Managing food allergy: GA2LEN guideline 2022

GALEN Food Allergy Guideline Group, Antonella Muraro*, Debra de Silva, Susanne Halken, Margitta Worm, Ekaterina Khaleva, Stefania Arasi, Audrey Dunn-Galvin, Bright I. Nwaru, Nicolette W. De Jong, Pablo Rodríguez Del Río, Paul J. Turner, Pete Smith, Philippe Begin, Elizabeth Angier, Hasan Arshad, Barbara Ballmer-Weber, Kirsten Beyer, Carsten Bindslev-Jensen, Antonella CianferoniCéline Demoulin, Antoine Deschildre, Motohiro Ebisawa, Maria Montserrat Fernandez-Rivas, Alessandro Fiocchi, Bertine Flokstra-de Blok, Jennifer Gerdts, Josefine Gradman, Kate Grimshaw, Carla Jones, Susanne Lau, Richard Loh, Montserrat Alvaro Lozano, Mika Makela, Mary Jane Marchisotto, Rosan Meyer, Clare Mills, Caroline Nilsson, Anna Nowak-Wegrzyn, Ulugbek Nurmatov, Giovanni Pajno, Marcia Podestà, Lars K. Poulsen, Hugh A. Sampson, Angel Sanchez, Sabine Schnadt, Hania Szajewska, Ronald Van Ree, Carina Venter, Berber Vlieg-Boerstra, Amena Warner, Gary Wong, Robert Wood, Torsten Zuberbier, Graham Roberts

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Food allergy affects approximately 2–4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA2LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy.

Original languageEnglish
Article number100687
Number of pages25
JournalWorld Allergy Organization Journal
Issue number9
Publication statusPublished - Sept-2022


  • Adolescent
  • Adults
  • Children
  • Food allergy
  • Food hypersensitivity

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