EAACI guidelines on the management of IgE‐mediated food allergy

EAACI · 2024 · Europe

Source and licence

Authors
Alexandra F. Santos, Carmen Riggioni, Ioana Agache et al.
Title
EAACI guidelines on the management of IgE‐mediated food allergy
Journal
Allergy, 2024
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC11724237

Licence statement of the original publication

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Dietary management

  • In patients with confirmed IgE‐mediated food allergy, avoidance of the food (or form of the food) to which the patient is allergic is recommended.Certainty of evidence: Low a; Strength of recommendation: Strong
  • 2 In patients with confirmed IgE‐mediated food allergy, continued consumption of tolerated foods is recommended.Certainty of evidence: Moderate a; Strength of recommendation: Strong
  • 3 In patients with confirmed IgE‐mediated food allergy, age‐appropriate individualised dietary advice is suggested, with support from a registered dietitian for complex patients, if available.Certainty of evidence: Very low; Strength of recommendation: Conditional

Psychological support

  • 4 In selected patients with IgE‐mediated food allergy and their caregivers, psychological support by a trained health care professional is suggested.Certainty of evidence: Low; Strength of recommendation: Conditional

Treatment plan

  • 5 In patients with IgE‐mediated food allergy, an individualised management plan is recommended.Certainty of evidence: Low a; Strength of recommendation: Strong
  • 6 In patients with IgE‐mediated food allergy at risk of anaphylaxis, prescription of adrenaline auto‐injectors to carry is recommended.Certainty of evidence: Low a; Strength of recommendation: Strong
  • 7 In patients with IgE‐mediated food allergy at risk of anaphylaxis, structured, comprehensive training to improve recognition of anaphylaxis and use of adrenaline autoinjectors is recommended, in addition to basic instructions about autoinjector use.Certainty of evidence: Low a; Strength of recommendation: Strong

Allergen‐specific immunotherapy (AIT)

  • 8 In patients with IgE‐mediated food allergy eligible for allergen‐specific immunotherapy, its administration is recommended under the guidance of a clinical team with experience in food immunotherapy and in managing its side effects and anaphylaxis.Certainty of evidence: Low a; Strength of recommendation: Strong

AIT for peanut allergy

  • 9 In children and adolescents with IgE‐mediated peanut allergy, peanut oral immunotherapy is recommended to achieve desensitisation.Certainty of evidence: High; Strength of recommendation: Strong
  • 10 In children and adolescents with IgE‐mediated peanut allergy, peanut epicutaneous immunotherapy is suggested to achieve desensitisation, if available.Certainty of evidence: High; Strength of recommendation: Conditional
  • 11 In children and adolescents with IgE‐mediated peanut allergy, peanut sublingual immunotherapy is suggested to achieve desensitisation.Certainty of evidence: Moderate; Strength of recommendation: Conditional

AIT for egg allergy

  • 12 In children (generally above 4 years of age) and adolescents with IgE‐mediated egg allergy, egg oral immunotherapy is suggested to achieve desensitisation.Certainty of evidence: Low; Strength of recommendation: Conditional

AIT for cow's milk allergy

  • 13 In children (generally above 4 years of age) and adolescents with IgE‐mediated cow's milk allergy, milk oral immunotherapy is suggested to achieve desensitisation.Certainty of evidence: Low; Strength of recommendation: Conditional

BIOLOGICS

  • 14 In patients with IgE‐mediated food allergy, omalizumab is suggested to achieve desensitisation.Certainty of evidence: Moderate; Strength of recommendation: Conditional

Dietary management

  • Recommendation 2In patients with confirmed IgE‐mediated food allergy, continued consumption of tolerated foods is recommended.
  • Recommendation 3In patients with confirmed IgE‐mediated food allergy, age‐appropriate individualised dietary advice is suggested, with support from a registered dietitian for complex patients, if available.

Psychological support

  • Recommendation 4In selected patients with IgE‐mediated food allergy and their caregivers, psychological support by a trained health care professional is suggested.

Treatment plan

  • Recommendation 5In patients with IgE‐mediated food allergy, an individualised management plan is recommended.
  • Recommendation 6In patients with IgE‐mediated food allergy at risk of anaphylaxis, prescription of AAI to carry is recommended.
  • Recommendation 7In patients with IgE‐mediated food allergy at risk of anaphylaxis, structured, comprehensive training to improve recognition of anaphylaxis and use of adrenaline autoinjectors is recommended, in addition to basic instructions about autoinjector use.

Allergen‐specific immunotherapy

  • Recommendation 8In patients with IgE‐mediated food allergy eligible for allergen‐specific immunotherapy, its administration is recommended under the guidance of a clinical team with experience in food immunotherapy and in managing its side effects and anaphylaxis.

Peanut‐specific immunotherapy

  • Recommendation 9In children and adolescents with IgE‐mediated peanut allergy, peanut oral immunotherapy is recommended to achieve desensitisation.
  • Recommendation 10In children and adolescents with IgE‐mediated peanut allergy, peanut epicutaneous immunotherapy is suggested to achieve desensitisation, if available.
  • Recommendation 11In children and adolescents with IgE‐mediated peanut allergy, sublingual immunotherapy (SLIT) is suggested to achieve desensitisation.

Egg‐specific immunotherapy

  • Recommendation 12In children (generally above 4 years of age) and adolescents with IgE‐mediated egg allergy, egg oral immunotherapy is suggested to achieve desensitisation.

Cow's milk‐specific immunotherapy

  • Recommendation 13In children (generally above 4 years of age) and adolescents with IgE‐mediated cow's milk allergy, milk oral immunotherapy is suggested to achieve desensitisation.

Biological treatments

  • Recommendation 14In patients with IgE‐mediated food allergy, omalizumab is suggested to achieve desensitisation.

Abstract

This European Academy of Allergy and Clinical Immunology (EAACI) guideline provides recommendations for the management of IgE‐mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Following the confirmation of IgE‐mediated food allergy diagnosis, allergen avoidance and dietary advice (with support of a specialised dietitian, if possible) together with the provision of a written treatment plan, education on the recognition of allergic symptoms and prescription of medication including adrenaline using an auto‐injector are essential. Patients with significant anxiety and requirement for coping strategies may benefit from support from a clinical psychologist. As immunomodulatory interventions, omalizumab is suggested for treatment of IgE‐mediated food allergy in children from the age of 1 and adults; and oral allergen‐specific immunotherapy is recommended for children and adolescents with peanut allergy and suggested for milk and egg allergies (generally after 4 years of age for milk and egg). Sublingual and epicutaneous immunotherapy are suggested for peanut allergy but are not yet available at the point of care. Future research into disease modifying treatments for IgE‐mediated food allergy are highly needed, with standardised and patient‐focused protocols and outcomes.

Contents of the original publication

The section headings of the original.

  • INTRODUCTION
  • METHODS
  • Scope of guidelines
  • Expert group and stakeholder involvement
  • Systematic review of the evidence and formulation of recommendations
  • Peer‐review and public consultation
  • GUIDELINE RECOMMENDATIONS
  • Dietary management
  • Psychological support
  • Treatment plan
  • Allergen‐specific immunotherapy
  • Peanut‐specific immunotherapy
  • Egg‐specific immunotherapy
  • Cow's milk‐specific immunotherapy
  • Biological treatments
  • DISCUSSION
  • Summary
  • Strengths and limitations
  • CONCLUSION

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