Food allergy

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d933 (Published 24 February 2011) Cite this as: BMJ 2011;342:d933
  1. Penny Fitzharris, specialist in clinical immunology and allergy1,
  2. Jan Sinclair, specialist in paediatric clinical immunology and allergy2
  1. 1Auckland City Hospital, Auckland 1023, New Zealand
  2. 2Starship, Auckland 1023, New Zealand
  1. pennyf{at}adhb.govt.nz

New guidelines are useful despite patchy and often poor quality evidence

Food allergy is common. In high income countries the prevalence is 3-7% in children and 1-2% in adults, and prevalence is increasing in developing countries.1 The need for guidelines on how to manage food allergies has been identified internationally. In the United Kingdom, reports from the House of Lords and the Department of Health identified gaps in the knowledge and skills of clinical practitioners dealing with the diagnosis of allergy and in planning, commissioning, baseline data, and research.2 3


A recent commissioned systematic review from the United States disappointingly concluded that “the evidence on the prevalence, diagnosis, management, and prevention of allergies is voluminous, diffuse and critically limited by the lack of uniformity for the diagnosis of a food allergy, severely limiting conclusions about best practices for management and prevention.”4 Why is the evidence base poor, and in view of this, how useful are recently developed guidelines?

One problem is the breadth of conditions included in the usual definition of food allergy—an immunologically mediated adverse reaction to food, with immediate, late phase, and delayed hypersensitivity reactions all included. Immediate (IgE mediated) allergy may be mild (for example, perioral urticaria or oral allergy syndrome) or severe (for example, anaphylaxis); conditions with …

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