Is it food allergy or not? Be sure. Be safe.

Transcription

1 Is it food allergy or not? Be sure. Be safe. New NICE and NIH Guidelines: New food allergy guidelines for early correct diagnosis, improved patient care and well-being

2 Food allergy: A growing and serious Food allergy is among the most common of the allergic disorders and has been recognised as a major paediatric health problem in western countries. This is because of the potential severity of reactions and a dramatic increase in prevalence over the past recent decades. NICE Guidelines 1 Prevalence is high and increasing Prevalence of food allergy in Europe and North America has been reported to range from 6 % to 8 % in children up to the age of 3 years. 1 A recent US study estimates that 5 % of children under 5 years of age and 4 % of teens and adults have food allergies. 2

3 health problem Food allergy (FA) is an important public health problem that affects adults and children [...] Moreover, the diagnosis of FA may be problematic, given that nonallergic food reactions, such as food intolerance, are frequently confused with FAs. NIH Guidelines 2 Major negative impact on patient well-being Food allergy can cause severe allergic reactions and even death from food-induced anaphylaxis. 1,2 Hospital admissions in the UK for food allergies have increased by 500 % since Patients with coexisting asthma often have the most severe reactions leading to intensive care unit visits. 1,2 Food allergy or suspicion thereof has a negative effect on quality of life for patients and caregivers. 1,2 Testing to confirm/rule out allergy Only % of self-reported food allergy is confirmed as true food allergy. Food allergy is often confused with food intolerance. 1 Testing can help confirm/rule out allergies and consequently reduce adverse reactions and limit unnecessary food avoidance. 1,2 Several new guidelines on diagnosis and management of food allergy Two influential health authorities, NIH and NICE, are now highlighting the severity and consequences of food allergy. In their respective guidelines, they offer recommendations on proper diagnosis and management of food allergy. 1,2 EAACI (European Academy of Allergy and Clinical Immunology) has recently announced that they also are working on new guidelines for the diagnosis and management of food allergies. 1. NICE Diagnosis and assessment of food allergy in children and young people in primary care and community settings, Boyce J et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of NIAID-Sponsored Expert Panel. J Allergy Clin Immunol 2010; 126: S1 S Gupta R, Sheikh A, Strachan DP, Anderson HR (2007). Time Trends in Allergic Disorders in the UK.

4 NICE 1 : New food allergy guidelines for early and correct diagnosis, improved care and well-being in children and young people Issued by the National Institute for Health and Clinical Excellence (NICE), assessing best practice in diagnosing and managing food allergy in children and young people in primary care and community settings.* 1 The target population is children and young people up to their 19 th birthday with suspected food allergy and who are at higher risk of developing food allergy. 1 NICE s report is a welcome guide to the assessment of food allergy in children. The Lancet 4 * Including the home environment and health visits, preschools, schools, children s centres and other childcare health settings, community pharmacy, community dietician and community paediatrician services. 1. NICE Diagnosis and assessment of food allergy in children and young people in primary care and community settings, Guidance on food allergy in children. Editorial. The Lancet. Vol 377: 691, February 26, 2011.

5 If food allergy is suspected [...] take an allergy-focused clinical history tailored to the presenting symptoms and age of the child or young person. NICE Guidelines 1 1. Suspect food allergy When a child or young person presents with one or more symptoms relating to: the skin e.g. eczema, pruritus, erythema, acute urticaria or angioedema 1 the gastrointestinal system e.g. swelling of lips/tounge, nausea, colicky abdominal pain, diarrhoea, vomiting 1 the respiratory system e.g. nasal itching, sneezing, congestion, cough, chest tightness, wheezing, shortness of breath 1 signs or symptoms of anaphylaxis or other systemic allergic reactions 1 When patients don t respond to intervention for atopic eczema, gastro-oesophageal reflux disease and chronic gastrointestinal symptoms (including chronic constipation). 1

6 2. Always offer a test if food allergy is suspected Allergy-focused clinical history is not enough All children and young people with suspected IgE-mediated food allergy should be offered an allergy test, such as a blood test for specific IgE-antibodies. 1 Test for the suspected foods and likely co-allergens. 1 Be aware of risk of anaphylactic reaction with skin prick tests Healthcare professionals undertaking skin prick tests should be competent and aware of the potential risks of such tests. 1 Skin prick tests and blood tests are equally cost-effective Skin prick tests and blood tests are equally cost-effective. Blood tests are cost-effective independent of number of individuals tested. 1 Yearly retesting until school age to identify outgrown allergies is cost-effective. 5 Based on the results of the allergy-focused clinical history, if IgE-mediated allergy is suspected, offer the child or young person a skin prick test and/or blood tests for specific IgE antibodies to the suspected foods and likely co-allergens. NICE Guidelines 1 Skin prick tests should only be undertaken where there are facilities to deal with an anaphylactic reaction. NICE Guidelines 1 health economic evidence showed that both the IgE antibody test and the skin prick test were cost effective compared with no test NICE Guidelines 1 inclusion of future retesting improves the cost effectiveness NICE Guidelines 5

7 3. Improve patient care and save costs Reduce risk Correct diagnosis, counselling and advice based on valid test results will help to reduce incidence of adverse reactions and improve quality of life. 1 Reduce unnecessary dietary exclusion and worry Correct diagnosis can help reduce unnecessary worry and avoidance of food that is actually safe to eat. 1 Reduce costs Earlier and more accurate diagnoses save cost due to reduced GP consultations, referrals to secondary care, misdiagnosis and emergency admissions. Further on, avoidance of unnecessary testing and medication will also save costs. 6 Correct diagnosis of food allergy, followed by counselling and advice based on valid test results, is important because it will help to reduce the incidence of adverse reactions resulting from true food allergies, and will also help to reduce the unnecessary dietary exclusion of foods that are safe and should be eaten as part of a normal, healthy diet. NICE Guidelines 1 1. NICE Diagnosis and assessment of food allergy in children and young people in primary care and community settings, Food Allergy in Children, Appendix 3, Health Economics Food allergy in children and young people. Costing report. Implementing NICE guidance,

