Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Food allergy in paediatrics

Clinical Discipline(s)/Organ System(s)
Immunology, Paediatrics, Dermatology, Otorhinolaryngology
Progress Test Topic(s)
Blood and lymph, Child health, Seriously ill patient
An 18 month girl arrives in the Emergency Department via ambulance. Within minutes of having a bite of toast with peanut butter, she started coughing and became breathless. She also has chronic eczema which seems to flare and become itchy after she eats eggs.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Pathophysiology of allergy
   - Know the common food allergens (cow’s milk, egg, peanut account for 75% of early food allergy) with other common allergens including fish, shellfish, tree nuts, kiwifruit, sesame, wheat and soy
   - Definition of food allergy as an adverse immunologic reaction to a food protein
   - IgE-mediated immediate hypersensitivity reactions; other immunological mechanisms that occur (intolerance, hypersensitivity, sensitisation)
   - Differences between food intolerance and food allergy (e.g. lactose intolerance vs. peanut anaphylaxis)
   - Theory around antenatal and infant allergen presentation
   - Anatomy of the upper and lower airways
   - Pharmacology of adrenaline and antihistamines
Clinical and Communication Skills 
   - History of an immediate allergic reaction, history of likely triggers and taking history of food consumption, including infant feeding and introduction of different foods
   - Take an atopy history (eczema, asthma, rhinitis, family history)
   - Examination of acute respiratory distress and other symptoms of anaphylaxis; know the signs and symptoms of an IgE mediated allergic reaction
   - Examination of the upper airway, ears and throat
   - Examination for atopy, skin conditions, growth and development
   - Interpretation of lateral neck X-ray and other Xray for inhaled foreign body
   - Management of anaphylaxis, use of adrenaline
   - Referral to specialist for any child with anaphylaxis or allergy to more than one food allergen
   - Advice around allergen avoidance and understanding written management plan detailing the signs, symptoms and management of allergic reactions
   - Know what an adrenaline autoinjector (“Epipen”) is and how to administer
   - Understand many food allergies will not be persistent and need reassessment over time
Personal and Professional Skills 
   - Best interests principle
   - Show empathy; understand how parents frightened/perceptions exaggerated by concept of anaphylactic food allergy
   - Social and financial impact of food restriction
   - Communicating with patient and their family/whānau
   - Managing therapeutic relationship; dealing with a patient or parent who requests non-standard treatment or is excessively anxious around food allergens
Hauora Māori 
   - Ensuring a culturally safe environment; interpretation of symptoms in an appropriate cultural context including differential health literacy needs of Māori patients and whānau
   - Understand inequities in access to social and health services care for different ethnic groups
   - Ethnic disparities in food allergies and in allergy testing in New Zealand
Population Health 
   - IgE-mediated food allergy is common (10% of children <5 yrs)
   - Impact and incidence of atopy in New Zealand children
   - Epidemiology of serious food allergy: time trends, risk factors, opportunities for prevention
Conditions to be considered relating to this scenario
Food anaphylaxis, food intolerance, acute asthma
Less common but 'important not to miss'
Foreign body inhalation
Parental extreme anxiety around allergy