How to manage asthma in a food-allergic patient: A practical approach

Abstract

This article examines the intricate interplay between food allergy and asthma by focusing on the challenges of managing food allergy in patients with asthma. Although asthma is a prevalent comorbidity in food allergy, often > 50% among older children, its impact on food allergy outcomes remains not fully understood. Studies indicate a higher prevalence of asthma among individuals experiencing fatal anaphylaxis, yet there is no consistent evidence that supports a direct causal link between food allergy and the development of asthma. Clinicians and patients often overestimate asthma control, which leads to underestimated risks associated with severe food allergy reactions. This article underscores the critical need for optimal asthma control before and during oral food challenges and dietary advancement therapies, highlighting the heightened risk of severe reactions in individuals with poorly controlled asthma. Whereas biologics such as omalizumab show promise in enhancing asthma control and increasing food allergy thresholds, a comprehensive, multifaceted approach that involves diligent asthma management, patient education, and appropriate treatment strategies is essential for ensuring safe and effective management of food allergy in individuals with asthma. Integrated management, which addresses both conditions concurrently, is vital for improving patient safety and quality of life.

Keywords: anaphylaxis; asthma; asthma control; dietary advancement therapies; food allergy; food ladders; oral food challenge; oral immunotherapy.