelines referencing specific diagnostic methods, including skin prick testing, allergen-specific serum IgE testing and oral food challenges, are also particularly useful from a clinical standpoint and may cause some physicians to alter their practice (Guidelines 4, 5, 7 and 11).

More Information

For free access to the 43 food allergy guidelines, visit http://www.niaid.nih.gov/topics/

foodallergy/clinical/Pages/default.aspx.

The expert panel endorsed both skin prick testing and specific IgE testing for identifying foods that may be provoking an allergic reaction. The guidelines concede, however, that neither test on its own is sufficient to diagnose a clinically significant food allergy. Rather, Dr. Calhoun said, the results must be correlated with the patient’s clinical history, and, in some cases, a supervised food challenge.

Dr. Mahoney and Dr. Reisacher concurred that the recommendations do a good job emphasizing the need to test rather than rely on a patient’s self-reporting, and recognizing that skin prick and specific IgE testing require prudence and follow up because of their high rate of false positive results.

The information itself may not be new, but Dr. Reisacher said the guidelines’ comprehensive summary and categorization should help doctors better organize their approach. Perhaps most of all, he said, the document offers a benchmark for a field with many unanswered questions. “I think the biggest benefit to the guidelines is really making us realize how far we still have to go concerning food allergies, on their diagnosis and management.”

Minding the Gaps

For each of the NIAID’s 43 guidelines on food allergy, an expert panel rated the quality of available evidence. Only three guidelines merited a high-quality rating, while the evidence for 27 received a quality score of “low.”

Otolaryngologists say the notations point to a field in flux and full of big knowledge gaps. “One of the most amazing ones to me is that we actually don’t even know the prevalence of food allergy,” said panelist Ronald A. Simon, MD, an allergy expert at the Scripps Research Institute in La Jolla, Calif.

Beyond a pressing need for better studies on prevalence and incidence, several doctors said more sensitive and specific biomarkers are also high on their wish list. The panel did note a range of other testing and treatment practices in limited use throughout the country, but the assembled experts cautioned that too little evidence exists to recommend the vast majority, including intradermal testing.