Multiple Food Reactions

Question 1

Clinical features and association of multiple food allergies

Answer 1

GIT: vomiting, diarrhea, colic and constipation
Respiratory: wheeze, rhinitis, asthma
Dermatological: atopic dermatitis, eczema, urticaria
Behavioral: irritability, crying, and milk refusal

Question 2

What to ask? HPI: Analysis of food taken

Answer 2

Type of food - which food taken?
Amount of food: how much amount?
Was he well before reaction?
Spread of reaction

Question 3

HPI: Describe the allergic reaction.

Answer 3

• fascial swelling, urticaria
• GIT: vomiting, abdominal pain, loose motion, difficulty swallowing
• Respiratory: difficulty of breathing, stridor, wheeze
• CVS: hypotension, collapse

Question 4

HPI: Response to anaphylaxis

Answer 4

given EpiPen, transport to hospital

Question 5

HPI: General survey questions

Answer 5

weight loss/fever/activity?

Question 6

HPI: Nutritional history in detail

Answer 6

Was breastfed or formula? For how long?
Time of weaning? Is it complete or partial weaning?
Recent dietary changes e.g.: introduction of formula milk? cereal, bread?
Time of start to give him mixed food? And what type of food you start with?
Did you give by mouth or through NGT?
Did you give special type of food?
How many times per day?
Any dietitian involved?
Allergy to any other type of food?

Question 7

PMH: K/C of multiple allergies

Answer 7

• when, where, by whom. how present
• investigations done: skin rpick test?
• treatment given, admitted or not? if admitted, ward or ICU?
• other allergic history: eczema: any skin changes on neonatal period? rhinitis: any seasonal symptoms? asthma
• Drug history: have EpiPen with you? any allergy to any drug?
• Other hospital admission? or surgical operation?
• Birth history

Question 8

Family History:

Answer 8

similar condition
atopy, coeliac, CF, IBD

Question 9

Social History:

Answer 9

personal
economic
environment: smoking, housing, animals

Question 10

Discussion: What is food allergy?

Answer 10

Food Allergy: is immune-mediated reaction to food antigen (protein). Classically by IgE mediated type 1 hypersensitivity. Signs include anaphylaxis, urticaria and atopic dermatitis

Question 11

Discussion: What is food intolerance?

Answer 11

is non-IgE mediated and characterized by delay or non-acute onset. Can be other than protein e.g.: lactose intolerance

Question 12

Discussion: What is mixed reactions to food?

Answer 12

involving both IgE and non-IgE responses

Question 13

Discussion: Classification of reactions

Answer 13

Mild:
Moderate:
Severe:

Question 14

Diagnosis of multiple food allergies:

Answer 14

clinical manifestation and history
SPT and IgE RAST can help
Stool analysis: alpha1-antitrypsin (AT), eosinophil cationic protein (ECP), immunoglobulin (Ig) A, and cow’s milk-specific IgA antibodies
Histologic confirmation if suspected colitis or enteropathy

Question 15

Discussion: To R/O other causes:

Answer 15

stool inspection: send for microbial C/S, virology and reducing substances
Blood: CBC, S/E, albumin, LFT, celiac screen (tissue TG + IgA), inflammatory markers

Question 16

Discussion: What is management in multiple food allergies?

Answer 16

Avoid allergen: food, drug
Amino acid-base formula in case of multiple food allergies e.g. soya, egg, wheat, and peanut
Adrenaline auto-injector

Question 17

Discussion: Team involved

Answer 17

Paediatrician, dietitian, allergy/immunology specialist