Managing food allergy: GA2LEN guideline 2022

Antonella Muraro*, Debra de Silva, GALEN Food Allergy Guideline Group, Susanne Halken, Margitta Worm, Ekaterina Khaleva, Stefania Arasi, Audrey Dunn-Galvin, Bright I. Nwaru, Nicolette W. De Jong, Pablo Rodríguez Del Río, Paul J. Turner, Pete Smith, Philippe Begin, Elizabeth Angier, Hasan Arshad, Barbara Ballmer-Weber, Kirsten Beyer, Carsten Bindslev-Jensen, Antonella CianferoniCéline Demoulin, Antoine Deschildre, Motohiro Ebisawa, Maria Montserrat Fernandez-Rivas, Alessandro Fiocchi, Bertine Flokstra-de Blok, Jennifer Gerdts, Josefine Gradman, Kate Grimshaw, Carla Jones, Susanne Lau, Richard Loh, Montserrat Alvaro Lozano, Mika Makela, Mary Jane Marchisotto, Rosan Meyer, Clare Mills, Caroline Nilsson, Anna Nowak-Wegrzyn, Ulugbek Nurmatov, Giovanni Pajno, Marcia Podestà, Lars K. Poulsen, Hugh A. Sampson, Angel Sanchez, Sabine Schnadt, Hania Szajewska, Ronald Van Ree, Carina Venter, Berber Vlieg-Boerstra, Amena Warner, Torsten Zuberbier, Graham Roberts

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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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.

Original languageEnglish
Article number100687
JournalWorld Allergy Organization Journal
Volume15
Issue number9
DOIs
Publication statusPublished - 1 Sep 2022

Bibliographical note

Funding Information:
Philippe Begin: personal fees: ALK, Aralez, Astra-Zeneca, Bausch health, DBV, Food Allergy Canada, Novartis, Pfizer, Sanofi, grants: Canadian Allergy and Immunology Foundation, Canadian Institutes of Health Research, DBV, Fonds de Recherches du Québec, Ministère de l’économie et de l'innovation du Québec, Novartis, Ontario Research Funds, Regeneron, Sanofi.

Funding Information:
Hasan Arshad: grant: Food Standard Agency, Natasha Allergy Research Foundation.

Funding Information:
Bertine Flokstra: employment: General Practitioners Research Institute (GPRI); GPRI has conducted investigator- and sponsor-initiated research funded by non-commercial organizations, academic institutes, and pharmaceutical companies (including AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Mundipharma, Novartis, and Teva).

Funding Information:
Paul J Turner: personal fees: from Aimmune Therapeutics, DBV Technologies, Allergenis, UK Food Standards Agency; grants: National Institute for Health Research (NIHR)/Imperial Biomedical Research Centre, UK Medical Research Council, UK Food Standards Agency, End Allergies Together, Jon Moulton Charity Trust.

Funding Information:
Antoine Deschildre: personal fees from Novartis, ALK, GSK, Sanofi, Aimmune Therapeutics, DBV Technologies, Nestlé Health Science, Boehringer Ingelheim, Stallergenes Greer, DBV Technologies, Nutricia. Grant from Fondation du Souffle, Conseil Régional Hauts-de-France Research Program 2014–2018.

Funding Information:
Elizabeth Angier: grant: Natasha Allergy Research Foundation; expert testimony UK Medicines and Healthcare Regulatory Authority; leadership BSACI, EAACI, WONCA.

Publisher Copyright:
© 2022

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