Building the evidence base for safety in food allergy

Abstract

The global prevalence of food allergies has steadily increased over the past two decades, according to a new report, Finding a Path to Safety in Food Allergy, released by the National Academies of Sciences on Nov 30. The comprehensive report assessed and defined the current landscape of food allergy in the USA, and outlined six courses of action—including expanding research, improving public policies, and increasing education of health-care providers—aimed at improving the quality of life of people with food allergies. Importantly, the report calls for reliance on evidence-based approaches for the diagnosis and prevention of food allergies. Currently, there are no simple and definitive tests for food allergies, with the accepted gold standard being the oral food challenge, which can be high risk for some patients, and is expensive. Accurate diagnoses of suspected food allergies must rely on evidence-based, standardised methods, and a patient needs to be referred to a specialist to appropriately assess and manage the allergy. The report emphasises that more research is fundamental to preventing and managing food allergies. Adding to the evidence base, in an Article published online in The Lancet on Dec 8, 2016, Osamu Natsume and colleagues report the findings of the PETIT trial, showing effective reduction of hen's egg allergy in high-risk infants aged 4–5 months by feeding them small quantities of cooked egg in a stepwise approach. Although the findings of PETIT are promising, further research in larger and more diverse populations is required to demonstrate generalisability and safety of this preventive strategy, adds Graham Roberts in an accompanying Comment. Physician education and further research are the mainstays of improving prevention and management of food allergies, not only in the USA but worldwide. Development of effective public health policies and prevention strategies, as well as engaging other stakeholders, such as food manufacturers, school leaders, consumers, and health-care providers, is crucial to understanding and preventing the rising global burden of food allergies. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trialIntroduction of heated egg in a stepwise manner along with aggressive eczema treatment is a safe and efficacious way to prevent hen's egg allergy in high-risk infants. In this study, we developed a practical approach to overcome the second wave of the allergic epidemic caused by food allergy. Full-Text PDF Another step towards prevention of food allergyFood allergy is an important clinical problem, which has a large impact on family life, particularly in childhood, where 3–4% of children are affected.1 Attempts to prevent the development of food allergy have focused on the avoidance of allergenic foods in infancy. The failure of this approach has led to various trials2,3 assessing whether or not the early introduction of allergenic foods into the diet might paradoxically succeed. Full-Text PDF