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Paediatric Food Allergy Overview and Pitfalls of Testing PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Paediatric Food Allergy Overview & Pitfalls of Testing” by Dr Lindsay Exell.

This medical PowerPoint presentation is talking about the pediatric food allergy, a common condition in which a childs immune system reacts negatively to certain foods. This can result in a range of symptoms, from mild to severe, including hives, swelling, vomiting, and anaphylaxis. The most common allergenic foods for children include milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish.

Tags : Paediatric Food Allergy, allergenic foods, food and nutrition, nutrients, nutrition, nutrition PowerPoint presentation

Published on : Apr 26, 2023 | Views : 1769 | Downloads : 1

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Overview of Wexham Park Paediatric Allergy Service Team of 3 senior doctors running personal clinics (Quadri / Exell / Oliver) Allergy Nurse (Jaymee Gordon) Skin-prick testing BSACI allergy action plans AAI Device training Specific IgE testing and component resolved diagnostics Hospital Based Oral Food Challenge service (OFC) Limited numbers and available only to children within Wexham allergy clinic Strong connections with WANG Future developments Peanut Immunotherapy maintenance Pollen and House dust mite immunotherapy
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What sort of food allergies do we see? Immediate IgE food allergies – MAIN FOCUS Delayed non-IgE food allergies- often managed in general POPD FPIES- uncommon, frequently missed Oral Allergy Syndrome Related Atopic Problems, e.g. early severe eczema good asthma care (cofactor for risk)
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Parenting Pitfalls >30% of parents believe their child has food allergy 6-8% actually do Poor understanding of true IgE food allergy and unrelated conditions such as dietary intolerance to non-food proteins such as lactose / IBS/ histamine intolerance Fixed belief that all eczema is caused by food allergy (It’s not) Parents value/trust tests even though these are often not indicated and counterproductive Testing has (at best) limited value and provides high level of false positives which reinforces beliefs and is hard to unravel Psychological bias once results known Fear of risk re early introduction over estimated Delayed introduction of key allergens increases the risk of food allergies developing Onslaught of private companies offering inappropriate testing, often with no evidence base to susceptible families Actual severity reaction versus visually-perceived severity
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IgE Food Allergy 14 major allergens Milk -baked forms tolerated first, most will resolve in childhood, but a small percentage can have lifelong high risk allergy (single highest cause of fatal anaphylaxis) Egg- 80% tolerate baked egg from the outset which supports tolerance ( introduce baked first) Peanuts, tree nuts and sesame-20% early allergy can resolve but most become lifelong with associated risk of further allergies developing due to delayed introduction Lentils/chickpeas- can be common but less risk or LTE Wheat- not common ( tests terrible) Soy – often associated with milk/PFS Fish and shellfish Oral allergy /PR10 crossover with implications for late onset symptoms to certain nuts (mustard/celery/lupin/sulphites)
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Not IgE food allergens Fruits generally in early childhood Contact fruit acid irritation Tomato based foods (fruit acid and histamine-like chemicals) Foods high in histamines/histamine-like compounds “histamine intolerance”-can cause allergy-like symptoms of flushing,itchiness, d/v, abdo pain>/=30minutes after meals Smoked foods/tinned fish /cheeses/tomatoes/aubergine/spinach and nuts Random foods Non typical foods such as rice/maize and barley Unhealthy foods (slush puppies/brain licker etc - genuine recent referrals) Foods that flare eczema several hours later (potentially non IgE) Itchiness at mealtimes when eczema bad-usually just driven by flared eczema which needs improved treatment
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IgE Food Allergy Diagnosis EATERS History – Cornerstone of diagnosis and of more value than testing E– Exposure A– Allergen T – Timing E – Environment R – Reproducibility S – Signs and Symptoms
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E– Exposure A– Allergen T – Timing E – Environment R – Reproducibility S – Signs and Symptoms Eating or skin contact Major food allergens Parties, restaurants, takeaways & high chair weaning (first exposure) Reacts every time to same food protein Urticaria, swelling, vomiting and ABC symptoms Usually within minutes and certainly one hour of eating food protein
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Value of Testing Limited! (If in doubt – don’t) Not required to make diagnosis which is EATERS based May help in clinic to assess emerging tolerance May be useful to assess co-factor allergens pre-introduction Can be helpful when food contains combined ingredients Mixed nuts Hummous -(chickpea/sesame) Pesto- (dairy/cashew/ pine-nut) Excellent for oral allergy/Pollen Food Syndrome (CRD) To determine when to consider an OFC in hospital or when to advise home introduction
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Who has read this?-appears on ICE results Text from hospital test result No other test on ICE starts with this type of statement
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Value of food allergy testing Only has good negative predictive value (NPV) and positive predictive value (PPV) for certain foods LEAP STUDY
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Never do SIgE testing for eczema alone or urticaria unrelated to eating Only test for specific foods for which there is a clear history of IgE symptoms Never tell families to stop eating nuts/foods that are already tolerated Avoid blanket exclusion diets Don’t believe tests are needed in order to make a referral Don’t believe tests predict severity of reactions Understand inappropriate panel testing is a modern day Pandora’s Box of Evil Take Home Messages – DO NOTs
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Encourage the milk ladder from 11 months in delayed milk allergy – actual treatment supporting tolerance acquisition ( we also use cautiously with mild IgE type) Encourage baked egg as early weaning food (If child then reacts to loose egg they can continue eating baked) Signpost parents to recommended early weaning with common allergens supported by BSACI early weaning advice Consider Pros and Cons of delays to introduction incurred by referring for tests first Use EATER's framework to support /exclude diagnosis Resist testing at parents’ request in absence of clear history and refer to us instead if necessary Refer for opinion or ask advice if not sure Take Home Messages - DOs
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Typical Follow-up in Outpatients 1-2 year reviews Establish evolving tolerance (milk and egg) Assess accidental ingestions and management Review new foods tolerated/ avoiding Adherence to safety and compliance Assess family understanding of management of acute reactions Parents for younger children Teenagers with emerging independence Co-factors and risk-taking behaviour Parachute analogy Sink analogy Discussion of future treatments ( immunotherapy)
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Why so much Adrenaline? Food allergy continues to increase Anaphylaxis incidence is increasing significantly year on year Anaphylaxis is increasing in younger children Nothing predicts risk of anaphylaxis accurately In 50% of cases of Anaphylaxis, the previous reaction was mild Level of SPT/SIgE does not predict severity of reactions More people eat in at risk environments / convenience foods Hidden nuts increasingly being used in vegan / vegetarian foods as protein substitute The only thing which predicts reduced likelihood of death from anaphylaxis is previous admission to ITU with anaphylaxis Actual versus perceived risk: More likely to die driving to and from allergy appointment than from the food allergy itself (when UK food allergy deaths are static at 10-12 per year)
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Parachute Analogy If you were told one day you were likely to need to jump from a plane and you were offered a parachute would you want one? Which flights would you take it on Long Haul only When travelling with parents If you thought riskier flight Or you might not bother as most flights should be fine Always- as you never know when If you were told you had to jump would you have: Checked parachute in to hold Left in under your seat Make sure you had it on your back Once you have jumped would you: Count til 5 and you were a safe distance from the plane and then deploy parachute to give it time to slow you down Would you wait til the last minute and use only then when it might be too late
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Sink Analogy If an allergic reaction is like leaving the taps running in the sink Antihistamines only pull the plug out ONLY adrenaline can turn off the taps If the taps are on full blast only adrenaline will stop the sink overflowing
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Familiar excuses for not using AAI