IgE- and non-IgE-mediated food allergies - summary from 2011 CSACI meeting

This summary was compiled from tweets posted by Dr. Stuart Carr @allergydoc4kidz, the president of the Canadian Society of Allergy and Clinical Immunology (CSACI). The tweets were labeled #CSACI and they reached more than 10,000 people. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future.

Zave Chad spoke on IgE- and non-IgE-mediated food allergies:

FPIES

FPIES presents with vomiting and diarrhea, and may progress to shock. It starts early in infancy. There is 50% resolution per year for milk-induced FPIES.

Adult non-IgE reactions to shellfish may be the same process as pediatric FPIES. Milk protein enteropathy looks similar to celiac disease, but it usually self-limiting.

Deficit in TGF-beta (and its receptors) may be important in development of FPIES. Increased TNF-alpha also seems to be important for FPIES.

Related: Food protein-induced enterocolitis syndrome (FPIES) - AAAAI Ask the Expert addresses clinical questions, 2012.

Tests for food allergy

Pre-test probability is still the most important factor in assessing the value of SPT or sIgE for food allergy. Component-resolved diagnostics are becoming increasingly useful in determining the appropriateness of an oral food challenge.

Atopy patch testing (APT)

Atopy patch testing (APT) is not routinely advocated. There is a lot of work to be done before it can be used in clinical practice. A 2-year clinical experience with APT in Halifax suggests poor PPV and NPV, and clinicians are not enthusiastic.

Time of food introduction

There is growing evidence that optimal timing of food introduction for development of tolerance is between 4-6 months.

The introduction of eggs at 4 months (4/12) is associated with less allergy than the introduction of egg at 12 months (12/12). There are similar data for gluten and celiac disease.

"Screening" tests for food allergy

Tim Vander Leek (@TedNorton) is speaking about the role of SPT and the lack of utility of "screening" tests for food allergy.

There is a lot discussion around role of "screening" tests for food allergy. Some allergists think that is should be avoided at all costs because it is “hard to to unring the bell.”

In atopic dermatitis, it is better to focus on good aggressive skin care rather than testing for (unlikely) causative/contributing foods.

The article by Campbell (J Paediatr Child Health 2011, June 17) is a good review of the limited causative role of food allergy in atopic dermatitis.

Wade Watson spoke on controversies around food allergy.

For example, in infant with confirmed cow’s milk allergy (CMA), what do you say/do about egg, peanut (PN), etc.?

According to Bill Moote, "skin testing for foods they have not eaten is probably not rational.” If the parents are anxious to introduce the food at home, consider “open feed” in the allergy clinic rather than test.

Children with food allergy have poorer perceived general health and quality of life (QOL).

There are few data and published recommendations on the subsequent food introduction in children with established food allergy.

Disclaimer: The text was edited, modified, and added to by me. I was invited to speak on the topic of social media use by the allergists during the 2011 CSACI meeting.

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