Continuing Medical Education
South African food allergy consensus document 2014
The prevalence of food allergy is increasing worldwide and is an important cause of anaphylaxis. There are no local South African food allergy guidelines. This document was devised by the Allergy Society of South Africa (ALLSA), the South African Gastroenterology Society (SAGES) and the Association for Dietetics in South Africa (ADSA).
Subjects may have reactions to more than one food, and different types and severity of reactions to different foods may coexist in one individual. A detailed history directed at identifying the type and severity of possible reactions is essential for every food allergen under consideration. Skin-prick tests and specific immunoglobulin E (IgE) (ImmunoCAP) tests prove IgE sensitisation rather than clinical reactivity. The magnitude of sensitisation combined with the history may be sufficient to ascribe causality, but where this is not possible an incremental oral food challenge may be required to assess tolerance or clinical allergy. For milder non-IgE-mediated conditions a diagnostic elimination diet may be followed with food re-introduction at home to assess causality.
The primary therapy for food allergy is strict avoidance of the offending food/s, taking into account nutritional status and provision of alternative sources of nutrients. Acute management of severe reactions requires prompt intramuscular administration of adrenaline 0.01 mg/kg and basic resuscitation. Adjunctive therapy includes antihistamines, bronchodilators and corticosteroids. Subjects with food allergy require risk assessment and those at increased risk for future severe reactions require the implementation of risk-reduction strategies, including education of the patient, families and all caregivers (including teachers), the provision of a written emergency action plan, a MedicAlert necklace or bracelet and injectable adrenaline (preferably via auto-injector) where necessary.
M E Levin, Division of Allergy, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
C L Gray, Private Practice, Vincent Pallotti Hospital, Pinelands, Cape Town, South Africa
E Goddard, Division of Paediatric Gastroenterology, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
S Karabus, Private Practice, Christiaan Barnard Memorial Hospital, Cape Town, and Division of Allergy, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
M Kriel, Private Practice, Alberton, Johannesburg, South Africa
A C Lang, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
A I Manjra, Private Practice, Westville, Durban, South Africa
S M Risenga, Department of Pulmonology and Allergy, Faculty of Health Sciences, Polokwane Campus, University of Limpopo, Polokwane, South Africa
A J Terblanche, Department of Paediatrics, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
D A van der Spuy, Private Practice, Cape Town, South Africa
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Date published: 2014-11-21
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