Closing the Knowledge Gap: New food allergy guidelines provide clarity to some otolaryngologists

Ronald A. Simon, MD, often illustrates a major food allergy misconception by showing a “Peanuts” cartoon of a bleary-eyed Snoopy lying atop his doghouse. “I think I’m allergic to morning,” Snoopy says.

Dr. Simon, head of the Allergy, Asthma and Immunology Division at the Scripps Clinic in La Jolla, Calif., said many patients tend to blame a dislike or intolerance on an allergy. In fact, research suggests that the positive predictive value of self-reported food allergies is strikingly poor. As a panelist and co-author of the National Institute of Allergy and Infectious Diseases’ (NIAID) first-ever guidelines on food allergies, Dr. Simon hopes the new document will better educate both doctors and patients about a medical condition that is still plagued by sizeable gaps in knowledge.

The guidelines, published in December in the Journal of Allergy and Clinical Immunology (126(6,):S1-S58), are based on an extensive literature review and the opinions of a 25-member expert panel. The document begins with a definition of food allergy and offers 43 recommendations on its diagnosis and management. Throughout the report, however, the authors point out multiple areas with low-quality evidence where further research could significantly change the recommendations.

The panel’s straightforward approach and acknowledgment of deficiencies has won praise from many other otolaryngologists. “I think it is a call for research and for people to fill in those knowledge gaps,” said Elizabeth Mahoney, MD, an assistant professor of otolaryngology-head and neck surgery at Boston University Medical Center. “From my standpoint, it’s a good launch pad for additional research and helps us to streamline our efforts so that people have more uniform practices.”

Karen Calhoun, MD, professor of otolaryngology-head and neck surgery at the Ohio State University Medical Center in Columbus, also gave the guidelines high marks. “The whole document is excellent, beautifully researched with clear data summaries and recommendations,” said Dr. Calhoun, chair of the American Academy of Otolaryngology-Head and Neck Surgery Allergy, Asthma, and Immunology Committee.

Bruce Gordon, MD, an otolaryngologist based in Hyannis, Mass., was less impressed. “The guidelines were a rehash of material previously available, and so they are only useful as a convenient summary, and, perhaps, for education of clinicians who are not often involved with care of food-allergic people,” he said.

Of the guidelines deemed most useful, the otolaryngologists who spoke with ENT Today highlighted recommendations on introducing foods to infants, administering vaccines to people with egg allergies, treating acute cases and diagnosing patients.