Commentary on Japanese Pediatric Guideline for Food Allergy 2016 Chapter 10 Evaluation and treatment of symptoms elicited by foods

Abstract

 Elicited symptoms caused by food allergies are evaluated for their severity for each organ, and we are required to treat them based on severity. The Japanese Pediatric Guideline for Food Allergy 2016 uses severity assessment as part of the Japanese anaphylaxis guidelines. Symptoms related to each organ (skin/mucosa, respiratory system, digestive system, nerves, circulatory system) are classified as grade-1 (mild), grade-2 (moderate), and grade-3 (severe). An intramuscular injection of adrenaline is indicated in cases with grade-3 symptoms and should be considered in some cases of grade-2 symptoms. Adrenaline is the first-line treatment option for anaphylaxis. There is no evidence as to the effect of histamine H₁ receptor antagonists and corticosteroids on anaphylaxis. The package inserts included with adrenaline injections in Japan state that their concomitant use with antipsychotic drugs with an alpha-blocking effect are contraindicated. However, if anaphylaxis develops in a patient who is being treated with the antipsychotic drugs mentioned above, the use of adrenaline is considered acceptable at the discretion of the physician.