Finding A Path To Safety In Food Allergy- a Summation of a review

Critical Issues in Food Allergy- Summarizing a review.

Recently, the National Academies of Sciences, Engineering, and Medicine hosted an effort to look at key issues surrounding the public health problem of food allergy. A report, ‘Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy’ was created.

A very nice summation of this work appeared in the journal Pediatrics written by Scott Sicherer, Katrina Allen, Gideon Lack, Steve Taylor, Sharon Donovan, and Maria Oria.

Key points from the review;

  1. Food Allergy involves an immune response and is one of many ways a food can cause a problem.
  2. The true prevalence of food allergy is not known. Best estimates are 1-10% of the population.
  3. Many foods can cause an allergic reaction however the most common responsible for the most serious reactions are cow’s milk, hen’s egg, peanut, tree nuts, and seafood.
  4. It was recommended that physicians use evidence-based standardized procedures as the basis for food allergy diagnosis and avoid Nonstandardized and unproven procedures.
  5. When food allergy is suspected, the patient should be evaluated by someone who has the training and experience to select and interpret appropriate diagnostic tests.
  6. Note the misconception and misunderstanding of widely available tests for food allergy- do not equate a positive skin test or blood test result as having an allergy to the food. These tests ONLY detect IgE antibody. These tests are not intrinsically diagnostic of a food allergy.
  7. The medical history is the key to the diagnosis. Food allergy should be considered when allergic symptoms occur within minutes to hours after the ingestion of a specific food, especially when they have occurred more than once.
  8. Large skin test response or elevated specific IgE levels correlate with higher risks of allergy, but sensitivity and specificity of these tests are often inadequate to confirm a diagnosis.
  9. The oral food challenge, especially when done in a double-blind fashion, is the gold standard for the diagnosis.
  10. Additional tests were not recommended and were considered unproven or non-standardized tests for food allergy include;
    • Allergen specific IgG, IgG4, or IgA
    • Provocation neutralization
    • Immune complexes
    • Human leukocyte antigen screening
    • Lymphocyte stimulation
    • Facial thermography
    • Gastric juice analysis
    • Endoscopic allergen provocation
    • Hair analysis
    • Applied kinesiology
    • Cytotoxic assays
    • Electrodermal testing
    • Mediator release assays
    • Bioresonance
    • Iridology
  11. Since sensitization alone is not diagnostic of allergy, panels of food tests should not be ordered without a rationale.
  12. Early introduction may help prevent the development of food allergy.
  13. There is limited evidence to support or discourage eliminating allergenic foods from the diet of pregnant or lactating women.
  14. Studies on the effects of partially or extensively hydrolyzed infant formulas for preventing food allergy are inconsistent and have flaws in the methods with which they were performed.
  15. Studies on the use of pre or pro biotics also have limits due to the methods used leading to the conclusion that there is no evidence to their use to decrease the risk of a food allergy.
  16. Emergency management focuses on recognition of a situation and the prompt use of epinephrine.
  17. Nutritional monitoring for children with food allergy is a major emphasis.
  18. Attention to the psychosocial part of food allergy is a major emphasis.
  19. The needs to be a major awareness campaign to dispel the myths and misconceptions regarding food allergy.
  20. Food labels need to more helpful and definitive.
  21. Schools and early child care facilities need to be included in efforts to better manage food allergy.
  22. Research needs
    • Determine the actual prevalence of food allergy
    • What is the cost of food allergy?
    • Diagnosis and prognosis
    • Risk factors
    • Prevention
    • Management in health care settings, food establishments, schools, and travel
    • Curative therapies
    • Best modalities for family and physician education about management.
    • Look to barriers to proper testing
    • Educational approaches
  23. Six Major Actions to Achieve Food Allergy Safety
    • Better information on prevalence which in turn is critical to knowing the scope of the problem
    • Improve the quality of diagnosis and provide evidence-based care
    • Evidence-based prevention strategies
    • Improved education and training to recognize, manage, and prevent reactions
    • Develop policies and related practices to help prevent and treat severe reactions
    • Most critical- address research priorities regarding diagnosis, mechanisms, risk determinants,and management. Identifying safe and effective therapies as the ultimate goal.

 

The original work was very detailed. The Consensus report whittles the details down to key learning points. My summary of the summary is intended for the reader to look further into this.

We have a FARE Center of Clinical Excellence and we have an active FARE Community Engagement Council. There are many action points here wanting for solutions. We are looking for help to make a difference.

FEL 7/25/2017

July 27, 2017 · fleickly · No Comments
Posted in: Uncategorized

Indianapolis Pollen Counts for Thursday July 20th through Monday July 24th, 2017

We are still in that pollen hiatus: that time between the end of the grass season and the beginning of the ragweed season.

Weed counts for the past 5 days have been low ranging from 1-5 grains of weed pollen per cubic meter of air sampled for the day. The weeds are mostly the same nettle and plantain that have been out there for weeks. Recently, a few chenopod weeds have shown themselves.

