Always carry an epinephrine self-injectable device that has been properly stored and is current (ie, not expired).
Have an H1-blocker medication (again, properly stored and not expired) in a syrup or chewable tablet form available.
Avoidance of allergen
Complete avoidance of the offending food allergen is the best strategic approach and the only proven therapy once the diagnosis of food hypersensitivity is established; therefore, these patients should be properly taught to recognize relevant food allergens that must be eliminated from their diet.
Instruct the patient about the proper reading of food labels and the need to inquire about food ingredients when dining out.
Encourage the patient to become familiar with recognizing different words that signify particular food allergens (eg, for cow milk, terms such as casein, whey, beta-lactoglobulin, alpha-lactalbumin).
If the patient is in doubt about a food or food ingredient, suggest avoidance of the food in question.
Inform patients with food allergies how to identify and use support groups.
One such organization is the Food Allergy and Anaphylaxis Network (10400 Eaton Place, Suite 107, Fairfax, VA, 22030-2208 USA; fax: 703-691-2713; phone: 703-691-3179 or 800-929-4040; email: email@example.com).
Educate patients regarding recognition of the early signs and symptoms of a food-induced allergic reaction, and provide them with a written management plan for successfully dealing with these reactions.
Write a specific list of clinical signs and symptoms to look for if a reaction may be occurring, and include a clear management plan. An excellent example of such a plan is available on The Food Allergy and Anaphylaxis Network Web site.
Demonstrate to the patient and family how to actually administer medications, especially injectable epinephrine, in the event of an allergic reaction. To accomplish this, use demonstration trainer devices in the clinic setting. Reinforce that if injectable epinephrine is administered, the patient must be immediately evaluated in a medical setting.
When performing oral food challenges, be prepared to recognize and treat adverse clinical symptoms immediately. Appropriately trained personnel and the necessary equipment for the treatment of anaphylactic shock must be available prior to and throughout the entire oral food challenge and observation period because of the risk of triggering an allergic reaction.
Do not perform an oral food challenge if the patient has a clear and convincing history of a severe life-threatening anaphylactic reaction following the isolated ingestion of a specific food. This is an absolute contraindication.
Patients should never perform an open food challenge at home if even a remote chance exists that the patient will develop severe symptoms.
Confirm negative results from a DBPCFC using an open feeding (open food challenge) of the food in question before giving final advice on dietary restrictions.
If the patient has a history of severe allergic reactions following the ingestion of food allergens, give specific advice in the form of a written emergency treatment plan. In addition, educate the patient on how to administer emergency medications (eg, injectable epinephrine, antihistamines) in the event of a severe life-threatening allergic reaction. Encourage the patient (when appropriate) or a caretaker to carry these medications with them at all times in case they are needed to manage symptoms.