abstractFood allergy is one of the most common chronic non infectious diseases worldwide, and its prevalence is on the rise. The European Society of Allergy and Clinical Immunology published guidelines for immunoglobulin E-mediated food allergy management in 2024. This guide adopts a hierarchical evaluation system of recommendation, assessment, development, and evaluation, and proposes 14 recommendations around five aspects: dietary intervention, psychological support, management plan, allergen specific immunotherapy, and biologics. Starting from the intensity of recommendations, reasons for recommendations, and practical significance, this guideline is interpreted in order to provide reference for clinical work and improve the management level of food allergies.keywordFood allergies; Severe allergic reactions; Diet; Biological agents; Allergen immunotherapyImmunoglobulin E (IgE) - mediated food allergy is the most common type of food allergy, and its clinical symptoms can appear within minutes or hours of ingestion of allergens, involving multiple organs/systems, with severity ranging from common urticaria to fatal severe allergic reactions [1-2]. Its management strategy has shifted from passive management of avoiding allergens, observing changes in the condition, and waiting for natural relief to more active management methods such as dietary intervention, allergen immunotherapy (AIT), and biologics. The European Academy of Allergy and Clinical Immunology (EAACI) has published the latest version of the IgE mediated food allergy management guidelines based on the "Guidelines for Food Allergies and Severe Allergic Reactions" and the "Guidelines for IgE Mediated Immunotherapy for Food Allergies" [3-4]. We will now provide a detailed interpretation of the 14 recommendations (Table 1) in the guidelines, in order to provide reference for the management of food allergies [5].onePurpose and methods of the guideThis guideline aims to provide recommendations for clinical physicians on the management of IgE mediated food allergies. To ensure the global adaptability of the guidelines, expert members come from Europe and countries outside of Europe (United States, Canada, Brazil, South Africa, China, Singapore, Australia). The guidelines are based on a systematic review of AIT and biologics for food allergies, as well as a systematic review of psychological interventions for food allergies. They are developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method [6-7], with 80% or more expert approval required to form recommendations.twoManagement recommendations for IgE mediated food allergiesThis guideline defines desensitization, remission or sustained unresponsive, and tolerance. Desensitization represents the effect during treatment, which is the ability of patients to consume a certain amount of food without experiencing allergic symptoms after receiving treatment. Relief or sustained non response represents the long-term effect after stopping treatment, that is, the ability to consume a certain amount of food without experiencing allergic symptoms after stopping treatment. Tolerance refers to the ability to consume food without being limited by frequency or quantity, and without symptoms. The above definition provides a standard for measuring short-term and long-term treatment outcomes, which helps evaluate the effectiveness of food allergy management plans. 2.1 Dietary intervention suggestion 1: Avoid foods and food forms that are clearly known to cause allergies (low level of evidence, strongly recommended). Suggestion 2: Continue to consume foods that are tolerable (medium level of evidence, strongly recommended). Suggestion 3: Provide personalized dietary advice that is age appropriate, and seek the help of a registered nutritionist if necessary (very low level of evidence, conditional recommendation). All patients should receive oral or written advice related to their allergy foods that is appropriate for their age, clearly indicating the types and forms of foods that need to be avoided [8]. Patients with pollen allergy syndrome, milk allergy, or egg allergy can tolerate cooked food by avoiding raw or unprocessed food forms [9-10]. Completely avoiding known allergenic food ingredients is the only treatment option for most patients, which helps prevent the occurrence of severe allergic reactions [11-13]. Patients who engage in long-term dietary avoidance should receive nutritional counseling, reasonable food replacement, nutritional assessment, and regular follow-up. Infants and young children are evaluated every 6 months, preschool children are evaluated annually, and school-age children are evaluated every 1-2 years. For patients who are in a persistent allergic state or have high levels of specific immunoglobulin E (sIgE), evaluation can be conducted every 2-5 years. Continuing to consume tolerable foods can reduce the problems of delayed introduction of complementary foods and