Food allergy
Also known as: oral immunotherapy · peanut allergy
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Food allergy: a practice parameter update
AAAAI/ACAAI Joint Task Force on Practice Parameters · 2014 · 2014 update
The most recent comprehensive US Joint Task Force practice parameter on food allergy, listed by AAAAI as current. It covers diagnosis and management of food allergy across the age range. A narrower 2020 Joint Task Force document addresses peanut allergy diagnosis specifically using GRADE methodology. Given its age, users should check the AAAAI practice-parameter index for a newer replacement.
EAACI guidelines on the management of IgE-mediated food allergy
European Academy of Allergy and Clinical Immunology (EAACI) · 2025
EAACI's current GRADE-based guideline on managing confirmed IgE-mediated food allergy. It covers allergen avoidance and dietetic support, written treatment plans, education on recognising reactions, adrenaline autoinjector prescription, psychological support where needed, and immunomodulatory options such as oral, sublingual and epicutaneous immunotherapy and biologics. It forms the management half of an updated framework whose companion document addresses diagnosis.
- Published in Allergy 2025;80(1):14-36; builds on the 2014 EAACI food allergy guidelines and the 2018 immunotherapy guidelines. source
- Developed with the GRADE approach by a large international EAACI task force. source
- Paired with a separately published EAACI document covering diagnosis of IgE-mediated food allergy. source
US vs EU key differences
- Version currency is the dominant difference: the US practice parameter dates from 2014 and predates licensed peanut oral immunotherapy and biologic therapy, while the EAACI guideline was issued in 2025 and strongly recommends peanut oral immunotherapy for children and adolescents on high-certainty evidence. source
- EAACI grades oral immunotherapy by food: strong for peanut, but only conditional for egg and milk and generally above age 4, on the reasoning that a large share of egg and milk allergy resolves spontaneously by school age. source
- A regulatory-guideline mismatch exists for omalizumab: EAACI only conditionally suggests it for desensitisation on moderate-certainty evidence while noting it is FDA-approved for food allergy in the USA, where the governing practice parameter is too old to address it. source
- EAACI separates epinephrine autoinjector indications into absolute (previous food-induced anaphylaxis, unstable or moderate-to-severe persistent asthma, systemic mastocytosis) and relative (teenage or young-adult age, remote location from medical help). source
What changed recently
- EU2014 → 20252024-10-30
This revision of the 2014 EAACI food allergy management guideline (which also absorbs the 2018 food immunotherapy guideline) shifts the emphasis from avoidance and watchful waiting to active management, recommending oral, sublingual and epicutaneous immunotherapy for peanut allergy plus oral immunotherapy for egg and milk, and incorporating omalizumab following its US approval for IgE-mediated food allergy from age one. It adds a conditional recommendation for psychological support in patients with significant anxiety and a strong recommendation to keep eating tolerated foods to protect nutrition.
- US2006 → 2014 update2014-08-01
The 2014 parameter substantially rewrites the 2006 version and folds in developments since the 2010 NIAID guidelines, adding entirely new material on delayed mammalian meat allergy caused by alpha-gal, component-resolved diagnostic testing, food additive and genetically modified food reactions, and recommendations aimed at preventing food allergy rather than only managing it.
source ↗curation confidence 90%
See the full update feed for changes across every system.