2.1.3 Food Allergy Application

Question 1

What is the definition of milk allergy?

Answer 1

Reproducible adverse reaction to one or more milk proteins mediated by one or more immune mechanisms, IgE or non-IgE

Question 2

What are the two milk proteins?

Answer 2

Casein
Whey

Question 3

What are the key facts about milk allergies?

Answer 3

• May have a delay of weeks before presentation
• All symptomatic before 12 months old
• Good prognosis, most tolerant by 5 years old

Question 4

What makes non-IgE milk allergies difficult to diagnose?

Answer 4

More common in the UK (60% vs 40% IgE)

Occurs earlier in life < 3months, more difficult to tell what is actually wrong with the child

Can mimic other benign infant GI conditions

Question 5

How do milk allergies present?

Answer 5

Variable

IgE- urticaria to anaphylaxis

Non-IgE-rectal bleeding to food protein induced enterocolitis syndrome
FPIES

Question 6

What happens to bloods in FPIES?

Answer 6

Raised WCC, but normal CRP value

Question 7

Why is diagnosis of FPIES frequently missed?

Answer 7

Long delay after ingestion

Atypical symptoms

Often thought to be sepsis

Question 8

Complete the table

Answer 8

Question 9

Complete the table for features of infant colic

Answer 9

Question 10

Complete the table gastro-oesophageal reflux

Answer 10

Question 11

What is pollen food syndrome?

Answer 11

Also called oral allergy syndrome, immediate allergic reaction to pollen-realted foods with oro-pharyngeal and systemic symptoms

Question 12

What are some key facts about pollen food syndrome?

Answer 12

• Common cause of food allergy, 2% of population
• Itching and mild swelling of mouth and throat immediately after
• symptoms arise from oro-pharyngeal contact with plant pollen in pollen sensitised individuals

Question 13

How does pollen food syndrome present?

Answer 13

Immediate IgE mediated

• Itching of lips
• Mouth
• Palate
• Throat

Also swelling of the throat

Question 14

What foods can cause pollen food syndrome?

Answer 14

Fruit- caused by Rosaceae family
- Apple
- Pear

Nuts
- Peanut
- All tree nuts except cashew

Vegetables
- Aubergine
- Celery

Question 15

Why do you not get any pollen allergy symptoms when the food is processed?

Answer 15

Pollern allergen is labile

Denatured by processing

Question 16

Complete the table for peanut allergies

Answer 16

Question 17

What allergen components are raised in a peanut allergy?

Answer 17

Ara h 2 and 3

Peanut specific markers

Pea nut, 2 things pea and a nut and both are 3 letters

Question 18

What allergen components are raised in pollen food syndrome?

Answer 18

Ara h 8

Marker of tree-pollen cross-reactivity

syndrome=8 letters, h8

Question 19

What are the challenges faced when diagnosing milk allergy?

Answer 19

• Patients non-verbal
• Cannot tell you subjective symptoms e.g. pruritis
• Symptoms are common to other conditions
• All conditions are common i.e. colic, GOR
• Child is allergic to entire diet

Question 20

What are the challenges faced when diagnosis pollen food syndrome

Answer 20

• Symptoms not unlike peanut allergy
• Anxiety about potential anaphylaxis
• Media skews interpretation
• Mis-diagnosis can cause unnecessary dietary exclusion and medical precautions

Question 21

What can help rule out peanut allergies?

Answer 21

symptom evolution, if previous asymptomatic exposure to allergy, unlikely to be true allergy

Question 22

What issues are faced when patients believe eczema is caused by allergy?

Answer 22

Food allergy does not cause eczema or it’s very rare

Patients avoid foods that they think cause their eczema with no benefit

Question 23

When should allergy tests be carried out?

Answer 23

With suggestion of allergy focused history