Japanese guidelines for food allergy 2017

Area of Science:

• Pediatric Allergy
• Clinical Immunology
• Gastroenterology

Background:

• The Japanese Pediatric Guideline for Food Allergy (JPGFA) underwent its second major revision in 2016.
• This revision incorporated recent scientific advancements in food allergy research published over the preceding five years.

Purpose of the Study:

• To update and provide comprehensive guidance on the diagnosis, management, and prevention of food allergies in children.
• To classify food allergies into distinct clinical types for tailored management approaches.

Main Methods:

• Classification of food allergies into four clinical types: neonatal/infantile gastrointestinal allergy, infantile atopic dermatitis with food allergy, immediate-type food allergy, and special forms (e.g., OAS, food-dependent exercise-induced anaphylaxis).
• Review and integration of diagnostic advancements, including probability curves, component-resolved diagnosis, and antigen-specific IgE.
• Evaluation of oral food challenges, oral immunotherapy (OIT), and current evidence on food allergy prevention.

Main Results:

• The guideline emphasizes immediate-type food allergies common in childhood and adolescence, and infantile atopic dermatitis as a key early manifestation.
• Diagnostic procedures are detailed, recommending stepwise oral food challenges to minimize food elimination.
• Oral immunotherapy (OIT) is discussed regarding efficacy and challenges, despite not being a routine insurance-covered treatment.

Conclusions:

• The revised JPGFA encourages physicians to adopt a principle of allowing patients to consume causative foods safely and as early as possible.
• The guideline addresses specific concerns, such as the use of adrenaline in cases of contraindication with antipsychotic drugs, allowing physician discretion.
• Updated recommendations on food allergy prevention are included, reflecting the latest scientific evidence.