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163. Managing food allergy: GA2LEN guideline 2022

Author

Muraro, Antonella, de Silva, Debra, Halken, Susanne, Worm, Margitta, Khaleva, Ekaterina, Arasi, Stefania, Dunn-Galvin, Audrey, Nwaru, Bright I., De Jong, Nicolette W., Rodríguez Del Río, Pablo, Turner, Paul J., Smith, Pete, Begin, Philippe, Angier, Elizabeth, Arshad, Hasan, Ballmer-Weber, Barbara, Beyer, Kirsten, Bindslev-Jensen, Carsten, Cianferoni, Antonella, Demoulin, Céline, Deschildre, Antoine, Ebisawa, Motohiro, Fernandez-Rivas, Maria Montserrat, Fiocchi, Alessandro, Flokstra-de Blok, Bertine, Gerdts, Jennifer, Gradman, Josefine, Grimshaw, Kate, Jones, Carla, Lau, Susanne, Loh, Richard, Alvaro Lozano, Montserrat, Makela, Mika, Marchisotto, Mary Jane, Meyer, Rosan, Mills, Clare, Nilsson, Caroline, Nowak-Wegrzyn, Anna, Nurmatov, Ulugbek, Pajno, Giovanni, Podestà, Marcia, Poulsen, Lars K., Sampson, Hugh A., Sanchez, Angel, Schnadt, Sabine, Szajewska, Hania, Van Ree, Ronald, Venter, Carina, Wood, Robert, and Roberts, Graham

Abstract

Food allergy affects approximately 2–4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA2LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy.

Published
2022

167. Managing food allergy: GA2LEN guideline 2022

Author

Muraro, Antonella, primary, de Silva, Debra, additional, Halken, Susanne, additional, Worm, Margitta, additional, Khaleva, Ekaterina, additional, Arasi, Stefania, additional, Dunn-Galvin, Audrey, additional, Nwaru, Bright I., additional, De Jong, Nicolette W., additional, Rodríguez Del Río, Pablo, additional, Turner, Paul J., additional, Smith, Pete, additional, Begin, Philippe, additional, Angier, Elizabeth, additional, Arshad, Hasan, additional, Ballmer-Weber, Barbara, additional, Beyer, Kirsten, additional, Bindslev-Jensen, Carsten, additional, Cianferoni, Antonella, additional, Demoulin, Céline, additional, Deschildre, Antoine, additional, Ebisawa, Motohiro, additional, Fernandez-Rivas, Maria Montserrat, additional, Fiocchi, Alessandro, additional, Flokstra-de Blok, Bertine, additional, Gerdts, Jennifer, additional, Gradman, Josefine, additional, Grimshaw, Kate, additional, Jones, Carla, additional, Lau, Susanne, additional, Loh, Richard, additional, Alvaro Lozano, Montserrat, additional, Makela, Mika, additional, Marchisotto, Mary Jane, additional, Meyer, Rosan, additional, Mills, Clare, additional, Nilsson, Caroline, additional, Nowak-Wegrzyn, Anna, additional, Nurmatov, Ulugbek, additional, Pajno, Giovanni, additional, Podestà, Marcia, additional, Poulsen, Lars K., additional, Sampson, Hugh A., additional, Sanchez, Angel, additional, Schnadt, Sabine, additional, Szajewska, Hania, additional, Van Ree, Ronald, additional, Venter, Carina, additional, Vlieg-Boerstra, Berber, additional, Warner, Amena, additional, Wong, Gary, additional, Wood, Robert, additional, Zuberbier, Torsten, additional, Roberts, Graham, additional, Bansal, Priya, additional, Berni–Canani, Roberto, additional, Blumchen, Katharina, additional, Bonertz, Andreas, additional, Bourgoin-Heck, Melisande, additional, Ceylon, Ozlem, additional, Divaret-Chauveau, Amandine, additional, Fleischer, David, additional, Gomez, Maximiliano, additional, Groetch, Marion, additional, Hernandez, Domingo Barber, additional, Hjorth, Betina, additional, Hussey, Lydia Collins, additional, Knulst, André C., additional, Leung, Agnes, additional, Mack, Douglas, additional, Mahler, Vera, additional, Mori, Francesca, additional, Namazova-Baranova, Leyla, additional, Palosuo, Kati, additional, Parisi, Claudio Alberto Salvador, additional, Pastorino, Antonio Carlos, additional, Rudzeviciene, Odilija, additional, Said, Maria, additional, Sawiec, Piotr, additional, Sicherer, Scott, additional, Sato, Sakura, additional, and Zubchenko, Svitlana, additional

