by Scott H. Sicherer, M.D., FAAP
A new report from The National Academies of Sciences, Engineering and Medicine provides a roadmap
to improve the care of those with food allergies.
Titled Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention,
Management, and Public Policy ( www.nationalacademies.org/
FoodAllergies), the report includes recommendations
on food allergy diagnostics, prevention, education of
various stakeholders, emergency and daily management, allergen labeling and development of policy
guidelines for a variety of settings to improve safety.
Supported by three federal and eight nonfederal
sponsors, the guidance is the product of a study by a
committee of 15 international experts considering a
vast array of issues in the field.
Most of the recommendations directly or indirectly
affect pediatricians in their management of food allergy. For example, current allergen food labeling practices
can be confusing for families. Allergens such as sesame
are not included in current laws, foods such as lychee
are considered nuts (it is a fruit) and advisory labeling
(i.e., “may contain”) is ambiguous and unregulated.
The report calls for action to improve labeling based
on a scientific standard. It also identifies numerous
areas that require further research, especially on prevalence, diagnostics, quality-of-life issues and treatments.
Of note, the committee recommended that various
stakeholders, including the American Academy of Pedi-
atrics, update guidelines on diagnosis, prevention and
management of food allergy. Following is a summary
of some of the areas in the report that are pertinent to
pediatrics, along with how the AAP has been and will
continue to be involved in these issues.
The report recommends that physicians use evidence-based, standardized procedures as the basis for
food allergy diagnosis and avoid unproven procedures
(e.g., applied kinesiology, immunoglobulin G panels,
The AAP clinical report Allergy Testing in Childhood:
Using Allergen-Specific Ig E Tests ( http://bit.ly/2hg3dvK)
is related to this topic.
The report recommends that clinical practice guidelines provide clear evidence regarding the timing of introduction of allergens related to prevention strategies.
The Academy had representation on a recent expert
panel describing early introduction of peanut as a modality of peanut allergy prevention (Togias A, et al. J
Allergy Clin Immunol. 2017;139:29-44). (See article on
page 1.) The Academy also is updating a 2008 clinical
report on atopy prevention ( http://bit.ly/2hwkhOK).
The report encourages training of various stakeholders such as medical students, residents and other health
care providers on food allergy and anaphylaxis management, including through professional organizations.
Of note, the AAP National Conference & Exhibi-
tion, various online programming and other educa-
tional initiatives have included and will continue to
include food allergy.
The committee recommended that health care providers and others use intramuscular epinephrine in all
infants, children and adults as a first line of emergency
management for episodes of food allergy-induced anaphylaxis. It also recommended that the Food and Drug
Administration evaluate the need for, and, if indicated,
industry should develop an auto-injector with 0.075
milligrams of epinephrine specifically designed for use
In a 2007 clinical report ( http://bit.ly/2gROVhK)
and two clinical reports coming in 2017, the Academy
provides guidance to clinicians regarding the indications of using and prescribing self-injectable epinephrine and for dosing, including recognizing that fixed-dose auto-injectors are lacking for infants who weigh
7. 5 kilograms or less.
Safety in various settings
The committee recommended that stakeholders,
including advocates such as the Academy, participate
in a task force to address emergency management and
prevention strategies for venues such as schools, early
care centers and transportation such as airplanes.
The Academy has been committed to these issues,
and recently resolutions were submitted at the Annual
Leadership Forum regarding availability of epinephrine
on airplanes. In addition, the Academy produced a
clinical report on food allergy management in schools
( http://bit.ly/2hqm9G2) and provided input on the
Centers for Disease Control and Prevention’s
Voluntary Guidelines for Managing Food Allergies in Schools
and Early Care and Education Programs (http://bit.
In summary, this landmark report provides numerous avenues for pediatricians to bring the recommendations to bear to improve health and safety for their
Disclaimer: The author is responsible for the content of this article, which does not necessarily represent
the views of the National Academies of
Sciences, Engineering, and Medicine,
their committees, or convening bodies.
Dr. Sicherer is past chair of the AAP
Section on Allergy and Immunology Executive Committee.
Report offers guidance on diagnosing, managing food allergies
2017 CERTIFYING EXAMINATIONS OF THE AMERICAN BOARD OF PEDIATRICS
111 SILVER CEDAR COURT, CHAPEL HILL, NC 27514-1513
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eligibility requirements and registration dates may also be found on the ABP website.
GENERAL PEDIATRICS EXAMINATION: Oct. 16–18, 2017
Registration: Jan. 18, 2017 – April 3, 2017
Late Registration: April 4, 2017 – May 15, 2017
• Pediatric Rheumatology Examination: March 29, 2017
• *Pediatric Emergency Medicine Examination: April 3, 2017
• Developmental-Behavioral Pediatrics Examination: April 4, 2017
• Pediatric Hematology-Oncology: April 6, 2017
• **Sports Medicine Examination: July 11-15, 2017
• Child Abuse Pediatrics Examination: Nov. 2, 2017
• Pediatric Endocrinology Examination: Nov. 8, 2017
• Pediatric Infectious Diseases Examination: Nov. 14, 2017
• Pediatric Gastroenterology Examination: Nov. 15, 2017
• *** Sleep Medicine Examination: Nov. 20, 2017
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All applicants for the Sports Medicine, Sleep Medicine and Pediatric Emergency Medicine Certifying Examinations must
apply through the Board in which they hold their primary certification. Registration dates may differ for each Board.
A new comprehensive report aimed at improving the
care of those with food allergies calls for action to
improve food labeling and identifies areas that require further research.