nutritional deficiencies [14-15]. Foods that have never caused allergic reactions can continue to be consumed. Foods that have been identified as allergic can be reintroduced if they can tolerate other forms of food (such as cooked milk or eggs). For previously allergenic foods, it is necessary to confirm tolerance to the food through outpatient and/or food challenge testing. If tolerated, appropriate doses can be reintroduced according to different ages. Food suspected of having allergens should not be avoided. Children who are allergic to hazelnuts should not limit their intake of other nut tolerant foods. Food allergy patients should not delay the introduction of other tolerant foods [16-17]. During each visit, in addition to indicating the foods to avoid, it is also necessary to provide food or food forms that can be consumed and evaluate the nutritional status. Registered nutritionists can improve the quality of personalized dietary management [18]. In a survey of 45 hospitals in China in 2018, it was found that pediatric clinical nutrition work has developed well in tertiary hospitals, with 71.1% of hospitals establishing nutrition support teams [19]. Patients should be reminded to pay attention to the difference between public nutritionists and registered nutritionists. Registered nutritionists refer to professionals with specialized knowledge and skills in nutrition and dietary nutrition, who are capable of independently managing individual or group diets, providing nutritional support and treatment, as well as providing nutritional counseling and guidance in healthy or diseased conditions. As of 2021, there are 10822 registered nutritionists registered with the Chinese Nutrition Society, which still has a significant gap compared to developed countries [20]. The total number and quality of registered nutritionists in China are still insufficient to meet the service needs of the nutrition industry, and further efforts are needed to strengthen the team building. 2.2 Psychological Support Suggestion 4: Patients and their caregivers in need should receive psychological support from professional healthcare personnel (low level of evidence, conditional recommendation). Psychological support can alleviate the pain of patients and their families, improve food allergy management, and enhance quality of life [7]. Food allergies are often associated with increased anxiety and psychological stress in patients [21-22]. Moderate to severe psychological problems related to food allergies should be prioritized for professional psychological support treatment. Interventions based on cognitive-behavioral therapy have shown significant improvement effects in highly anxious children with food allergies or their parents [7]. For patients with anxiety or avoidant/restrictive eating disorders, personalized dietary advice should be provided along with necessary psychological interventions to promote their physical and mental health [23]. Psychological support is not a one-time intervention, but covers various aspects from dietary intervention to immune regulation therapy, and requires regular evaluation of support effectiveness. 2.3 Management Plan Recommendation 5: Develop individualized management plans (low evidence level, strongly recommended). Suggestion 6: Patients at risk of severe allergic reactions should carry an adrenaline auto injector (AAI) with them (low level of evidence, strongly recommended). Suggestion 7: Provide comprehensive structured training for patients at risk of severe allergic reactions to improve their ability to accurately identify severe allergic reactions and correctly use AAI (low evidence level, strongly recommended). The management plan should be suitable for the patient's age, easy to understand, and user-friendly. The plan includes a list of food allergen avoidance, education on disease-related knowledge, medication list, guidance on medication use, and cultivating their ability to seek emergency medical services. The drugs involved include oral non sedating antihistamines, salbutamol aerosols, and AAI. It should be noted that adrenaline is the first choice for emergency treatment of severe allergic reactions, and antihistamines and hormones cannot replace its effects. The "Emergency Action Plan for Severe Allergic Reactions in Chinese Children" is a structured management tool for children with severe allergic reactions in China, which can guide them and their parents/caregivers to identify symptoms and signs early and take timely emergency measures. The dosage of AAI is more precise and the speed is faster. Clinicians, patients, and their families should be familiar with the indications for the use of AAI in IgE mediated food allergy patients (Table 2), and should have the ability to correctly use AAI in emergency situations [25]. The injection dose (1:1000 adrenaline) can be calculated based on the child's weight (0.01 mg/kg) or within a weight range of 7.5 to