Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Food allergy is one of the most common chronic conditions of childhood, impacting up to 10% of children.1-3 However, despite the apparent increasing prevalence of this condition, there remain gaps in understanding of the diagnosis and management. There is a common perception held by many regarding a fear of food allergens provoking life-threatening reactions, potentially
even fatal food-induced anaphylaxis. Although severe reactions do occur and deaths from food allergy have been reported, fatal food allergy is a very rare event (defined as <1 case per 100 000).4,5 Paradoxically, fear regarding a severe food allergy can cause more morbidity than the food allergy itself.6-8 There are also misconceptions in the presentation and diagnosis of food allergy; as urticaria is not pathognomonic of food allergy and diagnostic testing, although sensitive, is not specific. Finally, it is under-recognized that antihistamines have no place in the first-line management of anaphylaxis, nor do oral corticosteroids have a role in prevention of a biphasic reaction. The goal of this commentary is to review important themes that have emerged in our understanding of food allergy management.