Proactive management of food allergy: Allergen introduction

Abstract

There is an evolving paradigm shift occurring in the management of IgE-mediated food allergies. In addition to emerging immunotherapy and biologic treatments targeting disease modification, several other less intensive proactive management strategies are being more readily discussed and introduced into clinical practice. These are aimed at addressing often unduly heightened perceptions of disease severity (in a significant proportion of the allergic population), reducing dietary restrictions using individual patients' clinical data, and potentially also facilitate disease modification, or accelerate natural resolution pathways. Other emerging strategies represent modified forms of oral immunotherapy. Proactive food allergy management strategies include: Incomplete Allergen Avoidance (IAA): informed food label management, low-dose dietary allergen inclusion, processed-allergen dietary inclusion, food ladders for practical inclusion, and food ladders for immunomodulatory intent. These strategies, and the evidence behind each approach is discussed in this chapter. For non-IgE mediated food allergies the use of food ladders is more long-standing. Their history and evolution are also summarized here.