Food allergy

Question 1

Any food can trigger a reaction but 9 food allergens are responsible for up to 90% of allergic reactions to food. These are…

Answer 1

Cow’s milk
Egg
Peanut
Tree nuts
Fish
Shellfish
Wheat
Soy
Sesame

Question 2

Most children with _______ allergies will develop tolerance during childhood

Answer 2

Milk
Soy
Egg
Wheat

Question 3

Allergies to __________ usually persist

Answer 3

Peanuts
Tree nuts
Sesame
Fish
Shellfish

Question 4

Is cows milk allergy common? Does it persist usually?

Answer 4

Cow’s milk allergy is relatively common in infants and young children
IgE-mediated cow’s milk allergy resolves spontaneously in majority of cases

Question 5

Features of IgE mediated reactions

Answer 5

Produces classical allergic symptoms soon after food ingestion (within 2 hours). Once the allergy has developed, symptoms occur each time the food is ingested.

Question 6

Classical allergic symptoms

Answer 6

Skin – urticaria, angio-oedema
Gut – diarrhoea, vomiting, abdominal cramps
Respiratory system – cough, wheeze, stridor, sneezing, rhinorrhoea
Cardiovascular system – hypotension, collapse

Question 7

Can a food allergy cause resp sx without involvement of other systems?

Answer 7

It is rare for food allergy to cause respiratory problems without involvement of other systems.

Question 8

Delayed non-IgE mediated reaction

Answer 8

Not very common. Generally delayed from several hours to days after the food is ingested.
Symptoms must occur reproducibly on exposure

Question 9

Delayed non-IgE mediated reaction symptoms are predominantly _______

Answer 9

GI

Question 10

Delayed non-IgE mediated reaction symptoms generally occur in children aged…

Answer 10

<3yo

Question 11

Clinical presentations of IgE mediated reactions

Answer 11

Acute allergic reaction
Anaphylaxis
Oral allergy syndrome

Question 12

What is acute allergic reaction

Answer 12

An immediate allergic reaction to a food involving the skin or gut.
Does not involve the respiratory or cardiovascular systems.

Question 13

What is oral allergy syndrome

Answer 13

An allergy to certain fruit and vegetable, especially when eaten raw.
Usually causes redness, itching, burning, and swelling of the lips, inside of the mouth, tongue, and soft palate.

Question 14

Clinical presentations of non-IgE mediated reactions

Answer 14

Food protein-induced proctocolitis
Eosinophilic oesophagitis
Infantile colic (some cases)
Food protein-induced enterocolitis syndrome (FPIES)
Coeliac disease
Food protein-induced enteropathy

Question 15

Typical presentation of food protein‑induced proctocolitis

Answer 15

Well infant with visible specks of blood, with or without mucus in the stool

Question 16

_____ is the most common cause of food protein‑induced proctocolitis

Answer 16

Cows milk

Question 17

Eosinophilic oesophagitis presentation in infants/young children

Answer 17

Feeding difficulties, vomiting, and reflux symptoms not responding to standard treatment.

Question 18

Eosinophilic oesophagitis presentation in adolescents/older children

Answer 18

Dysphagia and oesophageal food impaction

Question 19

Infantile colic usually improves by 4 months of age without treatment but if any suspicion of food allergy, consider…

Answer 19

A short (2-week) trial of an extensively hydrolysed formula
If breastfed, maternal elimination of dairy foods.
Do not continue elimination unless there is a positive response.

Question 20

What is food protein‑induced enterocolitis syndrome

Answer 20

Acute episodes of repeated projectile vomiting, hypotonia, pallor, and sometimes diarrhoea 1 to 3 hours after ingestion of responsible food.

Question 21

Most common cause of food protein‑induced enterocolitis syndrome

Answer 21

Cow’s milk
Soy
Rice

Question 22

Suspect food protein-induced enteropathy in…

Answer 22

Children with failure to thrive and diarrhoea

Question 23

Food protein-induced enteropathy occurs mainly in what age group?

Answer 23

Infants

Question 24

Major triggers of food protein-induced enteropathy are…

Answer 24

Cow’s milk and soy

Question 25

What is food protein-induced enteropathy

Answer 25

Chronic symptoms within days to weeks of introduction of offending food, e.g: vomiting diarrhoea failure to thrive

Question 26

Limits of allergy testing

Answer 26

Tests are only indicated when the history suggests an IgE mediated food allergy Tests alone are not diagnostic of food allergy

Question 27

Management of IgE mediated food allergy

Answer 27

Antihistamines Eliminate suspected food allergen from diet (if uncertain allergen refer paeds) Provide an action plan Refer paeds

Question 28

Do not remove a food from a child's diet on the basis of...

Answer 28

A test result, either skin prick testing (SPT) or an enzyme allergosorbent test (EAST), if they are eating and tolerating that food.

Question 29

Can you predict the severity of future reactions?

Answer 29

The severity of a reaction to a food is variable. It cannot be predicted by the severity of past reactions or by allergy testing.

Question 30

General management of non-IgE mediated GI syndromes

Answer 30

Remove trigger from diet & ref paeds Reassure parents that most allergies will resolve by age 1 to 3 years, when the triggering food can be reintroduced.

Question 31

Cow's milk protein allergy - reaction can be...

Answer 31

Can be either IgE or non‑IgE mediated Presentation can range from anaphylaxis and urticaria to delayed reactions

Question 32

Prescription formula for CMPA

Answer 32

<6 months: extensively hydrolysed formula e.g. Aptamil Gold + Pepti Junior >6 months, try soy formula (not funded). If reaction to soy, start eHF.

Question 33

When to prescribe amino acid formula for CMPA

Answer 33

If an extensively hydrolysed formula has been trialled (2 to 4 weeks) and not tolerated If anaphylaxis or eosinophilic oesophagitis