FOOD ALLERGY & ANAPHYLAXIS
MICHIGAN ASSOCIATION
MICHIGAN ASSOCIATION
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Food Allergy & Anaphylaxis Michigan Association (FAAMA)
FAAMA is a professional association with a primary purpose to share expertise and partner with fellow healthcare professionals working with the food allergy patient population. FAAMA aims to advance formal health education on IgE mediated food allergy and anaphylaxis and to partner with health professional colleagues on food allergy research investigations. Consultations, selected resources, referrals and collaborative initiatives are shared with healthcare colleagues to assist in professional endeavors which impact patients with IgE mediated food allergy at risk for anaphylaxis. FAAMA provides selected resources and evidenced-based general information to school staff and patients/families. FAAMA also collaborates with legislators on food allergy related health policy efforts. FAAMA was founded in February 2015. |
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What is a food allergy? A food allergy is an adverse reaction to food arising from the immune system that occurs reproducibly on exposure to a specific food.[1-3] The body creates IgE antibodies to the food protein causing the allergy. Upon exposure to the food allergen, various cells in the body release histamine and other chemicals which cause different symptoms.[1-5] Any food may potentially cause an allergic reaction. However, the 9 most common foods triggering the majority of allergic reactions include[1-4]:
*Sesame was designated as the 9th major food allergen in the U.S. effective January 1, 2023 based on federal legislation. [6]
How much food does it take to cause a reaction? The amount of food and the route of exposure needed to cause an allergic reaction vary.[1-3] Tiny specks of food allergen exposure may be enough to trigger a reaction. How is a food allergy diagnosed? Children and adults with suspected food allergy should be evaluated by a board certified allergist. Such evaluation often includes a thorough medical history, physical examination, diagnostic testing and analysis of results. Customized patient/family education on daily management of food allergy and proper use of prescribed medications is often provided by registered nurses. Once a food allergy is diagnosed, physicians and nurses can provide and review individualized emergency care plans which include information on which food allergens to avoid, symptoms to watch for, and steps to take should a food allergen exposure occur resulting in an allergic reaction. Nutritional concerns may be addressed through referrals to a registered dietician. Such an interprofessional clinical team approach with sharing of diverse expertise, experience, and scientific knowledge is needed to provide ongoing quality care of individuals with food allergy.[1,4] Page last reviewed: October 7, 2024 |
Can a food allergy be life-threatening?
Yes. Food allergy is a common trigger of anaphylaxis, the severest form of an allergic reaction, which is a life-threatening medical emergency. Anaphylaxis may begin within minutes to hours after exposure to a food allergen. Anaphylaxis can progress very rapidly and may cause death.[1-5] What are symptoms of anaphylaxis? Symptoms may include: Skin: hives (raised redish welts on surface of skin); pruritus (itching); rash; flushing; itchy lips; angioedema (swelling); red, itchy watery eyes; tongue and/or mouth swelling; paleness or cyanosis (bluish skin appearance) Respiratory: nasal congestion; rhinorrhea (runny nose); coughing; throat itching; throat tightness; stridor (high-pitched noisy breathing due to obstructed air flow); wheezing; dyspnea (shortness of breath); chest tightness; laryngeal edema; choking; hoarseness; trouble speaking; difficulty swallowing Gastro-intestinal: abdominal pain; cramping; nausea; emesis (vomiting); diarrhea Cardiovascular: dizziness; tachycardia (very high heart rate); hypotension (decreased blood pressure); bradycardia (decreased heart rate); arrhythmia (irregular heart rate), hypotonia (decreased muscle tone) Neurological: mental confusion; lethargy; seizures; syncope (fainting); irritability; feeling a sense of doom; loss of consciousness Anaphylaxis may involve every body system. Anaphylaxis may also occur without seeing hives or other skin symptoms.[1-5] How is anaphylaxis treated? The first line treatment for anaphylaxis is an injectable medication called epinephrine. It must be given immediately. Chance of survival is directly correlated with how quickly epinephrine is given. Once epinephrine is administered, 911 must be called for prompt transfer of the individual to the nearest emergency department via ambulance for evaluation and monitoring by physicians and nurses. More than one dose of epinephrine may be needed if symptoms persist or return while waiting for the ambulance.[1-5] In August 2024, the FDA approved Neffy epinephrine nasal spray for the emergency treatment of allergic reactions, including anaphylaxis, in adults and children weighing 30 kilograms (about 66 pounds) and up.[18] Patients/caregivers may consider talking with their physician about what forms of prescription epinephrine are best for them to use. Is there a cure for food allergy? There is no cure for food allergy. Researchers are studying potential treatment options in clinical trials. Daily management of a diagnosed food allergy requires strict avoidance of the food allergen. This includes avoiding any food or non-food item that may contain the offending food allergen. Anaphylaxis prevention and preparedness is central to successful daily management.