The 3 national allergy and immunology societies—the American College of Allergy, Asthma and Immunology (ACAAI), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and … Practice parameter Food allergy: a practice parameter Chief Editors: Jean A. Chapman, MD; I. Leonard Bernstein, MD; Rufus E. Lee, MD; John Oppenheimer, MD; Associate Editors: Richard A. Nicklas, MD; Jay M. Portnoy, MD; ScottH. Sicherer, MD; Diane E. Schuller, MD; Sheldon L. Spector, MD; David Khan, MD; David Lang, MD; Ronald A. Simon, MD; Stephen A …

more sophisticated and more challenging. The objective of Food Allergy: A Practice Parameter is to improve the care of patients by providing the practicing physician with an evidence-based approach to the diagnosis and management of IgE-mediated (allergic) food reactions. The Task Force rec- ognizesthe importance of non-IgE-mediated immunologic and nonimmunologic food reactions and the role of the allergist-immunologist in their identification and management. These conditions are discussed in the context of differential diagnosis. This guideline was developed by the Joint Task Force on Practice Parameters, which has published 20 practice param- etersforthefield of allergy-immunology (see list of publications in the “Acknowledgments”section). The 3 national allergy and immunology societies—the American College of Allergy, Asthma and Immunology (ACAAI), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and the Joint Council of Allergy, Asthma and Immunology (JCAAI)—have given the Joint Task Force the responsibility for both creating new parameters and updating existing parameters. Although several previous parameters have addressed the diagnosis and management of anaphylaxis, this document is the first parameter that focuses on such reactions with respect to foods. It was written and reviewed by specialists in the field of allergy and immunology and was supported by the 3 allergy and immunology organizations noted above. The working draft of this Food Allergy Practice Parameter was prepared by the Joint Task Force on Practice Parameters with the help of Scott Sicherer, MD. Preparation of this draft included a review of the medical literature using a variety of search engines such as PubMed. Published clinical studies were rated by category of evidence and used to establish the strength of a clinical recommendation (Table 1). The working draft of the Parameter was then reviewed by a number of experts on food allergy selected by the supporting organizations. This document represents an evidence-based, broadly accepted consensus opinion. The FoodAllergy Practice Parameter contains an annotated algorithm that presents the major decision points for the appropriate evaluation and management of patients suspected of having food allergy. This is followed by summary statements, which represent the key points in the evaluation and management of food allergies. These summary statements can also be found before each section in this document, followed by text that supports the summary statement(s), which are, inturn, followed by graded references that support the statements in the text. The sections on diagnosis and management represent the core of this practice parameter. The diagnosis section discusses guidelines for establishing the diagnosis of food al- lergyand emphasizes the importance of obtaining a detailed history that is compatible with this diagnosis. There is also a detailed discussion of the appropriate use of skin prick or puncture tests, serologic tests for specific IgE, and oral food challenges. The section on management discusses strategies for avoidance and guidelines for anticipating and implementing the medical treatment of food allergy reactions. In addition to the sections on diagnosis and management, this parameter includes sections on immunology of food allergy, differential diagnosis, prevalence and epidemiology, natural history, risk factors, food allergens (including cross- reactivity), food additives, food-dependent exercise-induced anaphylaxis (EIA), genetically modified foods, and manage- mentinspecific circumstances (eg, schools).

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