Finding a Path to Safety in Food Allergy Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy (2017) / Chapter Skim
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9 Research Needs
9 Research Needs
Pages 365-378
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From page 365... ...
MECHANISMS OF FOOD ALLERGY (CHAPTER 2) Conducting research related to the mechanistic processes underlying food allergy is essential in making significant advances to develop better methods to prevent disease or reduce its severity; predict, diagnose, and monitor disease; and optimally manage and treat, and ultimately to cure, food allergy.
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From page 366... ...
Although the potential relationships between exposure to microbes early in life and the onset of food allergies have been explored, specific changes in the microbial profile of individuals, their particular interactions with the immune system, and how these interactions might be associated with food allergy have not been studied in depth. To fill gaps in knowledge in this area, studies should be conducted to accomplish the following objectives: • Elucidate the molecular and cellular mechanisms that account for the differences between innate tolerance versus food sensitization and between food sensitization versus food allergy.
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Medical expenditures for managing food allergy place financial burdens on society, as well as on the individuals affected and their caregivers. Additional costs relate to quality of life, productivity in school or at work, and food recalls.
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From page 368... ...
For example, currently available, simple diagnostic tests that are often used to diagnose IgE-mediated food allergies, the serum food-specific IgE test and the SPT, actually diagnose sensitization, not food allergy. A variety of diagnostic tests, such as component resolved diagnostics, the basophil activation test, and many others, are emerging or under study and may better inform diagnosis, prognosis, severity, and threshold.
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From page 369... ...
RESEARCH ON RISK DETERMINANTS AND PREVENTION (CHAPTER 5) Considerations for Study Designs Studies on the etiological factors associated with food allergies frequently present methodological flaws due to various reasons, including lack of accounting for confounding factors (e.g., breastfeeding)
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• Use the currently accepted gold standard -- double-blind, placebo controlled OFCs (employing standard dosing protocols and scor ing systems, so that the results of various studies can better be compared) -- as the food allergy outcome in research intervention studies until a simpler reliable method to measure food allergy is identified and validated.
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• Explore potentially unidentified risk factors that may influence food allergy. For example, although the data available to date have not shown evidence of a relationship, it is plausible that maternal and early childhood adiposity and metabolic disorders could be risk factors for food allergy development.
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with well-designed prospective studies and take into account the potential effect of differences in breast milk composition. • Determine, with RCTs, whether consuming or eliminating or avoid ing specific allergenic foods during pregnancy and lactation has any benefits.
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Numerous obstacles arise for food-allergic consumers attempting to obtain safe meals outside the home. Surveys among individuals with food allergy, caregivers, and health care providers reveal deficiencies in food allergy knowledge and concerns about accidents, especially among adolescents and young adults.
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. Risk Assessment and Factors Affecting Allergic Reactions to Foods Some allergenic foods have higher potency and cause more severe reactions than do others.
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From page 375... ...
However, for other factors, such as alcohol or medication use, biological cycles, psychological factors, stress, and concomitant allergen exposures, anecdotes are the main source of information. Identifying the factors that can modify the severity of allergic reactions and defining their influence on whether an allergic reaction is experienced upon exposure to a food allergen or in changing the specific eliciting dose are key pieces of information needed to provide advice to individual patients (see Chapters 6 and 7)
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From page 376... ...
For example, management plans for food allergy in early care and education settings, schools, camps, or other places where children are served food include providing instructions for safe meals, recognizing and managing reactions, and assigning roles and responsibilities. These plans require different strategies according to age of the child, skill level of the supervising adults, and cultural or socioeconomic context, but these factors have not been extensively studied and a paucity of data exist upon which to base best practices.
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From page 377... ...
• Develop and implement evidence-based, effective training programs for relevant personnel at settings where food is served particularly in early care and education settings, schools, camps, and food establishments in additional settings of concern, including restau rants, cafeterias, grocery stores, and commercial airliners (or other commercial means of travel)
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