Food Allergy in Children and Young People

Question 1

What is the first step in recognizing a food allergy in children?

Answer 1

Identify the possible food allergy

Question 2

What are some dermatological features of an IgE-mediated and Non-IgE-mediated allergic reaction?

Answer 2

• IgE-Mediated
  
  • Pruritus
  • Erythema
  • Urticaria
  • Angioedema
• Non-IgE-Mediated
  
  • Pruritus
  • Erythema
  • Atopic eczema

Question 3

What are some respiratory signs of an IgE-mediated allergic reaction?

Answer 3

• Upper respiratory tract symptoms:
  
  • Nasal itching
  • Sneezing
  • Rhinorrhoea or congestion (with or without conjunctivitis)
• Lower respiratory tract symptoms:
  
  • Cough
  • Chest tightness
  • Wheezing
  • Shortness of breath

Question 4

Which type of reaction (IgE-mediated or Non-IgE-mediated) is anaphylaxis seen in?

Answer 4

IgE-mediated allergic reaction

Question 5

What are some gastrointestinal features of an IgE-mediated and Non-IgE-mediated allergic reaction?

Answer 5

IgE-Mediated

• N&V
• Diarrhoea
• Colicky abdominal pain

Non-IgE-Mediated

• GORD
• Loose or frequent stools
• Blood and/or mucus in stools
• Abdominal pain
• Infantile colic
• Food refusal or aversion
• Constipation
• Perianal redness
• Pallor and tiredness
• Faltering growth plus one or more gastrointestinal symptoms above (with or without significant atopic eczema)

Question 6

If someone has a history that is suggestive of an IgE-mediated allergy, how should they be investigated?

Answer 6

1. Offer a skin prick test or RAST test (for IgE antibodies) to the specific foods.

Question 7

If someone has a history that is suggestive of a non-IgE-mediated allergy, how should they be investigated?

Answer 7

• Eliminate the suspected allergen for 2-6 weeks, then reintroduce.
• NICE advise to ‘consult a dietitian with appropriate competencies about nutritional adequacies, timings and follow-up’

Question 8

When would you refer a child with a food allergy to a secondary care specialist?

Answer 8

• Faltering growth in combination with one or more of the gastrointestinal symptoms described in signs and symptoms of possible food allergy
• Not responded to a single-allergen elimination diet
• Had one or more acute systemic reactions
• Had one or more severe delayed reactions
• Confirmed IgE-mediated food allergy and concurrent asthma
• Significant atopic eczema where multiple or cross-reactive food allergies are suspected by the parent or carer.