Introduction

Food allergy is a serious and potentially life-threatening health issue that appears to be increasing in the United States.^1-3 Indeed, food is the major cause of anaphylaxis in the United States,⁴ and food allergies are believed to account for 150 deaths per year.^5,6

Although the exact incidence is unknown, anaphylaxis may affect up to 2% of the population.7 Further, the annual incidence of anaphylaxis appears to be increasing in the United States, particularly among younger individuals.²

Given the potentially fatal consequences of anaphylaxis related to food allergy, health care professionals must be able not only to recognize and treat anaphylaxis promptly, but also to educate their patients on how to manage this life-threatening condition.

In order to assist health care professionals in making appropriate decisions regarding the diagnosis and management of food allergy, the National Institute of Allergy and Infectious Diseases (NIAID), working with more than 30 professional organizations, federal agencies, and patient advocacy groups, has developed clinical practice guidelines for the diagnosis and management of food allergy.¹ These guidelines were approved by ACEP, which had representation on the project’s coordinating committee.

The Growing Problem

Although difficult to compare due to difference in study design, recent epidemiologic studies suggest that the prevalence of food allergy has increased over the past 10-20 years.^1-3 Recent data indicate the prevalence of food allergy is 8.0% among children in the United States, a number greater than that previously reported.³ Among these children with food allergies, 38.7% had a history of severe reactions and 30.4% had multiple food allergies.³

Health care utilization associated with food allergy in the United States is considerable. Ambulatory care visits for food allergy in this country nearly tripled among children younger than 18 years of age between 1993 and 2006,² while hospitalizations among this group increased from an average of 2,600 discharges per year in 1998-2000 to 9,500 in 2004-2006.2 Further, extrapolation of data from the National Electronic Injury Surveillance System (NEISS) predicted that food-related allergic symptoms accounted for more than 20,000 hospital emergency department visits in the United States during a two-month period.⁸

Despite potentially fatal consequences, anaphylaxis due to food allergy is often underrecognized and/or undertreated. A recent review of food-allergic events from the NEISS indicated that 57% of likely anaphylactic events did not have an emergency department diagnosis of anaphylaxis according to standard criteria.⁸ Further, delay in the administration of epinephrine has been noted to contribute to fatalities associated with food related anaphylaxis.^5,9-12

Characterizing Food Allergy

A food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.1 Food allergens are those specific components of food or ingredients within food (typically glycoproteins) that elicit specific immune reactions.1 Although some allergens cause allergic reactions primarily if eaten raw, most food allergens can still elicit reactions even after they have been cooked or even digested.1 Cross-reactivity among food allergens is common, frequently occurring among different shellfish and among tree nuts.¹