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Food Allergy Treatments

Medication continued...

 

Drug NameHydrocortisone (Cortef)
DescriptionHas mineralocorticoid and glucocorticoid effects. Useful in management of inflammation caused by immune response.
Adult Dose100-200 mg IV q6-8h
Pediatric DoseNot to exceed 5-10 mg/kg IV q6-8h
ContraindicationsDocumented hypersensitivity; viral, fungal, or tubercular infections
InteractionsCorticosteroid clearance may decrease with estrogens; may increase digitalis toxicity secondary to hypokalemia
PregnancyC - Safety for use during pregnancy has not been established.
PrecautionsCaution in hyperthyroidism, osteoporosis, peptic ulcer, cirrhosis, nonspecific ulcerative colitis, diabetes, and myasthenia gravis

 

Drug NamePrednisone (Deltasone, Meticorten, Sterapred)
DescriptionImmunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Adult Dose20-40 mg PO qd with quick taper
Pediatric Dose1-2 mg/kg/d PO with quick taper; not to exceed 20-40 mg
ContraindicationsDocumented hypersensitivity; viral infection, peptic ulcer disease, hepatic dysfunction, connective tissue infections, and fungal or tubercular skin infections; GI disease
InteractionsCoadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
PregnancyC - Safety for use during pregnancy has not been established.
PrecautionsAbrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use

Follow-Up

Deterrence/Prevention

 

  • Emergency plan

    • Provide a written emergency treatment plan for the patient. Have copies of this plan available in appropriate places (eg, daycare, schools, work locations, college dormitory advisors).

    • Patients with food allergies should be advised to obtain and wear Medic Alert tags or bracelets indicating their specific food allergies.

    • Ensure that the patient has an emergency contact number available (eg, 911, their physician's office phone number, or a local emergency department) that can be used in the event of a major food-induced allergic reaction.

    • Anticipatory guidance measures cannot be overemphasized; for example, educate the patient about potential sources of accidental or inadvertent exposure to relevant food allergens (eg, daycare, school, travel, picnics, dining out).
       
  • Emergency medications

    • Ensure that the patient has self-injectable epinephrine readily available at all times. Also ensure that the patient receives proper training regarding when and how to use the device. An antihistamine (syrup or chewable tablet) should also be available. Patients with food allergies and asthma should always have access to a rapid-acting bronchodilator.

    • Self-injectable epinephrine is typically available by prescription (ie, Epi-Pen, Epi-Pen Jr, Twinject). These devices should be stored properly (avoiding extremes of temperature) and replaced before the expiration date.

    • Injectable epinephrine is the drug of choice for the initial management of a food-induced anaphylactic reaction.

 

 

Prognosis

 

  • Developing intolerance

    • In general, most infants and young children outgrow or become clinically tolerant of their food hypersensitivities.

    • Well-controlled prospective investigations of food allergy in infants and children demonstrate that by following proper elimination diets, 85% of confirmed symptoms resolve by 3 years of age.

    • Adults with food allergy can also lose their clinical allergic reactions to foods after implementation of appropriate food elimination diets.

    • Approximately one third of all children and adults lose their clinical reactivity to specific food allergens after 1-2 years of appropriate food allergen elimination therapy. Patients with allergies to peanuts, tree nuts, fish, and shellfish rarely lose their clinical reactivity.
       
  • Avoidance of allergen

    • How strictly the patient complies with the allergen avoidance diet appears to be directly associated with the ultimate clinical outcome (ie, development of oral tolerance).

    • Patients with allergic reactions to peanuts, tree nuts, shellfish, and fish rarely lose their clinical reactivity.
       
  • Breastfeeding

    • While exclusive breastfeeding is frequently promoted as a means of preventing food allergy and atopic disease in general, considerable controversy remains regarding the effectiveness of this practice.

    • Some investigations suggest that lactating mothers should eliminate highly allergenic foods (eg, peanuts, tree nuts, shellfish) that may induce life-long allergic sensitivity in their infants.

    • Further studies are needed to clarify the role of early elimination diets and breastfeeding in the prevention of food allergy.

WebMD Medical Reference from eMedicineHealth

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