S1 L2 Food allergy- management Flashcards
What are the different treatment options for food allergies management?
- Appropriate assessment
→ Allergy focused history and examination
→ Appropriately selected allergy investigations
→ Identify food causing symptoms - Dietary advice
→ Exclusions - which food/ food groups/ food formats to avoid
→ Inclusions - which foods/ groups /formats not to avoid
→ Label reading - ingredient labelling, patient advisory labels - Medical advice
→ Emergency management of allergic/ anaphylactic reactions
How is cows milk allergy managed?
- Selection of replacement infant formulas
1. Extensive hydrolysed formula - milk is broken down already - After >6 months can use infant soya milk (not before as it affects fertility of baby)
2. Amino acid formula - if baby is still sensitive → plant based no cows milk protein in it at all, just the free amino acids
3. Dairy-free weaning advice followed by milk re-introduction
Goats milk or lactose free milks are not an option as they contain a similar protein to cows milk
If allergic to cows milk often also allergic to soya milk
What is lactose intolerance?
Lactase → present on jejunal brush border apex, hydrolysis of lactose into monosaccharides galactose and glucose, detected from 8 weeks, rise from 32 week until birth
Lactase non persistence
- Occurs in most humans - variable degrees
- Typical symptoms - bloating, flatulence, explosive diarrhoea
- Onset subtle, progressive over years
- Most diagnosed as adolescent or adult
- Not always symptomatic with milk
Primary lactose intolerance - lactase enzyme diminishes
Secondary lactose intolerance - follow GI illness, damage to GI lining causes temporary lactose intolerance
Congenital lactase deficiency - extremely rare, autosomal recessive defect in lactase gene, cannot digest breast milk
How is milk re-introduced?
Milk ladder
Start with more denatured/ lower protein dose - LESS allergenic
End with less denatured/ higher protein dose- MORE allergenic
Usually using a milk ladder
- Stages 1-4 starting with crumb of biscuit containing <1g of cows milk protein
What are the 14 major food allergens?
- Celery
- Mustard
- Sesame
- Sulphur dioxide
- Lupin
- Molluscs
- Peanuts
- Soya
- Nuts
- Crustaceans
- Cows milk
- Hens eggs
- Fish
- Gluten
What is an oral food challenge?
Done after screening test
Expose patients to increasing amounts of allergen every 20 minutes
Observe between each dose to see if they have an allergic reaction
How are different food allergies managed?
Changed from a passive approach to active management
- Anticipatory allergen testing → at presentation patients are tested for cross-reactive allergens and potential future allergens to minimise dietary exclusions
- Dietetic advice for dietary exclusions → only avoid foods that are not tolerated and not classes of foods
- Prescription of emergency medication where indicated → epipens, autojext
- Early food introductions in infancy → active management, introduce lower allergenic forms of foods early as exposure will enhance further tolerance in established allergy
- Desensitisation to food allergens → treatment plans aimed to induce tolerance or desensitise these patients thereby ‘cure’ these allergies
- Oral food challenges for diagnostic verification
What dietary advice is given?
Advice on what to avoid
Packaging - 14 major allergens highlighted in bold
Advice on eating out and takeaways
‘May contain labels’
What is an allergy action plan?
Carried by every child who has an allergy who is at risk of anaphylaxis
Shows the signs and symptoms to be aware of
What to do
How to give and epipen injection
Who to contact
What is the first line treatment for anaphylaxis?
- Rapid treatment of adrenaline is first line treatment
- Via EpiPen or Jext pen
What are the signs/symptoms mild/moderate reaction? What should you do?
- Swollen lips, face or eyes
- Itchy/tingling mouth
- Hives or itchy skin rash
- Abdominal pain or vomiting
- Sudden change in behaviour
Action
- Stay with child- call for help if necessary
- Locate autoadrenaline injector (don’t give)
- Give antihistamine (if vomited repeat dose) - cetirizine preferable as quicker onset of action and less severe side effects
- Call parents or guardian / emergency contact
What are the sign/symptoms of anaphylaxis?
Can occur without skin symptoms
Always consider in someone with known allergy with sudden difficulty breathing
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
How is anaphylaxis treated?
- Get patient to sit or lie down
- Give adrenaline- autoinjector EpiPen or Jext
- Dial 999
- If in doubt give adrenaline
Must stay with patient, given second dose if needed (no improvement after 5 mins) commence CPR if needed, call parent
If history of asthma might want to give inhaled salbutamol
How do you give an adrenaline autoinjector?
- Locate EpiPen or Jext
- Remove from safety case
- Hold correct way around- blue to the sky orange to the thigh
- Safely remove cap - blue cap (safety release)
- Hold on anterolateral thigh (hear it click)
- For up to 10 seconds
- Then rub for 10 seconds
- Call ambulance
GW
- How to use an Epi-pen?
(look at this side of the card after looking at answer)
- For a Mild/moderate allergy:
- Signs and sx
- Action to take
- For a Severe allergy:
- Signs and sx
- Action to take
- What to do after ‘action to take’
