300 million people 5-6% OF YOUNG CHILDREN IN IRELAND8

Food allergy is one of the most common paediatric allergic disorders1, occurring in an estimated 5-6% of young children in Ireland8 and is an underlying cause of many common childhood conditions such as atopic eczema.1

300 million people 90% OF ALL ALLERGENIC FOODS3

Approximately 40% of infants and young children with eczema suffer from food allergy, with hen's egg, cow's milk, soy and wheat accounting for about 90% of allergenic foods3

300 million people 85% MILK ALLERGY 70% EGG ALLERGY

Approximately 70% of children with egg allergy and 85% with milk allergy will outgrow it by 5 years of age4. About 40-60% of children with egg or milk allergy will develop asthma and 30-55% will develop allergic rhinitis4

The benefits of allergy testing

Correct diagnosis of food allergy, followed by counselling and advice based on vaild test results, is important because it will help to reduce the incidence of adverse reactions resulting from true food allergies, and will also help to reduce the unnecessary dietary exclusion of foods that are safe and should be eaten as part of a normal, healthy diet.5

Targeted management of atopic patients could reduce the healthcare burden6,7

Is there a suspicion of allergy?

Go beyond symptoms
and identify the cause

  • Avoid unnecessary prescriptions
  • Avoid unnecessary consultations/referrals
  • Reduce the prescription burden and save costs
  • Reduce time off school, college or work and reduce waiting lists
  • Save time, costs and help patients live a less encumbered life

- Early diagnosis of allergy
- Determine the right treatment plan

  • Reduce emergency admissions
  • Reduce unnecessary prescriptions, consultations and referrals
  • Improve control
  • Enable patients to take part in normal daily activities
  • Save time, costs and help patients live a less encumbered life

Active
management

  • Improve quality of life

Common allergens

Allergy history

Food allergy can present with a vast number of symptoms. Symptoms can range in severity and duration depending on the allergy and often coincide with other allergic conditions. For instance food allergy is a causative factor in eczema and anaphylaxis. Other symptoms such as failure to thrive, vomiting, diarrhoea and colic can also be attributed to food allergy, as well as traditional allergic symptoms such as urticaria and hives.

Diagnosing food allergy starts with a physical examination and a food allergy-focused patient history3

An allergy-focused clinical history should be tailored to the presenting symptoms and age of the patient5

A few key questions will provide you with a detailed history and allow you to correctly manage your patient

Download an allergy-focused patient history form

Download

Testing & recommendations

Guided by the allergy-focused patient history, work through the most appropriate next steps:

Assess the need for testing

If the patient history suggests an IgE-mediated allergy, conduct a blood test (allergen-specific IgE), or by trained, competent clinical staff, in a clinical environment with sufficient clinical support and facilities to manage anaphylaxis, a skin prick test can be performed.5 Specific IgE testing can be performed on any patient irrespective of age, allergic symptoms (i.e. eczema) and medication.

When taking blood for a test a 1 ml sample of whole blood is sufficient to test for up to 10 different allergens.

Interpretation of test results

Results should be read in conjuction with the clinical history.

Management & referral

Recommendations from the NICE Food Allergy Guideline

Dr Adam Fox talks about implementing the NICE Guidelines.

The NICE Guidelines, published in 2011, offer clear advice on the diagnosis and management of food allergy.

Most patients, i.e. those with a clear diagnosis and mild but persistent symptoms, should be managed in primary care, but some will require referral and management to secondary care. Implementing the NICE Guidelines should help to diagnose or exclude food allergy early on in the patient's care pathway and thus reduce the number of unnecessary prescriptions patients receive, as well as reducing the number of patients on exclusion diets.5

The benefits of allergy testing
Ruth Charles paediatric dietitian talks about the benefits of working with a dietitian in the management of allergy

When to refer

The NICE guideline on food allergy offers specific advice on which patients should be referred to secondary care.

Managing anaphylaxis

Managing allergy is painless

Dr Susan Leech discusses patient management and when to issue patients with an adrenaline autoinjector

Printable action plans

Following diagnosis, to ensure your patient follows your management advice, it is important to provide them with an action plan.

Download these useful action plans to guide your management of allergy patients:

References
  1. Punekar YS and Sheikh A. Clin Exp Allergy 2009; 39:1889-1895.
  2. Simpson AB, et al. J Pediatr 2010; 156: 777-781.
  3. Pawankar R (Ed), et al. White book on allergy, 2011; World Allergy Organisation UK.
  4. Kurowski K, et al. Am Fam Physician 2008; 77: 1678-1688.
  5. National Institute for Health and Care Excellence. Food allergy in children and young people (CG116). 2011. London: National Institute for Health and Care Excellence.
  6. House of Lords, Science and Technology sixth report- the extent and burden of allergy in the United Kingdom. Available from www.bsaci.org/pdf/HoL_science_report_vol.1.pdf last accessed February 2014.
  7. Pearce L. Nursing Times 2012; 108(17): 20-22.
  8. Irish Food Allergy Network. Food allergy: Guidelines for diagnosis and management in Primary Care. 2012.