Supported by three federal and eight nonfederal sponsors, the guidance is the product
of a study by a committee of 15 international experts considering a vast array of
issues in the field.
Most of the recommendations directly or indirectly affect pediatricians in their management
of food allergy. For example, current allergen food labeling practices can be confusing
for families. Allergens such as sesame are not included in current laws, foods such
as lychee are considered nuts (it is a fruit) and advisory labeling (i.e., “may contain”)
is ambiguous and unregulated.
The report calls for action to improve labeling based on a scientific standard. It
also identifies numerous areas that require further research, especially on prevalence,
diagnostics, quality-of-life issues and treatments.
Of note, the committee recommended that various stakeholders, including the American
Academy of Pediatrics, update guidelines on diagnosis, prevention and management of
food allergy. Following is a summary of some of the areas in the report that are pertinent
to pediatrics, along with how the AAP has been and will continue to be involved in
The report recommends that physicians use evidence-based, standardized procedures
as the basis for food allergy diagnosis and avoid unproven procedures (e.g., applied
kinesiology, immunoglobulin G panels, electrodermal testing).
The report recommends that clinical practice guidelines provide clear evidence regarding
the timing of introduction of allergens related to prevention strategies.
The Academy had representation on a recent expert panel describing early introduction
of peanut as a modality of peanut allergy prevention (Togias A, et al. J Allergy Clin Immunol. 2017;139:29-44). The Academy also is updating a 2008 clinical report on atopy prevention.
The report encourages training of various stakeholders such as medical students, residents
and other health care providers on food allergy and anaphylaxis management, including
through professional organizations.
Of note, the AAP National Conference & Exhibition, various online programming and
other educational initiatives have included and will continue to include food allergy.
The committee recommended that health care providers and others use intramuscular
epinephrine in all infants, children and adults as a first line of emergency management
for episodes of food allergy-induced anaphylaxis. It also recommended that the Food
and Drug Administration evaluate the need for, and, if indicated, industry should
develop an auto-injector with 0.075 milligrams of epinephrine specifically designed
for use in infants.
In a 2007 clinical report and two clinical reports coming in 2017, the Academy provides guidance to clinicians
regarding the indications of using and prescribing self-injectable epinephrine and
for dosing, including recognizing that fixed-dose auto-injectors are lacking for infants
who weigh 7.5 kilograms or less.
Safety in various settings
The committee recommended that stakeholders, including advocates such as the Academy,
participate in a task force to address emergency management and prevention strategies
for venues such as schools, early care centers and transportation such as airplanes.
In summary, this landmark report provides numerous avenues for pediatricians to bring
the recommendations to bear to improve health and safety for their patients.
Disclaimer: The author is responsible for the content of this article, which does
not necessarily represent the views of the National Academies of Sciences, Engineering,
and Medicine, their committees, or convening bodies.
Dr. Sicherer is past chair of the AAP Section on Allergy and Immunology Executive