EAACI guidelines on the management of IgE-mediated food allergy

Alexandra F Santos; Carmen Riggioni; Ioana Agache; Cezmi A Akdis; Mubeccel Akdis; Alberto Alvarez-Perea; Montserrat Alvaro-Lozano; Barbara Ballmer-Weber; Simona Barni; Kirsten Beyer; Carsten Bindslev-Jensen; Helen A Brough; Betul Buyuktiryaki; Derek Chu; Stefano Del Giacco; Audrey Dunn-Galvin; Bernadette Eberlein; Motohiro Ebisawa; Philippe Eigenmann; Thomas Eiwegger; Mary Feeney; Montserrat Fernandez-Rivas; Alessandro Fiocchi; Helen R Fisher; David M Fleischer; Mattia Giovannini; Claudia Gray; Karin Hoffmann-Sommergruber; Susanne Halken; Jonathan O'B Hourihane; Christina J Jones; Marek Jutel; Edward F Knol; George N Konstantinou; Gideon Lack; Susanne Lau; Andreina Marques Mejias; Mary Jane Marchisotto; Rosan Meyer; Charlotte G Mortz; Beatriz Moya; Antonella Muraro; Caroline Nilsson; Lucila Camargo Lopes de Oliveira; Liam O'Mahony; Nikolaos G Papadopoulos; Kirsten P Perrett; Rachel Peters; Marcia Podesta; Lars K Poulsen; Graham Roberts; Hugh Sampson; Jürgen Schwarze; Peter Smith; Elizabeth Tham; Eva Untersmayr; Ronald Van Ree; Carina Venter; Brian Vickery; Berber Vlieg-Boerstra; Thomas Werfel; Margitta Worm; George Du Toit; Isabel Skypala

doi:10.1111/all.16345

EAACI guidelines on the management of IgE-mediated food allergy

Allergy. 2024 Oct 30. doi: 10.1111/all.16345. Online ahead of print.

Authors

Alexandra F Santos^{1

2

3}, Carmen Riggioni^{4

5}, Ioana Agache⁶, Cezmi A Akdis⁷, Mubeccel Akdis⁷, Alberto Alvarez-Perea^{8

9}, Montserrat Alvaro-Lozano^{10

11}, Barbara Ballmer-Weber^{12

13}, Simona Barni¹⁴, Kirsten Beyer¹⁵, Carsten Bindslev-Jensen¹⁶, Helen A Brough^{1

3}, Betul Buyuktiryaki¹⁷, Derek Chu¹⁸, Stefano Del Giacco¹⁹, Audrey Dunn-Galvin^{20

21}, Bernadette Eberlein²², Motohiro Ebisawa²³, Philippe Eigenmann²⁴, Thomas Eiwegger^{25

26

27

28}, Mary Feeney¹, Montserrat Fernandez-Rivas^{29

30}, Alessandro Fiocchi³¹, Helen R Fisher¹, David M Fleischer³², Mattia Giovannini^{15

33}, Claudia Gray^{34

35}, Karin Hoffmann-Sommergruber³⁶, Susanne Halken³⁷, Jonathan O'B Hourihane³⁸, Christina J Jones³⁹, Marek Jutel⁴⁰, Edward F Knol⁴¹, George N Konstantinou⁴², Gideon Lack^{1

2

3}, Susanne Lau¹⁶, Andreina Marques Mejias^{1

3}, Mary Jane Marchisotto^{43

44}, Rosan Meyer^{45

46}, Charlotte G Mortz¹⁷, Beatriz Moya^{47

48}, Antonella Muraro⁴⁹, Caroline Nilsson^{50

51}, Lucila Camargo Lopes de Oliveira⁵², Liam O'Mahony⁵³, Nikolaos G Papadopoulos^{54

55}, Kirsten P Perrett^{56

57

58}, Rachel Peters^{59

60}, Marcia Podesta⁶¹, Lars K Poulsen⁶², Graham Roberts⁶³, Hugh Sampson⁶⁴, Jürgen Schwarze⁶⁵, Peter Smith^{66

67}, Elizabeth Tham^{68

69

70}, Eva Untersmayr⁷¹, Ronald Van Ree⁷², Carina Venter⁷³, Brian Vickery⁷⁴, Berber Vlieg-Boerstra^{75

