Dietary Restrictions

Dietary restrictions for food allergy associated with ana-phylaxis and celiac disease should be maintained on a long term basis, whereas such measures can be lessened in other types of food allergy that resolve with time, particularly those presenting in early childhood. At one time it was thought that unlike other food allergies, peanut allergy was not outgrown. However, there are recent studies that indicate that there may be as high as a 50% chance of outgrowing a peanut allergy. As noted above, skin testing cannot be used to predict loss of clinical reactivity because skin tests may remain positive in a child who no longer has clinical manifestations of food allergy. Instead a decline in specific IgE levels followed by a negative oral challenge provides a better index of clinical loss of reactivity to a specific food antigen.

To date, there is no definite evidence that oral desensi-tization, injection immunotherapy, or similar techniques used for allergies to inhalant allergens, insect venoms, and medications, are beneficial in the prevention or modulation of food allergy. One exception to this is the oral allergy syndrome in which desensitization to the pollen benefits not only the symptoms of rhinitis but also food-induced oral manifestations. Immunomodulation via oral, subcutaneous and sublingual desensitization remain an area of controversy and these techniques are not routinely recommended in the management of food allergy.

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