Clerkship Ready: Pediatrics

Before You Counsel About Food Allergy Testing

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In this episode, we will discuss all things related to food allergies, including the difference between IgE-mediated and non-IgE-mediated allergies, clinical manifestations, the important questions to ask when taking a history, the options for doing allergy testing, and treatment. 

  • Definition of food allergies
    • Rates of food allergies
    • Possible pathophysiology of food allergies
    • Clinical manifestations of food allergies
      • IgE mediated food allergies 
        • Cutaneous symptoms
        • Ocular symptoms
        • Respiratory symptoms
        • GI symptoms
        • Neurological and cardiovascular symptoms
        • Anaphylaxis = involvement of 2 or more systems
        • Non-IgE mediated food allergies
          • Symptoms after 4 hours after ingestion
          • Eosinophilic esophagitis
          • Alpha-gal
          • Food protein induced enterocolitis syndrome (FPIES)
          • Food protein induced proctocolitis (FPIAP)
          • Questions to ask to hone your clinical history
            • Presenting symptoms
            • When did symptoms occur
            • Foods ingested
            • Other symptoms, other exposures
            • Any prior allergy testing
            • Family history?
            • Any food avoidance 
            • Testing options for food allergies
              • Clinical history
              • Oral food challenge - gold standard
              • Skin prick/puncture test
              • Serum IgE testing
              • Treatment of food allergy
                • Referral to allergy/immunology specialist and avoidance of offending food until appointment
                • Prescription for epinephrine autoinjector
                • Second generation antihistamines

                  • Resources/Links:

                  1. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management Scott H. Sicherer, MD, and Hugh A. Sampson, MD New York, NY
                  2. Mendonca CE, Andreae DA. Food Allergy. Prim Care. 2023 Jun;50(2):205-220. doi: 10.1016/j.pop.2023.01.002. Epub 2023 Mar 27. PMID: 37105602.
                    3. ...more
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                    Clerkship Ready: PediatricsBy MedReady
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