At the moment, there is no “cure” for food allergies. Avoidance of the offending food(s) is the mainstay of treatment. The patient needs to be educated about food labelling and hidden sources of the food. At the same time it is essential to provide a balanced diet which contains enough protein, calories, minerals and vitamins. Close co-operation between the patient, the doctor and a qualified Dietician is important to ensure this.
For immediate-type reactions the patient needs to be educated on how to recognise and treat an allergic reaction, in case they accidentally eat the food they are allergic to. This requires an emergency action plan and emergency treatment. For milder reactions, an antihistamine is given. For more severe reactions involving the airway or circulatory system, a dose of adrenaline may be needed and can be life-saving. The doctor will select whether or not the patient needs an adrenaline pen to keep at home/school if they are at risk of severe reactions.
For delayed type reactions, strict avoidance of offending foods is the key to successful treatment. If the recommended diet is not providing adequate symptom relief, medication may have to be added to the treatment in certain cases. The doctor will usually decide on the appropriate medication, depending on the patient’s symptoms and underlying condition.
There are some experimental treatments for food allergy such as oral tolerance induction (oral immunotherapy) and anti-IgE antibodies, which are still very much at the research stage. Such treatment options are not routinely available in South Africa and internationally are still restricted mainly to the research setting.
So what is the long term outcome of food allergies?
Many food allergies are outgrown, for example cow’s milk, soya, egg and wheat allergies are outgrown in the majority of cases by late childhood. There are some exceptions of adults who remain allergic to such foods. On the other hand, seafood and nut allergies are outgrown in only a minimum (20% or fewer) of people, hence these are usually allergies for life.
It is important for the allergic patient to be monitored regularly by a doctor who has specialist training in allergies, in order to determine whether they are adhering to the recommended diet, whether accidental reactions are being treated appropriately, and whether there are signs that the allergy may be outgrown. The doctor will determine whether a controlled food challenge may be indicated to check whether the allergy has been outgrown.