Food%20allergy%20(pediatric) Treatment

Food-induced Anaphylaxis

Epinephrine

• In life-threatening anaphylaxis, self injectable intramuscular (IM) Epinephrine (0.01 mg/kg) is the only first-line of treatment; all other treatments are adjunctive
  • IM route provides faster increase in plasma and tissue concentrations of Epinephrine compared to subcutaneous (SC) route
  • At least 2 auto-injections should be prescribed and carried at all times by patients at risk for food-induced anaphylaxis
• Intravenous (IV) Epinephrine is recommended for patients who do not respond to repeated IM Epinephrine injections and fluid resuscitation
• May be given every 5-15 minutes as needed to maintain blood pressure and control symptoms

Bronchodilators (Inhaled)

• Eg Albuterol
• Adjunctive treatment for bronchospasm not responsive to IM Epinephrine
• Nebulized therapy, if available, is considered more practical than metered-dose inhalers

Vasopressors

• Eg Dopamine
• Used in cases of persistent hypotension in anaphylaxis despite administration of Epinephrine and IV fluids
• Continuous monitoring of vital signs should be done

Glucagon

• May be used for refractory hypotension and bradycardia in patients who are taking beta blockers since vasopressor effects of Epinephrine may be decreased in these patients

Antihistamines (H1 and H2-receptor Antagonists)

• Limited evidence to support their use in emergency treatment of anaphylaxis
• Useful only for relief of urticaria and itching

Atropine

• May be considered for patients with bradycardia

Please see Anaphylaxis disease management chart for further information

Non-acute Food-induced Allergic Reactions 

Antihistamines (H1 and H2-receptor Antagonists)

• Remain the mainstay in managing symptoms of non-severe food-induced allergic reactions
  • Used mainly for cutaneous reactions (eg itching and urticaria) but not as first-line medication during anaphylaxis
• May also be used in cases where allergen avoidance is difficult or when it results in nutritional deficiencies
• Oral antihistamines used for first aid treatment of allergic reactions should be in chewable or liquid preparation to facilitate faster absorption
• Not recommended for prevention of food-induced allergic reaction

Corticosteroids

• Although not used in the treatment of acute anaphylaxis due to its slow onset of action, its empiric use is supported by healthcare professionals
• Anti-inflammatory properties of corticosteroids provide benefit in allergic diseases
• Help prevent recurrence of symptoms and biphasic or protracted reactions

Allergen Avoidance

• Considered 1st-line treatment in patients with documented and confirmed food allergies
• Patients should be advised regarding cross-reacting allergens in other foods, hidden food allergens (eg casein and whey for cow’s milk, ovalbumin for chicken’s egg) and high risk situations like anaphylaxis
• Elimination diet is advised only based on a positive history confirmed by skin prick test (SPT) or specific IgE test
  • Ensure that nutritional requirements of patients are met to avoid nutritional deficiencies
  • Ensure that the patient is clinically allergic to a particular food before removing it from their diet; may be pertinent to the patient’s growth and development
• Individuals without documented or confirmed food allergy (FA) are not recommended to avoid potentially allergenic foods as part of managing asthma, atopic dermatitis or eosinophilic esophagitis
• Allergen avoidance during pregnancy to prevent allergy in the offspring is not recommended due to risk in maternal and/or fetal nutrition, and lack of evidence to support its implementation