NIAID guidelines for food allergy

2017 NIAID Addendum Guidelines for the Prevention of Peanut Allergy in the United States

View key messages from the 2017 guidelines and 2010 addendum guidelines for peanut allergy below.

Key messages

• This update to the 2010 NIAID food allergy guidelines addresses the prevention of peanut allergy and is based on the findings of the LEAP (Learning Early About Peanut Allergy) clinical trial, which suggests that early introduction of peanut-containing foods could reduce the risk of peanut allergy in high-risk infants.

• This update is significant to dermatologists because atopic dermatitis patients have an increased risk for food allergy.

• The updated guideline provides three recommendations for infants at various risk levels.

  • Severe eczema and/or egg allergy: Consider food allergy testing, and based on test results, introduce peanut-containing foods at four to six months.

  • Mild to moderate eczema: Introduce peanut-containing foods around six months.

  • No eczema or food allergy: Introduce peanut-containing foods at the appropriate age in accordance with family and cultural preferences.

• The guideline does not recommend allergy testing for foods other than peanut, as this could lead to misinterpretation or overdiagnosis of food allergy and unnecessary dietary restrictions.

2010 NIAID Guidelines for the Diagnosis and Management of Food Allergy in the United States 

Key messages

• This guideline is relevant to dermatologists because skin reactions are some of the most common presentations of food allergy.

• Skin reactions include:

  • IgE-mediated: urticarial, angioedema, flushing, pruritus

  • Cell-mediated: contact dermatitis, dermatitis herpetiformis

  • Mixed IgE- and cell-mediated: atopic dermatitis

• Early onset severe atopic dermatitis is associated with risk for sensitization to food.

  A skin puncture test is recommended to assist in the identification of foods that may be provoking IgE-mediated food-induced allergic reactions, but it cannot be used alone in the diagnosis of food allergy.

• Intradermal testing should not be used to make a diagnosis of food allergy.

• It is suggested that children less than 5 years old with moderate to severe atopic dermatitis be considered for food allergy evaluation for milk, egg, peanut, wheat, and soy if:

  • The child’s AD persists despite optimized management and topical therapy.

    OR

  • The child has a reliable history of immediate reaction after ingestion of a specific food.