What is the primary treatment for a confirmed food allergy?

Primary Treatment for Confirmed Food Allergy

The primary treatment for a confirmed food allergy is strict dietary avoidance of the specific allergen(s), along with an emergency action plan that includes ready access to injectable epinephrine to treat reactions from accidental exposure. 1

Allergen Avoidance

• Food avoidance is the first-line treatment for food allergies because there are currently no recommended preventive medications 1
• Patients with documented IgE-mediated food allergy should strictly avoid ingesting their specific allergen(s) 1
• Carefully planned allergen-free diets can provide sufficient nutrients to maintain a healthy and active life 1
• Patients and caregivers should receive education on:
  • How to interpret ingredient lists on food labels 1
  • How to recognize labeling of food allergens used as ingredients in foods 1
  • Avoiding products with precautionary labeling (e.g., "may contain trace amounts of allergen") 1

Emergency Management Plan

• All patients with confirmed food allergy should be prescribed:
  • Epinephrine auto-injector (2 doses) with proper training on its use 1, 2
  • Antihistamines for mild symptoms (e.g., a few hives, mild nausea) 1
• Epinephrine is the mainstay for treatment of acute, systemic allergic reactions 1, 2
• Epinephrine dosing:
  • Adults and children ≥30 kg: 0.3 to 0.5 mg intramuscularly into anterolateral aspect of the thigh 2
  • Children <30 kg: 0.01 mg/kg, up to 0.3 mg, intramuscularly into anterolateral aspect of the thigh 2
  • May be repeated every 5-15 minutes if symptoms are not responding 1

Adjunctive Treatments for Allergic Reactions

• H1 antihistamines (e.g., diphenhydramine):
  • 1-2 mg/kg per dose, maximum 50 mg 3
  • Continue every 6 hours for 2-3 days after a reaction 3
  • Should not be used in place of epinephrine for severe reactions 3
• H2 antihistamines (e.g., ranitidine):
  • 1-2 mg/kg per dose, maximum 75-150 mg 3
  • Continue twice daily for 2-3 days after a reaction 3
• Corticosteroids (e.g., prednisone):
  • 1 mg/kg, maximum 60-80 mg 3
  • Continue daily for 2-3 days after a reaction 3

Education and Follow-up

• Patients should receive:
  • An anaphylaxis emergency action plan 1
  • Education on early recognition of signs and symptoms of anaphylaxis 1
  • Training on appropriate epinephrine administration 1
  • Medical identification jewelry or an anaphylaxis wallet card 1
• Follow-up appointment with primary healthcare professional after any food-induced allergic reaction 1
• Consider referral to an allergist/immunologist for specialized management 1
• Regular nutritional counseling and growth monitoring for children with food allergies 1

Common Pitfalls and Caveats

• Antihistamines should never be used alone to treat anaphylaxis, as they have a much slower onset of action than epinephrine 3
• Epinephrine is frequently underprescribed and underused despite being the first-line treatment for anaphylaxis 1
• Adolescents and young adults are at particularly high risk for fatal and near-fatal anaphylaxis due to risk-taking behavior 1
• Patients on beta-blockers may have reduced response to epinephrine; glucagon should be available as an additional treatment option 3
• There are currently no recommended medications for preventing IgE-mediated food-induced allergic reactions 1
• Allergen-specific immunotherapy is not currently recommended for treating IgE-mediated food allergy in routine clinical practice 1, 4

Special Considerations

• The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size 5
• For patients with refractory hypotension, glucagon can be administered (20-30 μg/kg for children or 1-5 mg for adults) 1
• Patients should be educated about cross-contact with allergens during food preparation and communicating effectively with those providing allergen-safe meals 6
• Food allergens may be present in non-food items such as cosmetics, bath products, vaccines, and medications 6