Pollen Counts 7-20 to 7-24

 

 

 

 

 

 

FEL 7/25/2017

July 25, 2017 · fleickly · No Comments
Tags: , ,  · Posted in: Pollen Counting- Indianapolis, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis

Indianapolis Pollen Counts for Tuesday July 18th and Wednesday July 19th, 2017

Not much to sneeze at for the past two days. Tuesday the weed count was 3 (low) and today it was 1 grain of weed pollen per cubic meter of air sampled for the day. Tuesday was a mix of nettle and plantain and today it was just a few pollen of the weed plantain.

Weed 7-18 & 7-19

 

 

 

 

 

 

Grass was barely detectable on Tuesday at 0.7 grains of grass pollen per cubic meter of air sampled and today there were no grass pollens at all. Of note the grass season ended last year on July 19th.

 

FEL 7/19/2017

July 19, 2017 · fleickly · No Comments
Tags: , , ,  · Posted in: Grass Pollen Counts Indianapolis, Pollen Counting- Indianapolis, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis

Indianapolis Pollen Counts for July 14 through 17, 207

Low levels for both grass and weed pollen Friday through Monday.

Weed pollen;

  • Friday 4
  • Saturday 4
  • Sunday 3
  • Monday 1

The weeds were still plantain and nettle.

Weed Pollen 7-14-7-17

 

 

 

 

 

 

Grass pollen;

  • Friday 4
  • Saturday 2
  • Sunday 1
  • Monday 3

Grass 7-14 to 7-17

 

 

 

 

 

 

FEL 7/17/2017

 

July 17, 2017 · fleickly · No Comments
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Support FARE at the Indianapolis FARE FOOD ALLERGY Heroes Walk – Saturday August 19th, 2017

FARE’s Food Allergy Heroes Walk is Saturday August 19th at White River State Park in Downtown Indianapolis – 10:00 am.

July 13, 2017 · fleickly · No Comments
Tags: ,  · Posted in: FARE, FARE Center of Clinical Excellenc, FARE Walk Indianapolis, Food Allergies, Food Allergy Community Events

Indianapolis Pollen Counts Tuesday July 11th through Thursday July 13th , 2017

Not much going on. The rain or the fact that it is July may have something to do with the lack of pollen activity recently. There has been a significant amount of rain this year. According to Indy Star we have had 35.63 inches of rain this year compared to last year’s 23.54. Rain will help plant growth, however many plants do not thrive in flood plains and will need a break with sunshine to grow.

Weeds were low for the past three days at 0.3, 4, and 2 grains of nettle or plantain weed pollen per cubic meter of air sampled for the day.

Weed 7-11 to 7-13

 

 

 

 

 

 

Grass pollen is almost gone with 0, 1 and 0 for the past three days.

Grass 7-11 to 7-13

 

 

 

 

 

 

FEL 7/13/2017

July 13, 2017 · fleickly · No Comments
Tags: , , ,  · Posted in: Grass Pollen Counts Indianapolis, Pollen Counting- Indianapolis, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis

Indianapolis Pollen Counts for July 7th through 10th, 2017

This interval has been the typical July hiatus for pollen. For both the grass and the weeds, the levels were zero for last Friday and low for Saturday – Sunday. The weed species were nettle and plantain.

Weed July 6-10

 

 

 

 

 

 

Grass 7-6 through 7-10

 

 

 

 

 

 

FEL 7/10/2017

July 10, 2017 · fleickly · No Comments
Tags: , , ,  · Posted in: Grass Pollen Counts Indianapolis, Pollen Counting- Indianapolis, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis

Indianapolis Pollen Counts for Thursday July 6th, 2017

Not much out there today- 1 for the weed pollen and if it was possible, 0.66 for grass. Since it is hard to imagine 0.66 of a grass pollen, we round it up to 1.

FEL 7/6/2017

July 6, 2017 · fleickly · No Comments
Tags: , , ,  · Posted in: Grass Pollen Counts Indianapolis, Pollen Counting- Indianapolis, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis

Indianapolis Pollen Counts July 3-5th 2017

Weed pollen counts were zero on July 3rd then low on the 4rth (8) and 5th (6) of July.

Weed Pollen 7-3 through 7-5-17

 

 

 

 

 

 

Grass pollen was low at 4 on Monday and moderate at 7 and 5 for Tuesday and Wednesday.

Grass pollen 7-3 through 7-5-17

 

 

 

 

 

 

FEL 7/5/2017

July 5, 2017 · fleickly · No Comments
Tags: , , ,  · Posted in: Grass Pollen Counts Indianapolis, Pollen Counting- Indianapolis, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis

Indianapolis Pollen Counts for Saturday July 1st and Sunday July 2nd, 2017

Weed pollen was low on both Saturday and Sunday. A bit higher on Saturday at 8 and half as many on Sunday at 4 grains of weed pollen per cubic meter of air sampled for the day. The weeds on Saturday were plantain, nettle, and marshelder.

July 1, 2 weed

 

 

 

 

 

 

Grass pollen was moderate both day at 14 and 7 grains of grass pollen per cubic meter of air sampled.

July 1,2 2017 Grass

 

 

 

 

 

 

FEL 7/1/2017

July 2, 2017 · fleickly · No Comments
Tags: , , ,  · Posted in: Grass Pollen Counts Indianapolis, Pollen Counting- Indianapolis, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis