Food Allergy Management

Question 1

How to manage a food allergy

Answer 1

Appropriate assessment - allergy focused history and examination, appropriate investigations

Dietary advice: exclusions, inclusions, label reading, food reintroduction

Medical advice: emergency management of allergic/ anaphylactic reaction

Question 2

What can you give for a milk allergy?

Answer 2

Extensive hydrolysed formula - hydrolysed to no longer be allergens (breaks down AA Chains)

Soya >6months old

AA formula

Dairy-free weaning advice followed by milk reintroduction

Question 3

Explain how milk reintroduction is carried out using the milk ladder

Answer 3

More denatures/ lower protein dose (less allergenic)
Stage 1 - small crumb biscuit <1g CMP per biscuit-> whole biscuit 5 weeks
Stage 2 - other baked productions CMP e.g. cakes, muffins, butter
Stage 3 - products with cooked cheese/ whole cows milk heated e.g. pizza, cheese sauce, rice pudding, chocolate
Stage 4 - uncooked cheese, uncooked desserts, cows milk UHT followed pasteurised then unpasteurised

Question 4

What do you do if the skin prick test comes back as low positive e.g. 2/3cm?

Answer 4

Hold off these foods until a diagnostic oral challenge is performed in clinic

Eat small piece - wait 30mins observe
Increase each time

Question 5

Mild/ moderate reaction signs and action to take

Answer 5

Swollen lips, face or eyes
Itchy/ tingling mouth 
Hives or itchy skin rash
Abdo pain or vomiting 
Sudden change in behaviour 

Action: stay with child, call for help if necessary, locate adrenaline autoinjectors, give antihistamine, phone parent/ emergency contact

Question 6

Signs of anaphylaxis

Answer 6

Always consider in known food allergy with sudden breathing difficulties

Airway - persistent cough, hoarse voice, difficulty swallowing, swollen tongue

Breathing - difficult or noisy breathing, wheeze or persistent cough

Consciousness - persistent dizziness, pale or floppy, suddenly sleepy, collapse/ unconscious

If 1+ of signs above present:
Lie child flat with legs raised (if breathing difficult allow child to sit), use adrenaline autoinjector without delay, dial 999
If in doubt give adrenaline

If no signs of life commence CPR
No improvement after 5mins five further adrenaline dose