Published
2022
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177. Allergen immunotherapy and/or biologicals for IgE-mediated food allergy: A systematic review and meta-analysis

Author

de Silva, Debra, Rodríguez Del Río, Pablo, de Jong, Nicolette W, Khaleva, Ekaterina, Singh, Chris, Nowak-Wegrzyn, Anna, Muraro, Antonella, Begin, Philippe, Pajno, Giovanni, Fiocchi, Alessandro, Sanchez, Angel, Jones, Carla, Nilsson, Caroline, Bindslev-Jensen, Carsten, Wong, Gary, Sampson, Hugh, Beyer, Kirsten, Marchisotto, Mary-Jane, Fernandez Rivas, Montserrat, Meyer, Rosan, Lau, Susanne, Nurmatov, Ulugbek, Roberts, Graham, and Internal Medicine

Subjects
Immunology, food and beverages, Allergens, Immunoglobulin E, Desensitization, Immunologic, Quality of Life, Animals, Humans, Immunology and Allergy, Cattle, Female, Egg Hypersensitivity, Chickens, Food Hypersensitivity
Abstract

Background\udThere is substantial interest in immunotherapy and biologicals in IgE-mediated food allergy.\ud\udMethods\udWe searched six databases for randomized controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis.\ud\udResults\udWe included 36 trials about immunotherapy with 2126 mainly child participants. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5.–21.4, high certainty); cow's milk (RR 5.7, 1.9–16.7, moderate certainty) and hen's egg allergy (RR 8.9, 4.4–18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300 mg or 1000 mg peanut protein was 2.\ud\udOral immunotherapy did not increase adverse reactions (RR 1.1, 1.0–1.2, low certainty) or severe reactions in peanut allergy (RR 1,6, 0.7–3.5, low certainty), but may increase (mild) adverse reactions in cow's milk (RR 3.9, 2.1–7.5, low certainty) and hen's egg allergy (RR 7.0, 2.4–19.8, moderate certainty). Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8–3.8, moderate certainty). Results were unclear for other allergies and administration routes.\ud\udThere were too few trials of biologicals alone (3) or with immunotherapy (1) to draw conclusions.\ud\udConclusions\udOral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow's milk and hen's egg allergy. More research is needed about quality of life, cost and biologicals.

