Recent changes in the management of patients with food allergy in a tertiary referral centre: A Dietitian’s perspective

Abstract

It is has been suggested that the prevalence of food allergy has increased over the last few decades with estimates now suggesting between 3.9-8% of children are food allergic (Kattan, 2016). Studies also suggest that rates of food allergy resolution are slowing, meaning more children are remaining allergic for longer (Sicherer et al, 2014). The mainstay of food allergy management is dietary exclusion of known food allergen/s. Exclusion diets are frequently difficult for patients and their families to manage and the literature highlights that they impact negatively on quality of life (Valentine et al, 2011) . The Paediatric Allergy Dietitian is a crucial member of the allergy multi- disciplinary team and is ideally placed to offer practical advice, support and guidance to food allergic patients and their families (Mackenzie et al, 2015). In recent years strategies used to manage food allergic patients have changed. Rather than strict avoidance, management of dairy and egg allergy now focuses on early introduction of extensively heat treated or "baked" al-lergen, allowing increased dietary choice, improved quality of life and poten-tially promoting tolerance to milk and egg in the raw state (Anagnostou et al, 2015). Similarly, traditionally nut allergic patients were advised to avoid all nuts regardless of whether they had mono or poly sensitised. Now, nut aller-gic individuals are actively encouraged to introduce safe selected nuts into their diets. This article explores the evidence in both these areas of food allergy man-agement, changes in practice and discusses the crucial role of the allergy Dietitians in practical implementation.