[1-5] What is Food Oral Immunotherapy & Xolair®? Food oral immunotherapy has emerged from clinical research trials into clinical practice. In January 2020, the U.S. Food & Drug Administration (FDA) approved use of Palforzia allergen powder to Aimmune Therapeutics for 4 - 17 year olds.[7]. In July 2024, the FDA approved the use of Palforzia in children 1 - 3 years old as well [8,9]. Palforzia is a form of peanut oral immunotherapy used as an elective, non-curative therapy for patients with persistent diagnosed IgE-mediated peanut allergy [7,10]. The aim of this therapy is to raise the threshold upon which the individual with peanut allergy has an allergic reaction thereby reducing their risk of having a severe reaction upon accidental exposure to trace amounts of peanut [10-13]. The delivery of this allergist-supervised food immunotherapy is a time-intensive process involving months of multiple clinic appointments with an allergy team certified to provide Palforzia [10-13]. Once the patient has completed the process, they still have to carry prescribed epinephrine, avoid the food allergen, read ingredient labels, and continue other allergen avoidance measures [10-13]. In February of 2024, the FDA approved the use of physician prescribed Xolair® (omalizumab) to lessen the risk of allergic reactions to one or multiple foods upon accidental exposure [14]. Xolair® is not a cure for food allergies nor is it indicated for use in treating anaphylaxis [14-17]. Thus, patients receiving Xolair® must still avoid their offending food allergen(s) and carry their prescribed epinephrine [14-17]. Patients/families should speak with their physician to determine if Xolair® and/or OIT are a safe and appropriate option for them. References: 1. Panel, N.S.E., 2010. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. Journal of Allergy and Clinical Immunology, 126(6), pp.S1-S58. 2. Sicherer, S.H. and Sampson, H.A., 2018. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. Journal of Allergy and Clinical Immunology, 141(1), pp.41-58. 3.Sicherer, S.H., Warren, C.M., Dant, C., Gupta, R.S. and Nadeau, K.C., 2020. Food allergy from infancy through adulthood. The Journal of Allergy and Clinical Immunology: In Practice, 8(6), pp.1854-1864. 4. Russell, A.F., Gosbee, L.L. and Huber, M.M., 2012. Part 2: pertinent food allergy education in a pediatric ambulatory care setting with a focus on anaphylaxis. Journal of Asthma & Allergy Educators, 3(4), pp.162-171. 5. Shaker, M.S., Wallace, D.V., Golden, D.B., Oppenheimer, J., Bernstein, J.A., Campbell, R.L., Dinakar, C., Ellis, A., Greenhawt, M., Khan, D.A. and Lang, D.M., 2020. Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. Journal of Allergy and Clinical Immunology, 145(4), pp.1082-1123. 6. Food Allergy Safety, Treatment, Education & Research Act of 2021. Available at https://www.congress.gov/bill/117th-congress/senate-bill/578. 7. Food & Drug Administration (FDA). FDA approves first drug for treatment of peanut allergy in children. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treatment-peanut-allergy-children. 8. FDA Extends Palforzia Approval to Children 1 to 3 Years Old With Peanut Allergy. Available at https://www.pharmacytimes.com/view/fda-extends-palforzia-approval-to-children-1-to-3-years-old-with-peanut-allergy. 9. Palforzia. Available at www.fda.gov/vaccines-blood-biologics/allergenics/palforzia 10. American Academy of Allergy, Asthma & Immunology (AAAAI). The current state of oral immunotherapy. Available at: https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/the-current-state-of-oral-immunotherapy. 11. Begin P, Chan ES, Kim H. et al. CSACI guidelines for the ethical, evidenced-based and patient oriented clinical practice of oral immunotherapyin IgE-mediated food allergy. Allergy, Asthma & Clinical Immunology. 2020; 16(1):1-45. 12. Pajno GB, Fernandez-Rivas M, Arasi S, etal. EAACI guidelines on allergen immunotherapy: IgE-mediated food allergy. Allergy. 2018;73(4):799-815. 13. Pepper, AN, Assa'ad A, Blaiss M, et al. Consensus report from the food allergy research and education (FARE) 2019 oral immunotherapy for food allergy summit. Journal of Allergy and Clinical Immunology. 2020;146(2):244-9. 14. U.S. Food & Drug Administration. FDA approves first medication to help reduce allergic reactions to multiple foods after accidental exposure. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-help-reduce-allergic-reactions-multiple-foods-after-accidental. 15. National Institutes of Health. Antibody reduces allergic reactions to multiple foods in NIH clinical trial. Available at: https://www.nih.gov/news-events/news-releases/antibody-reduces-allergic-reactions-multiple-foods-nih-clinical-trial. 16. Wood, R.A., Togias, A., Sicherer, S.H., Shreffler, W.G., Kim, E.H., Jones, S.M., Leung, D.Y., Vickery, B.P., Bird, J.A., Spergel, J.M. and Iqbal, A., 2024. Omalizumab for the Treatment of Multiple Food Allergies. New England Journal of Medicine. 390:889-899 17. Allergy and Asthma Network. FDA approves Xolair as first treatment to reduce risk of food allergic reactions. Available at: https://allergyasthmanetwork.org/news/omalizumab-and-oral-immunotherapy/. 18. U.S. Food & Drug Administration. FDA approves first nasal spray for treatment of anaphylaxis. Available at: www.fda.gov/news-events/press-announcements/fda-approves-first-nasal-spray-treatment-anaphylaxis |
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