Published
2022

183. Managing food allergy:GA2LEN guideline 2022

Author

Muraro, Antonella, de Silva, Debra, Halken, Susanne, Worm, Margitta, Khaleva, Ekaterina, Arasi, Stefania, Dunn-Galvin, Audrey, Nwaru, Bright I., De Jong, Nicolette W., Rodríguez Del Río, Pablo, Turner, Paul J., Smith, Pete, Begin, Philippe, Angier, Elizabeth, Arshad, Hasan, Ballmer-Weber, Barbara, Beyer, Kirsten, Bindslev-Jensen, Carsten, Cianferoni, Antonella, Demoulin, Céline, Deschildre, Antoine, Ebisawa, Motohiro, Fernandez-Rivas, Maria Montserrat, Fiocchi, Alessandro, Flokstra-de Blok, Bertine, Gerdts, Jennifer, Gradman, Josefine, Grimshaw, Kate, Jones, Carla, Lau, Susanne, Loh, Richard, Alvaro Lozano, Montserrat, Makela, Mika, Marchisotto, Mary Jane, Meyer, Rosan, Mills, Clare, Nilsson, Caroline, Nowak-Wegrzyn, Anna, Nurmatov, Ulugbek, Pajno, Giovanni, Podestà, Marcia, Poulsen, Lars K., Sampson, Hugh A., Sanchez, Angel, Schnadt, Sabine, Szajewska, Hania, Van Ree, Ronald, Venter, Carina, Vlieg-Boerstra, Berber, Warner, Amena, Zuberbier, Torsten, Roberts, Graham, Muraro, Antonella, de Silva, Debra, Halken, Susanne, Worm, Margitta, Khaleva, Ekaterina, Arasi, Stefania, Dunn-Galvin, Audrey, Nwaru, Bright I., De Jong, Nicolette W., Rodríguez Del Río, Pablo, Turner, Paul J., Smith, Pete, Begin, Philippe, Angier, Elizabeth, Arshad, Hasan, Ballmer-Weber, Barbara, Beyer, Kirsten, Bindslev-Jensen, Carsten, Cianferoni, Antonella, Demoulin, Céline, Deschildre, Antoine, Ebisawa, Motohiro, Fernandez-Rivas, Maria Montserrat, Fiocchi, Alessandro, Flokstra-de Blok, Bertine, Gerdts, Jennifer, Gradman, Josefine, Grimshaw, Kate, Jones, Carla, Lau, Susanne, Loh, Richard, Alvaro Lozano, Montserrat, Makela, Mika, Marchisotto, Mary Jane, Meyer, Rosan, Mills, Clare, Nilsson, Caroline, Nowak-Wegrzyn, Anna, Nurmatov, Ulugbek, Pajno, Giovanni, Podestà, Marcia, Poulsen, Lars K., Sampson, Hugh A., Sanchez, Angel, Schnadt, Sabine, Szajewska, Hania, Van Ree, Ronald, Venter, Carina, Vlieg-Boerstra, Berber, Warner, Amena, Zuberbier, Torsten, and Roberts, Graham

Abstract

Food allergy affects approximately 2–4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA2LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy.

Published
2022

184. Allergen immunotherapy and/or biologicals for IgE-mediated food allergy:A systematic review and meta-analysis

Author

de Silva, Debra, Rodríguez del Río, Pablo, de Jong, Nicolette W., Khaleva, Ekaterina, Singh, Chris, Nowak-Wegrzyn, Anna, Muraro, Antonella, Begin, Philippe, Pajno, Giovanni, Fiocchi, Alessandro, Sanchez, Angel, Jones, Carla, Nilsson, Caroline, Bindslev-Jensen, Carsten, Wong, Gary, Sampson, Hugh, Beyer, Kirsten, Marchisotto, Mary Jane, Fernandez Rivas, Montserrat, Meyer, Rosan, Lau, Susanne, Nurmatov, Ulugbek, de Silva, Debra, Rodríguez del Río, Pablo, de Jong, Nicolette W., Khaleva, Ekaterina, Singh, Chris, Nowak-Wegrzyn, Anna, Muraro, Antonella, Begin, Philippe, Pajno, Giovanni, Fiocchi, Alessandro, Sanchez, Angel, Jones, Carla, Nilsson, Caroline, Bindslev-Jensen, Carsten, Wong, Gary, Sampson, Hugh, Beyer, Kirsten, Marchisotto, Mary Jane, Fernandez Rivas, Montserrat, Meyer, Rosan, Lau, Susanne, and Nurmatov, Ulugbek

Abstract

Background: There is substantial interest in immunotherapy and biologicals in IgE-mediated food allergy. Methods: We searched six databases for randomized controlled trials about immunotherapy alone or with biologicals or biological monotherapy in food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis. Results: We included 36 trials about immunotherapy with 2126 mainly child participants. Oral immunotherapy increased tolerance whilst on therapy for peanut; cow's milk and hen's egg allergy. The number needed to treat to increase tolerance to a single dose of 300 mg or 1000 mg peanut protein was 2. Oral immunotherapy did not increase adverse reactions or severe reactions in peanut allergy, but may increase (mild) adverse reactions in cow's milk and hen's egg allergy. Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut. Results were unclear for other allergies and administration routes. There were too few trials of biologicals alone (3) or with immunotherapy (1) to draw conclusions. Conclusions: Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow's milk and hen's egg allergy. More research is needed about quality of life, cost and biologicals.

Published
2022

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