Pharmacological management of acute food-allergic reactions

There is currently no well-established disease-modifying treatment for food allergy, so management relies upon strict avoidance of food allergen(s), implementation of risk minimisation strategies to avoid inadvertent exposure and allergic reactions, and prompt management of acute allergic reactions, should they occur. The pharmacological management of acute food-induced allergic reactions is dependent on the underlying pathophysiology of the allergic reaction and the severity of clinical symptoms and signs. Mild to moderate symptoms of an immunoglobulin E-mediated acute allergic reaction may be treated effectively with an oral anti-histamine. In patients exhibiting the clinical features of anaphylaxis, adrenaline is the only first-line therapy recommended by expert consensus. Adjunctive therapies, including anti-histamines, beta-agonists and glucocorticoids, may be used in the subsequent management of immunoglobulin E-mediated anaphylaxis. Here, we present the current recommendations for the pharmacological management of acute food-induced allergic reactions, together with a summary of the evidence supporting these recommendations.