Treatment of Food Allergy

The cornerstone of the management of food allergy is avoidance of the offending allergen. This is particularly important in cases of peanut allergy where trace amounts of allergen can cause significant reactions. Most fatalities due to food allergy have been due to peanut allergy. Patients with food allergies should learn to read and understand labels for hidden food allergens and to recognize the potential for foods to cross-react with other antigens (eg, banana and kiwi with latex, and birch pollen with apple, carrot, and hazel nut).

In North America the Food Allergy and Anaphylaxis Network (1-800-929-4040, <www.foodallergy.org>) is a source of valuable information for those with various types of food allergy. Similarly, it is important for celiac patients to join local celiac disease foundations and support groups that can provide valuable information used to determine sources of gluten free foods and medications.

Infants with cow's milk protein allergy present a unique situation because avoidance of their major source of nutrition poses difficulty in this age group. Formulas with reduced antigenicity have been developed and include those in which milk proteins are partially hydrolyzed by heat or enzymes, as well as more extensively hydrolyzed preparations. It is recommended that extensively rather than partially hydrolyzed preparations are used for those who are truly allergic to cow's milk protein because only the latter are truly hypoallergenic. For the 10% of infants that still react to even the more hydrolyzed formulas, amino acid based preparations should be used. For infants with IgE-mediated cow's milk allergy there is only a small chance they will also be allergic to soy protein, whereas infants with cow's milk protein-induced enteropathy involving other immune mechanisms have a > 50% likelihood of developing soy protein-induced enterocolitis.

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