8 NIH guidelines 2 also emphasize the importance of early correct diagnosis for improved patient care and well-being Early diagnosis can lead to better management of food allergies and reduce the risk of exposure to food antigens. NIH Guidelines 2 The NIH Guidelines is the first consensus document aimed at a broader group of healthcare professionals* on how to diagnose and manage food allergy. 2 Developed by National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) in cooperation with 30 professional organisations, federal agencies and patient advocacy groups Test early The first 5 years are often decisive when developing allergies. 2 Ruling out allergies is as important as confirming them to limit unnecessary food avoidance, worry and negative social impact. 2 Self-reports are often incorrect. parent and patient reports of food allergy must be confirmed, because multiple studies demonstrate that 50 % to 90 % of presumed food allergies are not allergies. 2

9 The Expert Panel recommends sige tests for identifying foods that potentially provoke IgE-mediated food-induced allergic reactions... NIH Guidelines 2 Results of follow-up testing can guide decision-making regarding whether and when it is safe to introduce or re-introduce allergenic food into the diet. NIH Guidelines 2 2. Be specific Medical history alone is not enough....a thorough medical history is very important in identifying symptoms associated with food allergy and focusing the diagnostic work-up, but alone cannot be considered diagnostic. 2 SPT is not enough. SPTs have low specificity and low positive predictive value for making an initial diagnosis of FA. Thus, use of SPTs in clinical setting may lead to over-diagnosis. ImmunoCAP provides precise, safe, quantitative and standardized results for accurate diagnosis. The predictive values of ImmunoCAP are superior compared to other systems Follow-up Regular follow-ups ensure a proper management and medication. 2 Tolerance may develop later in life, making medication and food avoidance unnecessary. 2 Annual testing is often the practice for determining whether allergy to milk, egg, soy, and wheat have been outgrown and the testing interval is extended to 2 to 3 years for allergy to peanut, tree nuts, fish, and crustacean shellfish. 2 * allergists/immunologists and clinical researchers and practitioners in the areas of pediatrics, family medicine, internal medicine, dermatology, gastroenterology, emergency medicine, pulmonary and critical care medicine, and others. 2. Boyce J et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of NIAID-Sponsored Expert Panel. J Allergy Clin Immunol 2010; 126: S1 S58.

10 ImmunoCAP precise results for improved patient care and well-being Quantitative results can help predict and follow the disease development, help predict the risk of a severe reaction and explain cross-reactivity. Low-level detection of specific IgE-antibodies is possible, thanks to the allergens and allergen components associated with ImmunoCAP. The predictive value of ImmunoCAP in diagnosing food allergy is superior to other assay systems e.g Turbo-MP and Immulite. 7,8 Gold standard: ImmunoCAP is used in more than 7 out of 10 allergy laboratory tests performed worldwide. Nail down the allergy. Liberate the patient. Easy: It can be performed irrespectively of a patient s age, skin condition, medication, symptom, disease activity and pregnancy. Reliable: Performed without procedure variations and the results are of excellent standardization. 8 Quantitative: The quantitative results can help you predict and follow the disease development and determine what your patient is allergic to. 9,10 2. Boyce J et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of NIAID-Sponsored Expert Panel. J Allergy Clin Immunol 2010; 126: S1 S Wood R et al. Accuracy of IgE antibody laboratory results. Ann Allergy Asthma Immunol. 2007; 99: Hamilton R et al. Proficiency Survey-Based Evaluation of Clinical Total and Allergen-Specific IgE Assay Performance. Arch Pathol Lab Med. 2010; 134: Yunginger J et al. Quantitative IgE antibody assays in allergic disease. J Allergy Clin Immunol 2000; 105: Sampson H et al. Utility of food-specific IgE concentrations in predictin symptomatic food allergy. J Allergy Clin Immunol 2001; 107:

11 The predictive values associated with clinical evidence of allergy for ImmunoCAP cannot be applied to Turbo-MP and Immulite. NIH Guidelines 2

12 Always offer a test if food allergy is suspected: Based on the results of the allergy-focused clinical history, if IgE-mediated allergy is suspected, offer the child or young person a skin prick test and/or blood tests for specific IgE antibodies to the suspected foods and likely co-allergens. NICE Guidelines 1 Skin prick tests should only be undertaken where there are facilities to deal with an anaphylactic reaction. NICE Guidelines 1 health economic evidence showed that both the IgE antibody test and the skin prick test were cost effective compared with no test NICE Guidelines 1 inclusion of future retesting improves the cost effectiveness NICE Guidelines 5 Be specific: The Expert Panel recommends sige tests for identi fying foods that potentially provoke IgE-mediated food-induced allergic reactions... NIH Guidelines 2 ImmunoCAP : The predictive values associated with clinical evidence of allergy for ImmunoCAP cannot be applied to Turbo-MP and Immulite. NIH Guidelines 2 ImmunoCAP is a registered trademark of Phadia AB. Phadia AB. P O Box 6460, SE Uppsala, Sweden Phone Fax Head office Sweden Austria Belgium Brazil China Czech Republic Denmark Finland France Germany Great Britain/Ireland India /56 Italy Japan Korea Netherlands Norway Portugal South Africa Spain Sweden Switzerland Taiwan United States Other heart.se