Managing food allergy: GA²LEN guideline 2022

Antonella Muraro¹, Debra de Silva², Susanne Halken³, Margitta Worm⁴, Ekaterina Khaleva⁵, Stefania Arasi⁶, Audrey Dunn-Galvin⁷, Bright I Nwaru⁸, Nicolette W De Jong⁹, Pablo Rodríguez Del Río¹⁰, Paul J Turner¹¹, Pete Smith¹², Philippe Begin¹³, Elizabeth Angier⁵, Hasan Arshad¹⁴, Barbara Ballmer-Weber¹⁵, Kirsten Beyer⁴, Carsten Bindslev-Jensen¹⁶, Antonella Cianferoni¹⁷, Céline Demoulin¹⁸, Antoine Deschildre¹⁹, Motohiro Ebisawa²⁰, Maria Montserrat Fernandez-Rivas²¹, Alessandro Fiocchi⁶, Bertine Flokstra-de Blok^{22

23

24}, Jennifer Gerdts²⁵, Josefine Gradman³, Kate Grimshaw²⁶, Carla Jones²⁷, Susanne Lau⁴, Richard Loh²⁸, Montserrat Alvaro Lozano²⁹, Mika Makela³⁰, Mary Jane Marchisotto³¹, Rosan Meyer¹¹, Clare Mills³², Caroline Nilsson³³, Anna Nowak-Wegrzyn^{34

35

36}, Ulugbek Nurmatov³⁷, Giovanni Pajno³⁸, Marcia Podestà³⁹, Lars K Poulsen⁴⁰, Hugh A Sampson⁴¹, Angel Sanchez⁴², Sabine Schnadt⁴³, Hania Szajewska⁴⁴, Ronald Van Ree⁴⁵, Carina Venter⁴⁶, Berber Vlieg-Boerstra⁴⁷, Amena Warner²⁷, Gary Wong⁴⁸, Robert Wood⁴⁹, Torsten Zuberbier⁴, Graham Roberts^{5

50

51}; GA2LEN Food Allergy Guideline Group; GALEN Food Allergy Guideline Group

Collaborators, Affiliations

Affiliations

¹ Food Allergy Centre, Padua University Hospital, Italy.
² The Evidence Centre, UK.
³ Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark.
⁴ Charité - Universitätsmedizin Berlin, Germany.
⁵ University of Southampton, UK.
⁶ Bambino Gesù Children's Hospital (IRCCS), Italy.
⁷ University College Cork, Ireland.
⁸ University of Gothenburg, Sweden.
⁹ Internal Medicine, Allergology & Clinical Immunology, Pediatric Allergology, University Medical Centre, Rotterdam, the Netherlands.
¹⁰ Niño Jesus University Children's Hospital, Spain.
¹¹ Imperial College London, London, United Kingdom.
¹² Griffith University School of Medicine, Australia.
¹³ Université de Montréal, Canada.
¹⁴ Faculty of Medicine, University of Southampton, UK.
¹⁵ Department of Dermatology, University Hospital Zürich and Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, Switzerland.
¹⁶ Department of Dermatology and Allergy Center, Odense University Hospital, Denmark.
¹⁷ University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁸ Association Francaise pour la Prevention des Allergies, France.
¹⁹ CHU Lille, Univ.Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France.
²⁰ NHO Sagamihara National Hospital, Japan.
²¹ Hospital Clínico San Carlos, Universidad Complutense Madrid, IdISSC, Spain.
²² General Practitioners Research Institute, Groningen, the Netherlands.
²³ University of Groningen, University Medical Center Groningen, Groningen Research Institute Asthma and COPD (GRIAC), Groningen, the Netherlands.
²⁴ University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, the Netherlands.
²⁵ Food Allergy Canada, Canada.
²⁶ Dietetic Department, Salford Care Organisation, Northern Care Alliance NHS Group, UK.
²⁷ Allergy UK, UK.
²⁸ Perth Children's Hospital, Australia.
²⁹ Hospital Sant Joan de Déu, Esplugues, Spain.
³⁰ Helsinki University Hospital, Finland.
³¹ USA.
³² School of Biological Sciences, Manchester Institute of Biotechnology, University of Manchester, Manchester, M17DN, UK.
³³ Karolinska Institutet, Dept. of Clinical Science and Education, Södersjukhuset and Sachs' Children and Youth Hospital, Sweden.
³⁴ Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
³⁵ Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
³⁶ Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
³⁷ School of Medicine, Cardiff University, Wales, United Kingdom.
³⁸ Policlinico Hospital-University of Messina, Italy.
³⁹ Food Allergy Italia, Italy.
⁴⁰ Copenhagen University Hospital, Denmark.
⁴¹ Icahn School of Medicine at Mount Sinai, USA.
⁴² AEPNAA Spanish Association for People with Food and Latex Allergy, Spain.
⁴³ DAAB, Deutscher Allergie- und Asthmabund e.V, Germany.
⁴⁴ Department of Paediatrics, Medical University of Warsaw, Poland.
⁴⁵ Amsterdam UMC, the Netherlands.
⁴⁶ Children's Hospital Colorado, University of Colorado, USA.
⁴⁷ OLVG Hospital, Department of Paediatrics, Amsterdam, the Netherlands.
⁴⁸ Chinese University of Hong Kong, Hong Kong.
⁴⁹ Department of Pediatrics, John Hopkins University School of Medicine, USA.
⁵⁰ Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵¹ David Hide Asthma and Allergy Centre, St Mary's Hospital, Isle of Wight, UK.

