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Managing food allergy: GA²LEN guideline 2022.

ABSTRACT: Food allergy affects approximately 2-4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA²LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy.

SUBMITTER: Muraro A

PROVIDER: S-EPMC9467869 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Managing food allergy: GA<sup>2</sup>LEN guideline 2022.

Muraro Antonella A de Silva Debra D Halken Susanne S Worm Margitta M Khaleva Ekaterina E Arasi Stefania S Dunn-Galvin Audrey A Nwaru Bright I BI De Jong Nicolette W NW Rodríguez Del Río Pablo P Turner Paul J PJ Smith Pete P Begin Philippe P Angier Elizabeth E Arshad Hasan H Ballmer-Weber Barbara B Beyer Kirsten K Bindslev-Jensen Carsten C Cianferoni Antonella A Demoulin Céline C Deschildre Antoine A Ebisawa Motohiro M Fernandez-Rivas Maria Montserrat MM Fiocchi Alessandro A Flokstra-de Blok Bertine B Gerdts Jennifer J Gradman Josefine J Grimshaw Kate K Jones Carla C Lau Susanne S Loh Richard R Alvaro Lozano Montserrat M Makela Mika M Marchisotto Mary Jane MJ Meyer Rosan R Mills Clare C Nilsson Caroline C Nowak-Wegrzyn Anna A Nurmatov Ulugbek U Pajno Giovanni G Podestà Marcia M Poulsen Lars K LK Sampson Hugh A HA Sanchez Angel A Schnadt Sabine S Szajewska Hania H Van Ree Ronald R Venter Carina C Vlieg-Boerstra Berber B Warner Amena A Wong Gary G Wood Robert R Zuberbier Torsten T Roberts Graham G

The World Allergy Organization journal 20220907 9

Food allergy affects approximately 2-4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA<sup>2</sup>LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of Apr ...[more]

PMID: 36119657

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Project description:BackgroundAsthma is common worldwide and a large part of subjects with asthma have concomitant allergic multimorbidity in the form of rhinitis and/or eczema.ObjectiveThe aim of this study is to investigate whether the presence of allergic multimorbidity in asthma relates to allergic sensitization, allergic and respiratory symptoms, quality of life, inflammatory markers, lung function, use of medication and background factors.MethodsA total of 437 asthmatics from the (GA2 LEN) cross-sectional survey in Sweden were grouped depending on the presence of rhinitis and/or eczema. The impact of allergic multimorbidity was assessed in terms of allergic sensitization, allergic and respiratory symptoms, quality of life, type-2 inflammatory markers (exhaled nitric oxide, eosinophil activation markers, periostin), lung function, use of medication and background factors.ResultsSubjects with asthma, rhinitis and eczema were more likely to be sensitized to seasonal allergens (67% vs 32%, P < .001), food allergens (54% vs 18%, P < .001) and to have a higher degree of sensitization than subjects with only asthma (23% vs 10%, P < .001). Subjects with allergic multimorbidity more often had allergic reactions to food (28% vs 10%, P = .002), more respiratory symptoms and anxiety/depression (40% vs, 14%, P < .001) than subjects with only asthma, despite having similar levels of type 2 inflammatory markers. Individuals with allergic multimorbidity were more likely to be diagnosed with asthma before the age of 12 (48% vs 27%, P = .016) and to have maternal heredity for allergy (53% vs 33%, P = .011) than subjects with only asthma.Conclusion and clinical relevanceAsthmatics with allergic multimorbidity are more likely to be sensitized to seasonal aeroallergens, food allergens and they have a higher degree of sensitization compared with those with only asthma. Allergic multimorbidity is associated with respiratory and allergy symptoms, anxiety and/or depression.

Project description:IntroductionFood allergy affects up to 10% of Australian children, and living with food allergic children can be challenging for parents. This study explored parental perceptions and knowledge as they navigate a new reality of keeping their child safe.MethodsParents of children with food allergies completed an online food allergy survey in 2015. Questions explored health knowledge, skills, and attitudes (KSAs) as well as quality of life (QoL) through the inclusion of the Food Allergy Quality of Life - Parental Burden instrument (FAQL-PB). Notification of the survey included advertisements to more than 700 randomly selected Australia-wide preschools, 44 allergy specialists, and Allergy & Anaphylaxis Australia. Responses were tabulated and analysed.ResultsOf the 400 participants who logged on, 357 commenced the survey and 318 finished. Questionnaire analysis showed that 44.1% of parents (n = 135) hesitated to use an adrenaline auto-injector and may be influenced by a classification system where symptom severity is not universally understood. While 79% would sign up to a national Anaphylaxis Registry, intention to participate in clinical trials using vaccines was disclosed by only 56%. Allergen labelling and community acceptance continue to be the most challenging aspects of managing a food allergy, and 50% of parents reported that food allergy played a role in choosing a preschool or primary school. Overall, quality of life for participants was influenced more by gender (male) and age of the child than where they lived - capital city or regional location; however, regional participants were more frustrated over lack of appreciation relating to the seriousness of food allergy (p = 0.010).ConclusionResults highlight the need for educational strategies for both the food allergy community and public, particularly in regional areas, since there is a perceived lack of appreciation as to the seriousness of food allergy. Educational resources and relevant networks are required to support parents and caregivers in the management of children with food allergy.

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Managing food allergy: GA²LEN guideline 2022.

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Managing food allergy: GA<sup>2</sup>LEN guideline 2022.

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Managing food allergy: GA2LEN guideline 2022.

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Managing food allergy: GA&lt;sup&gt;2&lt;/sup&gt;LEN guideline 2022.

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