Building a Safer Environment for People with Food Allergies

Research

Just as an elevator spans all the floors of a building, current gaps in scientific research affect all stakeholder groups. To improve safety for people with food allergies, pressing questions need to be addressed through new research.

More research is needed regarding underlying biology, better diagnostic tools, effective educational approaches, and evidence-based guidelines for all stakeholders. Prospective and clinical trials are also needed to support or refute current hypotheses on the development of food allergies. A key long-term goal is the development of effective and safe therapies.

The pursuit of this research agenda will inform and benefit the work that each stakeholder group can do to maximize public safety as a whole.

Government

Federal authorities are responsible for informing people of food allergy risks in packaged foods. For example, companies may include a voluntary, precautionary allergen label (or PAL, which states that “X allergen may be present”), but these currently bear no relationship to actual risk. Federal authorities, guided by scientific evidence, should regularly update the priority list of allergens and should work with industry to replace PAL with a new, risk-based approach.

Federal agencies (e.g., the Food and Drug Administration) should convene a special task force with the medical community, food companies, and advocacy stakeholder groups to establish and implement guidelines around management of and response to food allergy emergencies.

State, local, and tribal governmental agencies should adopt the 2013 FDA Food Code, which includes provisions for food establishments on the prevention of food allergic reactions. In collaboration with other stakeholders, the agencies should propose that the Food Code requires the person in charge in a food establishment to pass an accredited food safety certification program, including basic food allergy management. Agencies should develop guidance on effective approaches to inform consumers with food allergies in food service establishments.

Industry

Food industry leaders should provide the necessary resources for integrating food allergy training into existing general food safety and customer service training for employees—at all levels and stages in the food industry. This includes processing, retail food and grocery stores, restaurants, and other food service venues such as school cafeterias.

Health Care Providers

Physicians should use evidence-based, standardized procedures as the basis for food allergy diagnosis and avoid non-standardized and unproven procedures. When a food allergy is suspected, a physician with the training and experience needed to select and interpret appropriate diagnostic tests should evaluate a patient.

Health care providers should also counsel patients and their caregivers on the food allergy, following the most recent food allergy guidelines and emphasizing the need to take age-appropriate responsibility for managing their food allergy. Counseling is especially important for those at high risk of food allergy and severe food allergy reactions, such as adolescents, young adults, and those with both food allergy and asthma. Adrenaline should be used as a first line of emergency management for episodes of food allergy anaphylaxis.

Public Health Authorities

The true prevalence of food allergies remains unknown. To prioritize food allergy as a public health concern and help ensure enough resources, the Centers for Disease Control and Prevention (CDC) should obtain prevalence estimates in a systematic and statistically sound manner. The CDC should also work with other public health authorities to initiate a public health campaign to increase awareness and dispel misconceptions.

In regard to prevention, there is strong evidence that early introduction of peanut is protective against peanut allergy in infants at high risk. Public health authorities and clinical practice guidelines should include consistent, clear, and evidence-based advice for families and health care providers about the potential benefits of introducing allergenic foods to infants in the first year of life. Specifically, this should occur around 6 months of age when an infant is developmentally ready, but not before 4 months of age, particularly to those at high risk of allergy. Evidence is insufficient to associate any of the following behaviors with prevention: food allergen avoidance diets for pregnant or lactating women; prolonged allergen avoidance in infancy; vaginal delivery; breastfeeding; use of infant formulas containing partially or extensively hydrolyzed protein; and supplementation with specific nutrients.

Professional Organizations

Professional organizations, such as the American Academy of Pediatrics or the American Academy of Allergy, Asthma & Immunology, along with public health authorities, such as the National Institutes of Health, should regularly update guidelines on the diagnosis, prevention, and management of food allergy based on strong scientific evidence, as emerging scientific data become available.

Professional organizations like the American Red Cross—which provide emergency training to the general public and to first responders and first aid personnel in various professions and workplaces— should include food allergy and anaphylaxis management in their curricula.

Educational Institutions

Medical schools, residency and fellowship programs, and other relevant schools should include training for health care providers in the management of food allergy and anaphylaxis. Health care providers, including dietitians and mental health professionals, should also receive training on approaches to counseling patients and their caregivers. Counseling training should be provided, in part, by professional organizations through various means, including online.

Individuals and families

People with food allergies must navigate many issues when dining away from home. Some challenges include avoiding allergens included in the source ingredients of foods and cross contact of allergens at buffets and food preparation areas. People with food allergies and their families should inform the establishment about the allergy, and the establishment should also take precautions to provide safe food to the public.

Avoiding allergens in the home requires constant vigilance regarding cross contact, label reading, and hidden ingredients. Safeguards may be needed to protect a child from ingesting allergens. Families may need to keep the individual with a food allergy away from the allergen in food preparation areas if aerosolization is possible (e.g., frying eggs, boiling milk, or preparing food with wheat flours or powdered milk). It can be challenging and time consuming to maintain a continuously safe environment at home. Health care providers should review these issues with patients and families.

To learn more about food allergies, read the report at nationalacademies.org/FoodAllergies.