food%20allergy%20(pediatric)
FOOD ALLERGY (PEDIATRIC)
Food allergy is an adverse reaction due to a specific immune response occurring reproducibly upon exposure to certain foods. It occurs minutes to hours after food consumption.
Immunological mechanisms can be IgE mediated, non-IgE mediated or mixed IgE and non-IgE mediated.
It may be life-threatening and is the most common cause of anaphylaxis in children.
It should be differentiated from food intolerance in which adverse reactions from exposure to food arise from non-immunological mechanisms.

Prevention

  • In the history, take note of allergy record of patient’s parents, siblings, relatives on maternal or paternal side
    • Predictive family score may be used to identify patients at-risk of developing allergy
  • There is an ongoing research on allergy prevention strategies, although findings are small or with unconfirmed effects; newer strategies are still in experimental stages

Breastfeeding and Milk Formulas

  • Exclusive breastfeeding of infants until 4-6 months is recommended, especially in children at high risk of allergic disease
    • Reported protection against allergic disease in the early years of life is relatively small, and some studies suggest an increased risk of disease in later life
    • Currently, there are no conclusions on the role of breastfeeding duration in preventing or delaying the onset of specific food allergies
  • Dietary restrictions for breastfeeding mothers to prevent food allergy in their child is not recommended if the infant is asymptomatic and thriving
  • If breastfeeding is not possible in high-risk infants, a hydrolyzed formula is recommended
    • However, evidence is lacking to show that extensively or partially hydrolyzed formulas prevent atopic disease in infants and children, even in those whose risk for allergic disease is high
  • Prospective studies have shown that soy formula and other mammalian milks (eg sheep/buffalo/goat’s formula) are not recommended for the reduction of food allergy risk
  • More studies are needed to support the use of probiotics/prebiotics for infant diet supplementation

Solid Food

  • It is recommended that introduction of solid food, including those with potential allergens, should be done at 4-6 months of age, without delay
    • Dietary restriction in high risk patients is not recommended due to insufficient evidence
  • Introduction of peanuts into the diet of ≥6-month old infants with mild-moderate atopic dermatitis is recommended
    • For infants aged 4-6 months with severe atopic dermatitis, egg allergy, or both, consider IgE measurement prior to introduction of peanut-containing food 
  • Regular follow-up should be encouraged: Every 6-12 months when child reaches 1 years of age

Follow Up

Observation

  • Patients should be observed for 4-6 hours or longer for possible recurrence as the effect of Epinephrine wears off

Re-evaluation of Patients with Food Allergy (FA)

  • Important to determine if the allergy to food has resolved or if tolerance has been obtained over time
  • Upon follow up, if skin prick test (SPT) or the specific IgE test shows negative result or has decreased to low levels, food challenge should be recommended
    • If food challenge is negative, patient may introduce the food to his/her diet

Timing of Examinations

  • Food-specific IgE tests may be done:
    • Every 6 months for patients <3 years old
    • Every 6-12 months for patients 3-5 years old
    • At least every 12 months for patients >5 years old
  • Food challenge test may be done:
    • Every 6-12 months for patients <3 years old
    • Every 1-2 years for patients 3-5 years old
    • Every 2-3 years for patients >5 years old

Referral to Allergist-Immunologist

  • Symptoms are recurrent or difficult to control and/or daily medications for prevention are required
  • Patient has confirmed IgE-mediated food allergy (FA) and is asthmatic
  • Tests are negative but there is strong suspicion of IgE-mediated FA
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