How long ago did your food allergy journey start? If your answer goes farther back than the last 12 months, it’s time to chat with your allergist about revisiting your allergy management plan. There’s been a flurry of research in the last several years that has updated and changed the way we approach mitigating the risk of reactions – as well as reducing the risk of developing allergies! If you’ve been in this game for a while and your day-to-day allergy plans look the same as they did on day 1, it’s time for a refresh.
Of course, what follows in this article comes with an important caveat: don’t make any changes without consulting your board-certified allergist. We’re going to take a quick, high-level look at some of the new options and changes in approach that come on the heels of current research, but that doesn’t mean those changes are right for you.
Yes, as someone living with, or caring for someone living with food allergies, you should be staying on top of the studies and recommendations connected to your medical needs, but before you make changes to the way you do things, consult your physician who has the education and training to look past the surface of the studies and distill what the right course of action is for you and your family.
1st Generation Antihistamines vs. Newer Options
It wasn’t all that long ago that your allergy response kit included a pack of single dose, over-the-counter diphenhydramine (for example, Benadryl). You might even have used a dose before heading out into situations where your child’s (or your) allergens were likely to be present. Newer research, however, has shifted the thinking on this particular medication – not just about its use as part of your allergy management protocol, but about using it in general.
Current studies suggest that diphenhydramine may have links to long-term cognitive decline and other health risks. A dose can impair your short-term cognitive abilities and induce drowsiness, which is why it’s recommended that you not operate heavy machinery after taking it. It may make you sleepy, but it can negatively impact the quality of that sleep. Newer, second-generation antihistamines offer similar benefits without the same risks and side effects. This video from allergist Zachary Rubin does a good job explaining it: ACAAI 2nd Gen Antihistamines.
No Delay
The more we research, the better we do. The way we introduce infants to different food textures and ingredients has evolved over time. Kids born 20+ years ago, as an example, were introduced to food on a schedule that delayed the introduction of common allergens. Kids, particularly those at higher risk of developing allergies, were encouraged to wait until 2 years old to add peanuts and tree nuts to their diets, as an example. Milk and eggs were delayed closer to the first birthday. About a decade ago, however, the LEAP study turned those recommendations on their head. That study found that the very steps we took as an attempt to ward off allergies may, in fact, have been increasing the risk of developing them.
Today’s food introduction schedule has changed dramatically in light of LEAP. Parents of infants and toddlers are encouraged to introduce common allergens at a much younger age than they were before the study was released. You’ll find some good info on the study and its impact at the links shared above or here: AAAAI Ask the Expert.
Preventive Care Advances
A common mantra among experts and experienced patients alike is, “There is no cure for food allergies.” Those diagnosed with food allergies focused on avoidance and treating reactions when they occur. There has been no magic trick or medication that could release an allergic person from this day-to-day alert. You read labels. You make choices. You skip foods you can’t identify or determine the safety of. You likely even skip social experiences and spaces in order to avoid exposure to your allergens. And yet, while there is still no “cure,” there is progress and hope.
From OIT (oral immunotherapy) trials to the LEAP study, to Xolair and other studies exploring ways we can increase tolerance and reduce severity of reactions, there’s been progress. And progress means hope that maybe some day there will be a cure or a preventive treatment. This article in Allergic Living has a good overview of these treatments: Is a Cure for Food Allergies Getting Close?
To ER Or Not ER
A recent study has changed the way we use epinephrine. Let’s be clear: swift administration of epinephrine is still the recommendation. Delayed administration can increase the risk of deadly reactions. Your allergist will give you a response plan that includes when to administer epinephrine. Follow that advice. However, it’s worth having a conversation with your doctor to clarify what symptoms and cues you’re looking for.
New guidelines provide specific recommendations based on symptoms, medical history, and access to emergency healthcare. The updated guidelines may also change guidance about whether you need to call for an ambulance and/or proceed to the emergency room, or if you can continue to manage symptoms at home.
Articles like this one from Cincinnati Children’s Hospital can provide a good overview of the changes, however, they do not replace your allergist’s advice. Have a conversation with a board-certified allergist that is familiar with your medical history for updated guidelines that apply to your needs.
