Prevalence, Natural History, Diagnosis, and Treatment of Food Allergy: A Systematic Review of the Evidence

Food allergies have significant deleterious effects on family economics, social interactions, school and work attendance, and health-related quality of life. However, currently licensed treatments target only the symptoms of reactions and anaphylaxis, not the allergies themselves. Food allergies are heterogeneous in terms of both their underlying pathophysiology (eg, mediated via both IgE and non-IgE immunologic pathways) and their clinic manifestations (ranging from mild rashes to life-threatening anaphylaxis). The literature on food allergies lacks a clear consensus regarding the most effective diagnostic and management approaches to even the most common conditions. Under contract from the National Institute of Allergy and Infectious Diseases (NIAID) and in support of ongoing work to produce clinical practice guidelines, the authors reviewed the available evidence on the prevalence, diagnosis, management, and prevention of food allergies. This review presents their findings for the most common allergenic foods: cow's milk, hen's egg, peanut or tree nut, and shellfish or fish, which account for more than 50% of all allergies to food.

The research described in this report was prepared for the National Institute of Allergy and Infectious Diseases and performed under the auspices of RAND Health.

This publication is part of the RAND working paper series. RAND working papers are intended to share researchers' latest findings and to solicit informal peer review. They have been approved for circulation by RAND but may not have been formally edited or peer reviewed.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.