Allergens

Question 1

Most common allergens?

Answer 1

Peanut (Most common cause anaphylaxsis)
Treenut
Cow Milk
Egg (Most common allergen)
Seafood
Soy
Wheat

Question 2

Risk of death in anaphylaxsis

Answer 2

Adolescent/Young Adult
Poorly treated Asthma
Upright posture
Nuts
Seafood
Delay in treatment (Live far from medical service)

Question 3

Outpatient management of Anaphylaxsis?

Answer 3

Refer to allergen
Confirm with skin prick test or serum specific IgE
Avoid the trigger
Get a dietician if multiple food allergens
Prescribe adrenaline and DESCRIBE usage
ASCIA action plan
REVIEW:
Nuts/Seafood every 5 years (Tolerance chance is low)
CowsMilke/Egg/Wheat (Staple foods) - review 12-18/12 and repeat SPT or ssIgE

Question 4

SPT

Vs.

SsIgE

Answer 4

Skin Prick Test

Control with saline (?Dermatographism)
Control with histamine (?has antihistamine Rx washed out?)

• Benefit is rapid turn around
  Cant use with oral anti histamine within 5/7, uncontrolled eczema, dermatographism
• Can use fresh allergens (Like fresh kiwi)
  Positive = >3mm and MBS available
• But equipment and operator dependent = not standardised

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Serum Specific IgE
Allergen on well, add serum, then Anti-IgE marker (ELISA)
Not called RAST

• Standarardised
• Allergen range not as > as SPT and
  >0.35KuA/L
• Only 4 x covered on MBS

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USE OF BOTH is to confirm the diagnosis and gives baseline

• Down the track if level is low can we CHALLENGE?
• Value is for titration of allergen
• > 3mm positive
  — >7mm likely to fail challenge
  Predicts IF will react
  But does not predict SEVERITY of reaction

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Don’t do $400 IgG food panel test - IgG is normal physiology

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Don’t do if tolerating food anyway
ONLY FOR IMMEDIATE REACTION TO FOOD
Not for What is the cause of my eczema?
Not for Chronic idiopathic urticaria (Heat)
Food intolerance
If non-IgE mediated food allergy

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Question 5

Cow’s Milk Allergy- What milk can they have?

What is chance of cross reaction

Answer 5

Formula - No
Sheep/Goat - No (75% cross reactive)
Partially Hydrolysed formula - no (50% cross reactive)
/———/
Soy - Yes 5%

Extensively Hydrolysed EHF - Yes 5% Pepti Junior/Alfare

Novolac Allergy - Yes - Rice based formula (Not rice milk) - OTC pharmacy $40/tin

Amino Acid Formula Yes - 0% reactive(Neocate, elecare, alfamino )

AAF But tastes super gross - consider medically supervised EHF or if SPT/IgE -ve can trial soy

Question 6

If cow’s milk allergy or whole egg reaction - chance of baked tolerance?

Answer 6

60-70% will tolerate baked

Trial under medical supervision
Reactivity more common if asthma or >3 food allergens

Question 7

Non ige reactions to food?

Answer 7

Food protein enteropathy (aka coeliac- milk)
Milk soy or egg will be rechallenged
Chronic diarrhoes; failure to thrive
Hypoalbuminemia
Milk:soy high cross reactivity

Treat EHF or AA if FTT

Proctocolitis
Cows milk in mums diet (2-8weeks)
Blood, mucus, som diarrhoea: gradual onset
Thriving
..

FPIES 1:1000
Delayed gut reaction, 4/24
Rice most common, milk, egg
oats
Acute vomiting hypotension hypothermia, masquerades as sepsis
Increased wcc but negative CRP

Rechallenge medically
May transform into IGE

..

EoE
Boys
Stuck food
Family hx
Rescope post elimination for histologically changes