Today’s post comes from Dr. David Stukus, MD of Nationwide Children’s Hospital. David Stukus, MD, is board certified in Allergy/Immunology and is an Assistant Professor of Pediatrics at Nationwide Children’s Hospital and The Ohio State University in Columbus, Ohio. His clinical and research interests focus on asthma and food allergies, especially improving education and adherence for patients and families. He also cares for children with all types of allergic conditions, including allergic rhinitis, venom allergy and eczema. As part of his research, Dr. Stukus has created novel technology and educational tools using mobile health apps to improve the care of patients.
Many parents have concerns about food allergies in their children and a visit with the pediatrician is the typical first step in the evaluation. When meeting with your pediatrician, it is very helpful to know what questions they may ask to help them provide an accurate diagnosis, and also have questions of your own as well. To make the most of your visit, I have provided some tips and things to consider before your appointment:
· What symptoms have you observed?
o Itching, swelling, skin rash (hives), vomiting, and difficulty breathing are the most common symptoms due to immediate onset (IgE mediated) food allergy. These can occur individually or collectively.
· What is the timing of onset?
o IgE mediated food allergies can occur within minutes of ingestion, almost always within a few hours. Delayed onset allergies (milk protein allergy in newborns) may not occur for 1-2 days.
· How long did the symptoms last?
o Chronic symptoms lasting weeks or months, especially abdominal pain, gastroesophageal reflux, diarrhea, constipation are not typically due to an allergic or immunologic reaction to a specific food. Some foods may aggravate the underlying condition, but rarely are the direct cause.
· Did you have to give any treatment to make the symptoms go away?
o It is very helpful to know if antihistamines (Benadryl) were given at any point. If your child required emergency room care, it will be helpful to know if they were given a shot in their leg called epinephrine at any point. Epinephrine is the treatment for anaphylaxis, which is a sudden onset, severe allergic reaction.
· Do the symptoms resolve completely when the food is avoided and/or return with every ingestion?
o Allergic reactions to a food only occur when that food is encountered. In addition, they should occur every time that food is eaten, regardless of form. For example, someone with milk allergy should have symptoms after eating cheese, yogurt, or ice cream.
· What are the foods that you are concerned about?
o Many parents want to have their child ‘tested for everything’ and request allergy testing for as many foods as possible. Unfortunately, food allergy skin and blood tests are not good screening tools due to high rates of false positive results. This creates confusion about relevance and need for avoidance. Having a list of specific foods that concern you can help with your own expectations as well as help your pediatrician decide if any testing is necessary.
· Does anyone in your immediate family have a history of allergies, asthma, or eczema?
· Does your child have eczema (recurrent dry, irritated skin inside the elbows/knees, face or on the trunk), seasonal allergies or asthma?
o Eczema is a very strong risk factor for development of food allergy.
Your pediatrician will use the history that you provide to determine whether any additional testing or avoidance needs to occur. They should provide the following information to you during your visit, and if they don’t, now you know to ask!
· Is allergy testing through blood work or referral to an allergist for skin prick testing necessary?
o If the history is suggestive of immediate onset food allergy (hives, swelling, or difficulty breathing occurring within minutes of ingestion), then confirmation through testing should always occur.
o Many times, the history is not consistent with food allergy and other reasons exist for having symptoms.
· They should provide a list of exact foods to avoid.
o The only treatment for food allergy is strict avoidance of that food. However, with non-allergy food sensitivities, you may just need to limit the amount of a certain food they eat or take breaks from time to time.
· Do you need to have self-injectable epinephrine prescribed and immediately available?
o Anyone with a history of anaphylaxis or at risk for anaphylaxis absolutely needs to have epinephrine available at all times in case of accidental ingestion.
Many times your pediatrician may feel more comfortable referring you to an Allergist to help provide an accurate diagnosis and management plan. This should be someone who is board certified in Allergy/Immunology and experienced in caring for children.
These are just a few things to consider when discussing food allergies with your pediatrician. Hopefully this provides a framework to help make the most out of your visit.