Management of food allergies

The mainstay of successful management of food allergy is the identification of the offending food(s), as verified by the elimination-challenge test. Dietary elimination is the most effective and inexpensive method, but its success depends on several factors. Initially, dietary elimination may need to be strict, but later certain patients may discover that they can tolerate limited quantities or certain preparations of the offending food without significant symptoms. In certain cases, provision of a substitute or a nutritional supplement may be needed. Food allergy in infants who are exclusively breast-fed requires elimination of the offending food from the mother's diet. Because of cross-antigenicity, certain patients may also need to avoid other members of the food family. This phenomenon is especially noticeable among seafoods. In certain patients who have mild to moderate sensitivity to multiple foods that cannot be completely avoided, rotation diets may be both effective and more convenient. In a few patients, conventional elimination diets may be followed for limited time periods until all offending foods are identified. In addition to symptomatic treatment, pharmacologic agents may be taken for prophylaxis. Antihistamines, oral cromolyn and possibly other medications, when taken before an anticipated exposure or on a regular basis, may prevent or minimize the symptoms in certain patients. At present, no adequate evidence supports the use of hyposensitization therapy with food extracts. The prognosis of food allergy is more favorable in children than in adults. Most food-sensitive infants and young children will tolerate the offending food after 1-2 years of avoidance.