76

77}, Thomas Werfel⁷⁸, Margitta Worm¹⁶, George Du Toit^{1

3}, Isabel Skypala^{79

80}

Affiliations

¹ Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
² Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.
³ Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK.
⁴ Division of Immunology and Allergy, The Hospital for Sick Children and the SickKids Food Allergy and Anaphylaxis Program, Toronto, Ontario, Canada.
⁵ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Faculty of Medicine, Transylvania University, Brasov, Romania.
⁷ Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland.
⁸ Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁹ Gregorio Marañón Health Research Institute, Madrid, Spain.
¹⁰ Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
¹¹ Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
¹² Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
¹³ Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
¹⁴ Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
¹⁵ Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁶ Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense, Denmark.
¹⁷ Department of Pediatrics, Division of Pediatric Allergy, Koc University School of Medicine, Istanbul, Türkiye.
¹⁸ McMaster University, Hamilton, Canada.
¹⁹ Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy.
²⁰ Paediatrics and Child Health, INFANT Centre, HRB-CRF, University College Cork, Cork, Ireland.
²¹ Paediatrics and Child Health, Royal College of Surgeons in Ireland, Children's Health Ireland, Dublin, Ireland.
²² Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.
²³ Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan.
²⁴ Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
²⁵ Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.
²⁶ Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St.Pölten, Austria.
²⁷ Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
²⁸ Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
²⁹ Allergy Department, Hospital Clinico San Carlos, Madrid, Spain.
³⁰ Facultad de Medicina, Universidad Complutense, IdISSC, ARADyAL, Madrid, Spain.
³¹ Allergy Department, Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy.
³² University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
³³ Department of Health Sciences, University of Florence, Florence, Italy.
³⁴ Red Cross Children's Hospital and Kidsallergy Centre, Cape Town, South Africa.
³⁵ Department of Paediatrics, University of Cape Town, Cape Town, South Africa.
³⁶ Dept. of pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria.
³⁷ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
³⁸ Royal College of Surgeons in Ireland and Childrens Health Ireland, Dublin, Ireland.
³⁹ School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
⁴⁰ Department of Clinical Immunology, Faculty of Medicine, Wrocław Medical University; and ALL-MED Medical Research Institute, Wroclaw, Poland.
⁴¹ Department Center of Translational Immunology and Department Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴² Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece.
⁴³ EAACI Patient Organisation Committee, Zurich, Switzerland.
⁴⁴ MJM Advisory, New York, New York, USA.
⁴⁵ Dept. Nutrition and Dietetics, Winchester University, Winchester, UK.
⁴⁶ Department of Medicine, KU Leuven, Leuven, Belgium.
⁴⁷ Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain.
⁴⁸ Instituto de Investigación Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain.
⁴⁹ Food Allergy Referral Centre, Padua University Hospital, Padua, Italy.
⁵⁰ Department of Clinical Science and Education, Karolinska Institutet, Solna, Sweden.
⁵¹ Sachs Children and Youth Hospital, South Hospital, Stockholm, Sweden.
⁵² Division of Allergy and Clinical Immunology, Department of Paediatrics, Federal University of São Paulo, São Paulo, Brazil.
⁵³ Department of Medicine, School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland.
⁵⁴ Allergy Dpt, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁵⁵ Lydia Becker Institute, University of Manchester, Manchester, UK.
⁵⁶ Population Allergy, Murdoch Children's Research Institute, Parkville, Australia.
⁵⁷ Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁵⁸ Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia.
⁵⁹ Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁶⁰ Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia.
⁶¹ European Federation of Allergy and Airways Diseases Patients' Associations and the EAACI Patient Organisation Committee, Zurich, Switzerland.
⁶² Allergy Clinic, Copenhagen University Hospital at Herlev-Gentofte, Copenhagen, Denmark.
⁶³ Paediatric Allergy and Respiratory Medicine, University of Southampton, NIHR Southampton Biomedical Research Centre and David Hide Asthma and Allergy Centre, St Mary Hospital, Isle of Wight, UK.
⁶⁴ Department of Pediatrics, Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁶⁵ Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK.
⁶⁶ Clinical Medicine, Griffith University, Southport, Queensland, Australia.
⁶⁷ Queensland Allergy Services Private Practice, Southport, Queensland, Australia.
⁶⁸ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁶⁹ Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS), Singapore, Singapore.
⁷⁰ Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁷¹ Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
⁷² Department of Experimental Immunology and of Otorhinolaryngology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
⁷³ Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado, Boulder, Colorado, USA.
⁷⁴ Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
⁷⁵ Department of Paediatrics, OLVG Hospital, Amsterdam, the Netherlands.
⁷⁶ Rijnstate Allergy Centre, Rijnstate Hospital, Arnhem, The Netherlands.
⁷⁷ Vlieg Dieticians, Private Practice for dietary management of food allergy, Arnhem, the Netherlands.
⁷⁸ Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
⁷⁹ Part of Guys and St Thomas NHS Foundation Trust, Royal Brompton and Harefield Hospitals, London, UK.
⁸⁰ Department of Inflammation and Repair, Imperial College, London, UK.

PMID: 39473345
DOI: 10.1111/all.16345

Abstract

This European Academy of Allergy and Clinical Immunology (EAACI) guideline provides recommendations for the management of IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Following the confirmation of IgE-mediated food allergy diagnosis, allergen avoidance and dietary advice (with support of a specialised dietitian, if possible) together with the provision of a written treatment plan, education on the recognition of allergic symptoms and prescription of medication including adrenaline using an auto-injector are essential. Patients with significant anxiety and requirement for coping strategies may benefit from support from a clinical psychologist. As immunomodulatory interventions, omalizumab is suggested for treatment of IgE-mediated food allergy in children from the age of 1 and adults; and oral allergen-specific immunotherapy is recommended for children and adolescents with peanut allergy and suggested for milk and egg allergies (generally after 4 years of age for milk and egg). Sublingual and epicutaneous immunotherapy are suggested for peanut allergy but are not yet available at the point of care. Future research into disease modifying treatments for IgE-mediated food allergy are highly needed, with standardised and patient-focused protocols and outcomes.

Keywords: IgE‐mediated food allergy; allergen immunotherapy; anaphylaxis; biologicals; diet; food allergy; management; treatment.

Grants and funding

European Academy of Allergy and Clinical Immunology