3 - Paeds - Gastro - Food allergy/Intolerance

Question 1

Allergy?

Intolerance?

Answer 1

pathological immune response against specific food protein - usually IgE mediated

non-immune hypersensitivity reaction

Question 2

Type 1 allergies occur because? 3 infant agents, 4 older kids agents?

Answer 2

kids don’t develop immune tolerance to food
infants - milk, eggs, peanut
older kids - peanut, tree nut, fish and shellfish

Question 3

type 2 allergies.. allergy begins later because…? how severe are these compared to type 1

Answer 3

begins later due to cross-reactivity between proteins in fresh fruit/veg/nuts and those in pollens (eg tolerates apples > dev allergy to birch tree pollen > dev allergy to apples (v similar proteins)

usually more mild

Question 4

what is diff between mediation of type 1 and type 2

non-allergic/hypersensitivity Sx?

Answer 4

type 1 - ige mediated
type 2 - non-ige mediated

D+V, watery stools

Question 5

clinical features of type 1 - Sx, time after ingestion

Answer 5

Hx of allergic Sx - urticarial rash to facial swelling to anaphylaxis - usually 10-15m after ingestion, usually first time food is ingested

Question 6

clinical features of type 2 - 4 main Sx, 2 other possible Sx, what is possible in first few weeks of life

Answer 6

abdo pain, D + V, FTT
colic/eczema
sometime blood in stools in first weeks of life from proctitis

Question 7

gold standard for diagnosis of BOTH allergy types

Answer 7

withdrawal of food from diet under dietician supervision - followed by double blind placebo controlled food challenge in hospital with close monitoring

Question 8

how is non-Ige mediated diagnosed (type 2)

Answer 8

by Hx + Ex, endoscopy/biopsy may be used, supported by eosinophilic infiltrates

Question 9

how is IgE mediated allergy diagnosed? type 1

Answer 9

skin prick test and measurement of specific IgE Abs in blood - ^ response = like to be allergy - -ve response makes allergy unlikely

Question 10

MGMT

Answer 10

avoid relevant foods
advice of paed dietician
self mgmt plan and training for an attack
antihistamines for mild
epipen for severe