Multiple food reactions

Child with egg , peanut and seasem allergy , on recent anaphylactic reaction

Clinical features and association of multiple food allergies :

- GIT : vomiting , diarrhea , colic and constipation.

- Respiratory : wheeze , rhinitis , asthma
- Dermatological : atopic dermatitis , eczema , urticaria.
- Behavioural : irritability , crying and milk refusal

What to ask ?

HPI :

 Anylasis of food taken :

- Type of food : Which food taken ?
- Amount of food : how much amount ?
- Was he well before reaction
- Spead of reaction
- Prescribe the reaction :
 Fascial swelling , urticaria
 GIT : vomiting , abdominal pain , loose motion , difficulty swallowing ,
 R.S : difficulty of breathing , stridor , wheeze
 CVS : hypotension , collapse.
- Response to anaphylaxisis : given epipen , transport to hospital

 General : Wt loss./fever / activity ?

 Nutritional history in detail:

- Was he in breast feed 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 mix food? And what type of food u start with?

- Did u give by mouth or through NGT.

- did u give especial type of food ?
- how many times /day?
- Any dietien involve ?
- He had any allergy to any type of food?

past history : k/c of multiple allergies

 When , where , by whom , how present ?

 investigations done : skin prick test?
 treatment given , admitted or not ? where to ward or ICU ?
 medical hx. Of other allergic hx.-
 eczma : any skin changes on neonatal period ?
 rhinitis : any seasonal symptoms?
  asthma :
 drug hx. – have epipen with you ? any allergy to any drug
 other hospital admission ? or surgical operation ?
 birth hx.–

allergic hx. :

 to food , to drug

vaccination hx.:

developmental hx.:

family hx :

 Similar condition
 atopy – ceolic – CF – IBD.

Social hx.:

- Personal :
- Economic :
- Environment : smoking , housing , animals

Discussion

What is the difference b/w allergy and intolerance ?

- Allergy : is immune – mediate reaction to food antigen (protein). Classically this by IgE mediated
type 1 hypersensitivty. Signs include anaphylaxis , urticaria and atopic dermitis.
- Intolerance : is non-IgE mediated and characterize by delay or non acute onset. Can be other
than protein e.g : lactose intolerance.
- Mixed reaction involving both IgE and non – IgE responses

Classification reactions :

- Mild :
- Moderate :
- Severe :

Diagnosis of multiple food allergies :

- Clinical manifestation and history.

- Skin – prick testing and IgE radioallergosorbent testing (RAST) can help.
- Stool analysis : alpha1-antitrypsin (AT), eosinophil cationic protein (ECP), immunoglobulin (Ig) A,
and cow's milk-specific IgA antibodies ".
- Histological confirmation if suspected colitis or enteropathy.

- To r/o other causes :

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

What is management in multiple food allergies? Team involved : pediatrician , dietician , allergic
doctor of immune :

 Avoid allergen : food , drug

 Amino acid-base formula in case of multiple food allergy e.g soya , egg , wheat and
peanut.
 Adrenaline auto injector