Should avoidance of foods be strict in prevention and treatment of food allergy?
OBJECTIVE
To discuss whether strict allergen avoidance is the most appropriate strategy for managing or preventing food allergy.


RESULTS
The standard of care for the management of food allergy has been strict allergen avoidance. This advice is based upon the suppositions that exposure could result in allergic reactions and avoidance may speed recovery. Recent studies challenge these assumptions. Studies now demonstrate that most children with milk and egg allergy tolerate extensively heated forms of these foods. Moreover, clinical trials of oral immunotherapy show that oral exposure can lead to desensitization. Additionally, recent epidemiologic studies fail to support the notion that delaying introduction of highly allergenic foods to infants and young children prevents the development of food allergy. In fact, the data suggest that delays may increase risks.


CONCLUSIONS
Recent data indicate that strict allergen avoidance is not always necessary for treatment, exposure may be therapeutic, and extended delay in introduction of food allergens to the diet of young children may increase allergy risks. However, in many circumstances strict avoidance is clearly necessary for treatment. Additional studies are needed to determine the risks and benefits of exposure to tolerated allergen, including identification of biomarkers to identify patients who may benefit.
Kim
Jennifer S
JS
Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, New York 10029-6574, USA. jennifer.kim@mssm.edu
Sicherer
Scott
S
D000485:Allergens / Q000276:immunology / Q000627:therapeutic use; D002648:Child; D002986:Clinical Trials as Topic; D003888:Desensitization, Immunologic; D004044:Dietary Proteins / Q000276:immunology / Q000627:therapeutic use; D005512:Food Hypersensitivity / Q000178:diet therapy*; D006801:Humans; D007108:Immune Tolerance
D000485:Allergens; D004044:Dietary Proteins