Treatment

One of the major tasks in the management of food allergy is the avoidance of the responsible foods. In practice, this approach is not as simple as it seems. Often, allergy specialists are confronted with patients who have had a poor diet (from a nutritional point of view) for a long time, simply because foods have progressively been eliminated from their diet by their physician on purely subjective grounds. Therefore, it is worth the clinician spending time in controlling the elimination-reintroduction procedure in order to identify for certain the offending foods. Further, the dose-response is highly variable from patient to patient, several of whom can tolerate a small amount of the food to which they are sensitive, an amount which can be determined by means of provocation tests. The new diet has to be appetizing and complete as far as nutrients, vitamins and minerals are concerned. For this specific aspect, the skill of a dietician is of major importance.

Drug therapy directed against the patient's symptoms is required, whatever the local organ involved. This is especially important in the case of chronic gastrointestinal and colic disturbances.

Drugs

A number of studies have shown that allergic reaction to foods can be ameliorated or prevented by sodium cromoglycate (SCG). This drug seems to be efficient in IgE-mediated reactions as well as in the case of histamine-releasing foods. There is sometimes intolerance to the drug itself. The best way of minimizing this problem is to start the treatment at low doses, increasing it daily to efficient levels by 10-15 days. However, the experience of several clinicians is that after several months of treatment the effect of SCG often decreases and sometimes disappears completely; therefore this therapeutic approach can only exceptionally be considered as a long-term treatment.

The best way of managing the food allergy problem is to introduce the correct elimination diet. If followed for a long period of time (more than 1 year), a relative tolerance to the offending food is frequently observed.

Hyposensitization

This therapeutic approach has never really been evaluated by allergologists, and in most cases there is no real indication for such a treatment. However, there are two different situations in which such a treatment can be useful, even life-saving:

1. Anaphylactic shock to egg, celery, nuts, fish, milk, etc. is rather frequent in adult patients. Recently, ten such patients were hospitalized and a rush-desensitization procedure was undertaken. The treatment was continued at home. After 3 months of treatment, the offending foods could be tolerated by each patient.

2. Allergy to milk in infants is frequently complicated by an allergy to soya. We suggest an oral hyposensitization regimen beginning with 1:10 000 or 1:100 000 diluted cow's milk. After 3 months of increasing the oral dose daily, 80% of treated children are able to tolerate a glass of milk.

Thus this type of treatment seems to produce a long-lasting tolerance in most patients and is relatively easy to apply.

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