PMID: 36119657
PMCID: PMC9467869
DOI: 10.1016/j.waojou.2022.100687

Review

Managing food allergy: GA²LEN guideline 2022

Antonella Muraro et al. World Allergy Organ J. 2022.

. 2022 Sep 7;15(9):100687.

doi: 10.1016/j.waojou.2022.100687. eCollection 2022 Sep.

Authors

Affiliations

¹ Food Allergy Centre, Padua University Hospital, Italy.
² The Evidence Centre, UK.
³ Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark.
⁴ Charité - Universitätsmedizin Berlin, Germany.
⁵ University of Southampton, UK.
⁶ Bambino Gesù Children's Hospital (IRCCS), Italy.
⁷ University College Cork, Ireland.
⁸ University of Gothenburg, Sweden.
⁹ Internal Medicine, Allergology & Clinical Immunology, Pediatric Allergology, University Medical Centre, Rotterdam, the Netherlands.
¹⁰ Niño Jesus University Children's Hospital, Spain.
¹¹ Imperial College London, London, United Kingdom.
¹² Griffith University School of Medicine, Australia.
¹³ Université de Montréal, Canada.
¹⁴ Faculty of Medicine, University of Southampton, UK.
¹⁵ Department of Dermatology, University Hospital Zürich and Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, Switzerland.
¹⁶ Department of Dermatology and Allergy Center, Odense University Hospital, Denmark.
¹⁷ University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁸ Association Francaise pour la Prevention des Allergies, France.
¹⁹ CHU Lille, Univ.Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France.
²⁰ NHO Sagamihara National Hospital, Japan.
²¹ Hospital Clínico San Carlos, Universidad Complutense Madrid, IdISSC, Spain.
²² General Practitioners Research Institute, Groningen, the Netherlands.
²³ University of Groningen, University Medical Center Groningen, Groningen Research Institute Asthma and COPD (GRIAC), Groningen, the Netherlands.
²⁴ University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, the Netherlands.
²⁵ Food Allergy Canada, Canada.
²⁶ Dietetic Department, Salford Care Organisation, Northern Care Alliance NHS Group, UK.
²⁷ Allergy UK, UK.
²⁸ Perth Children's Hospital, Australia.
²⁹ Hospital Sant Joan de Déu, Esplugues, Spain.
³⁰ Helsinki University Hospital, Finland.
³¹ USA.
³² School of Biological Sciences, Manchester Institute of Biotechnology, University of Manchester, Manchester, M17DN, UK.
³³ Karolinska Institutet, Dept. of Clinical Science and Education, Södersjukhuset and Sachs' Children and Youth Hospital, Sweden.
³⁴ Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
³⁵ Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
³⁶ Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
³⁷ School of Medicine, Cardiff University, Wales, United Kingdom.
³⁸ Policlinico Hospital-University of Messina, Italy.
³⁹ Food Allergy Italia, Italy.
⁴⁰ Copenhagen University Hospital, Denmark.
⁴¹ Icahn School of Medicine at Mount Sinai, USA.
⁴² AEPNAA Spanish Association for People with Food and Latex Allergy, Spain.
⁴³ DAAB, Deutscher Allergie- und Asthmabund e.V, Germany.
⁴⁴ Department of Paediatrics, Medical University of Warsaw, Poland.
⁴⁵ Amsterdam UMC, the Netherlands.
⁴⁶ Children's Hospital Colorado, University of Colorado, USA.
⁴⁷ OLVG Hospital, Department of Paediatrics, Amsterdam, the Netherlands.
⁴⁸ Chinese University of Hong Kong, Hong Kong.
⁴⁹ Department of Pediatrics, John Hopkins University School of Medicine, USA.
⁵⁰ Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵¹ David Hide Asthma and Allergy Centre, St Mary's Hospital, Isle of Wight, UK.

PMID: 36119657
PMCID: PMC9467869
DOI: 10.1016/j.waojou.2022.100687

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.

Keywords: Adolescent; Adults; Children; Food allergy; Food hypersensitivity.

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Figures

Summary of the Ga²len managing food allergy 2022 guideline.

See this image and copyright information in PMC

References

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Managing food allergy: GA²LEN guideline 2022

Collaborators

Affiliations

Managing food allergy: GA²LEN guideline 2022

Authors

Collaborators

Affiliations

Abstract

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References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous