Food Allergies in Pediatrics

Lauren Cunningham
Bon Secours Memorial College of Nursing

PATHOPHYSIOLOGY &
BACKGROUND

A food allergy is when the body has a

reproducible immune reaction to a specific
food.
This reaction may be an emergency that we
refer to as anaphylaxis. Anaphylaxis is the
systemic allergic reaction which occurs after
ingesting an allergen. It is a severe allergic
reaction that is potentially life threatening and
must be treated immediately. Typically, the
more common foods that cause anaphylactic
allergies are with peanuts, tree nuts, milk,
fish, shellfish, egg, soy and wheat.

(Sicherer & Sampson, 2014)

PREVENTION STRATEGIES

Primary prevention strategies are

aimed at preventing a disease or
condition from occurring in the
first place.
An example of this is a child
being allergy tested.
There

are 2 types of tests:

Prick/puncture. An allergen is applied

with a prick/puncture on the top of
the skin.
Intradermal. Uses a very thin
needle, a diluted allergen is injected
right below the skin surface.

(American College of Allergy, Asthma & Immunology, 2014)

SECONDARY PREVENTION

Secondary prevention is
aimed at minimizing the
disease so that quick and
efficient management of the
condition can be initiated.
An example of this with food
allergies could be to avoid
certain foods that are known
to cause an allergic reaction.
Foods known to commonly
cause allergic reactions:
peanuts,

tree nuts, milk, fish,

shellfish, egg, soy and wheat

(Sicherer & Sampson, 2014)

TERTIARY PREVENTION

Tertiary prevention is
focused on reducing the
complications of a condition
once it has developed.
The goal with tertiary
prevention is to eliminate
and decrease complications
or disability caused by the
disease.
An example oftertiary
prevention is the use of an
Epinephrine pin after being
exposed to an allergen.

(Center for Disease Control and Prevention, 2013)

ADDITIONAL PREVENTION

The American College of Allergy, Asthma, and

Immunology suggests that with pregnancy
diets allergen avoidance is not
recommended.
Studies are beginning to suggest that
prolonged avoidance of an allergen is not
protective, and that it actually may be a risk
factor regarding food allergy prevention.

(American College of Allergy, Asthma & Immunology, 2014)

HOW TO AVOID HAVING AN

ALLERGIC REACTION

Because there is no cure for

food allergies, strict
avoidance of the allergen is
the only way to avoid a
reaction (American College
of Allergy, Asthma &
Immunology,2014).
This explains why it is so
important to develop a plan
for dealing with allergic
reactions (Center for Disease
Control and Prevention,
2013).
A medical alert bracelet is
also recommended to ensure
identification of an allergy.

NURSING CARE &

INTERVENTIONS

Some nursing interventions that may

be used during an allergic reaction or
anaphylaxis include:
Administer

oxygen as needed
Maintain airway
Place the patient in Fowlers position
Assist in the administration of
Epinephrine
Assess and monitor patients reaction to
medications
Monitor patients oxygen saturations
(Doenges, Moorhouse, & Murr, 2009)

PATIENT CARE AFTER EXPOSURE

TO ALLERGEN

Patient may experience a number of

symptoms after exposed to an allergen.
Some symptoms may include: uticaria,
bronchospasm, hypotension, shortness of
breath, wheezing, laryngeal edema, flushing,
hives, swollen lips and tongue
If patient is know to have a severe reaction,
patient should use EPI pen immediately and
follow up with emergency care where
additional treatment and care can be
provided.
The patient will continue to be monitored,
also may be given more epinephrine and an
antihistamine.

(Sicherer & Sampson, 2014)

PATIENT TEACHING

The importance of patient

teaching with food allergies is
critical. Patients must develop
an individualized action plan in
case of an emergency.
In addition to avoidance of an
allergen, having a plan if exposed
helps to decrease the level of
chaos in an emergency (Center
for Disease Control and
Prevention, 2013).
The patient must be
knowledgeable on how to use
their EPI pen and the importance
of calling 911, in the case of
anaphylaxis.

PATIENT TEACHING: HOW TO

USE AN EPIPEN?
Remove the EpiPen Auto-Injector from the carrier tube and
follow these 2 simple steps:
Hold firmly with orange tip pointing
downward.
Remove blue safety cap by pulling straight
up. Do not bend or twist.

Swing and push orange tip firmly into

mid-outer thigh until you hear a click.
Hold on thigh for several seconds.

(Pfizer, 2014)

ADDITIONAL TEACHING: HOW TO USE AN

EPI PEN?

https://www.youtube.com/watch?
v=tjILFYPE3Uw&x-yt-ts=1422579428&x-ytcl=85114404&feature=player_detailpage

COMPLICATIONS & LONG TERM

CONSEQUENCES

In addition to physical complications,

children suffering from allergies may have a
reduced quality of life.
Psychological effects, such as bullying, affect
up to 45% of children with food allergies.
These bullied children have a lower quality
of life and increased anxiety, as compared to
children without food allergies.

(Sicherer & Sampson, 2014)

COMPLICATIONS & LONG TERM

CONSEQUENCES

According to WAO patients have with food

allergies may also have a coexisting disease such
as asthma, rhinitis, uticaria, eczema, and
drug/insect allergies (WAO, 2011).
Food allergies may have serious complications
such as anaphylaxis. Anaphylaxis could result
in intubation of the child or even death. Early
identification and intervention are key in
preventing these complications.

(Pawankar, Canonica, Holgate & Lockey, 2011)

WORLD ALLERGY ORGANIZATION:

RECOMMENDATIONS & GOALS

WAO has determined that there are

200 to 250 million people that suffer
from food allergies worldwide.
This number is expected to grow to
400 million by 2025.
One of the goals of the WAO is to
increase the availability of trained
professionals to treat and diagnose
these allergies.
In addition, making these services
(such as medications) more
affordable and accessible to the
public.
(Pawankar, Canonica, Holgate & Lockey, 2011)

DEVELOPING A PLAN OF ACTION

The CDC has developed Voluntary Guidelines for

Managing Food Allergies includes these 5
recommendations for prevention of food allergies in
schools and early care/education programs.
1.

Ensure the daily management of food allergies in

individual children.
2. Prepare for food allergy emergencies.
3. Provide professional development on food allergies
for staff members.
4. Educate children and family members about food
allergies.
5. Create and maintain a healthy and safe educational
environment.
(Center for Disease Control and Prevention, 2013)

REFERENCES

American College of Allergy, Asthma & Immunology. 2014. Allergy testing: testing
standards. Retrieved from http://acaai.org/allergies/treatment/allergytesting/skin-test

Center for Disease Control and Prevention. October 13, 2013. Adolescent and
schools health: food allergies in schools. Retrieved from
http://www.cdc.gov/healthyyouth/foodallergies/

Doenges, M. E., Moorhouse, M. F., Murr, A. C. (2009). Nursing care plans: guidelines
for individualizing client care across the life span. Philadelphia, PA: F.A.Davis.

Hobbs, C. B., Skinner, A. C., Burks, A. W., & Vickery, B. P. (2015). Food allergies
affect growth in children. The Journal Of Allergy And Clinical Immunology. In
Practice, 3(1), 133-134.e1. doi:10.1016/j.jaip.2014.11.004

Pawankar, R., Canonica, G. W., Holgate, S. T., & Lockey, R. F. (2011). WAO white
book on allergy. Milwaukee, WI: World Allergy Organization, 3, 156-157

Pfizer Canada Inc. (2014). How do I use epipen? Retrieved from

http://www.epipen.ca/en/about-epipen/how-to-use-epipen

Sicherer, S., & Sampson, H. January 2, 2014. Food allergy: Epidemiology,

pathogenesis, diagnosis, and treatment. Journal of Allergy and Clinical
Immunology, 133, 291-307. DOI: http://dx.doi.org/10.1016/j.jaci.2013.11.020

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I have neither given nor received aid, other

than acknowledged, on this assignment or
test, nor have I seen anyone else do so.
Lauren E Cunningham