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

The cautious approach hasn’t sat well with everyone. “I have two big issues with the guidelines,” said Bruce Gordon, MD, an otolaryngologist based in Hyannis, Mass. “One, they did not deal at all with the important issue of non-IgE food allergies, and two, they generically panned intradermal testing for food allergy, when it is a useful and safe (although controversial) test for non-IgE food allergies.”

But Dr. Simon said existing studies simply don’t support a clinical indication, especially given the risk of serious anaphylactic reactions with intradermal tests. In general, he said, non-IgE food allergies remain poorly characterized.

A lack of understanding, in fact, has clouded the potential role of food allergy in several medical conditions, including eosinophilic esophagitis, atopic dermatitis and asthma.

“There seems to be a link between them and food allergies, but we’re not really at the point where we understand that linkage and how to use that information,” said William Reisacher, MD, an otolaryngologist at Weill Cornell Medical College/New York-Presbyterian Hospital. Nor, he said, have researchers really begun to examine the psychosocial aspects of food allergy as questions about quality of life and anxiety become increasingly common.

Dr. Mahoney gives the panel credit for doing the best they could with the limited information available to them. “It’s just an area where practitioners are going to have to stay current with what is being published and with what new research is going to become available to us,” she said. “Just reading these guidelines now and calling it a day is not going to be sufficient.”