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Management of food allergy: Avoidance

Scott H Sicherer, MD, FAAAAI
Section Editor
Robert A Wood, MD
Deputy Editor
Elizabeth TePas, MD, MS


The primary therapeutic strategy in the management of food allergy is avoidance of the culprit allergen. Complete avoidance is typically prescribed for immunoglobulin E (IgE)-mediated food allergies as well as food-protein enterocolitis in infants. (See "Food protein-induced proctocolitis of infancy".)

Successful allergen avoidance is straightforward in theory. However, in reality, avoidance requires extensive patient education. Clinicians should know how to instruct patients to read labels on packaged foods, prepare safe meals at home, and avoid food allergens in restaurant meals. Unintended exposure through cross-contact of foods in a variety of settings must be avoided. Food ingredients may be components of nonfood items, such as medications and vaccines. They may also be incorporated into substances that are inadvertently ingested, such as cosmetics and children's crafts. Lastly, exposure to allergen-containing saliva may occur during kissing or sharing of utensils. This topic review will present each of these issues individually.

The management of food allergy in daycare, schools, and camp settings is presented separately. (See "Food allergy in schools and camps".)


Patients with food allergy are typically instructed to practice strict avoidance. However, most patients attempting to eliminate a certain food from the diet will not be entirely successful, despite best efforts [1,2]. Thus, patients must be prepared to treat an unexpected reaction at all times and in any setting. A validated food allergy educational curriculum that describes specific food allergy disorders and addresses issues related to food allergen avoidance and use of self-injectable epinephrine is available for free at the Food Allergy Educational Program of the Consortium of Food Allergy Research [3].

How strict must avoidance be? — Strict avoidance is recommended for most patients with food allergy. However, thresholds of clinical reactivity vary dramatically among allergic individuals and can also vary depending upon how the food is processed. (See "Food allergens: Overview of clinical features and cross-reactivity" and "Pathogenesis of food allergy" and "Molecular features of food allergens".)

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Literature review current through: Nov 2017. | This topic last updated: Jun 16, 2017.
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