title: Diagnosis and management of food allergies: new and emerging options: a systematic review.
abstract: It is reported that 6% of children and 3% of adults have food allergies, with studies suggesting increased prevalence worldwide over the last few decades. Despite this, our diagnostic capabilities and techniques for managing patients with food allergies remain limited. We have conducted a systematic review of literature published within the last 5 years on the diagnosis and management of food allergies. While the gold standard for diagnosis remains the double-blind, placebo-controlled food challenge, this assessment is resource intensive and impractical in most clinical situations. In an effort to reduce the need for the double-blind, placebo-controlled food challenge, several risk-stratifying tests are employed, namely skin prick testing, measurement of serum-specific immunoglobulin E levels, component testing, and open food challenges. Management of food allergies typically involves allergen avoidance and carrying an epinephrine autoinjector. Clinical research trials of oral immunotherapy for some foods, including peanut, milk, egg, and peach, are under way. While oral immunotherapy is promising, its readiness for clinical application is controversial. In this review, we assess the latest studies published on the above diagnostic and management modalities, as well as novel strategies in the diagnosis and management of food allergy.
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada ; Department of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: O'Keefe
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: De Schryver
authors.affiliation: Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mill
authors.affiliation: Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mill
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Alizee
authors.initials: A
authors.lastname: Dery
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Moshe
authors.initials: M
authors.lastname: Ben-Shoshan
keywords: component testing; epinephrine autoinjector; oral challenge; oral immunotherapy; skin prick testing; specific IgE