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Food Allergy Treatments

Miscellaneous continued...



Special Concerns


  • Diagnosis

    • Because specific laboratory tests for some food hypersensitivities are not available, diagnosing non–IgE-mediated food allergies (eg, cow milk–induced and soy-induced enterocolitis syndromes, allergic eosinophilic gastroenteritis) is more difficult than diagnosing IgE-mediated food allergies.

    • In cases of allergic eosinophilic gastroenteritis, a biopsy may need to be performed. Elimination diets with gradual reintroduction of foods and supervised oral food challenges are often needed to help identify the causative foods.

    • For food protein–induced enterocolitis syndrome, perform a food challenge with 0.15–0.30 grams of protein per kilogram of body weight of the implicated protein and observe the patient for several hours. Positive reactions (eg, profuse vomiting and diarrhea) are typically accompanied by a rise in the absolute neutrophil count of more than 3500 cells/mm3. Because of the potential for shock, these challenges are best performed in the hospital setting.

    • When the history of an allergic reaction to a food suggests that the onset of symptoms is delayed by hours or days following ingestion, adjust the timing and monitoring of the challenge to correspond to these characteristics.

    • The successful administration of oral food challenges to young children requires a great deal of preparation, patience, and creativity. Young children may refuse to ingest the challenged food. Prior planning with the family is important to choose proper vehicles (eg, juice, cereal, solid food) for disguising the challenged substance.
  • Vaccines

    • Recent scientific data support the routine 1-dose administration of the measles-mumps-rubella vaccine to all patients with egg allergy, even those with severe anaphylactic reactions following egg ingestion.  In the child with a history of a previous reaction to the measles-mumps-rubella vaccine, consider the possibility of allergy to gelatin or neomycin. 

    • If the patient has a clinical history of egg allergy and has experienced systemic reactions (eg, anaphylaxis) following the ingestion of egg, the administration of the influenza vaccine requires special diagnostic consideration. Test the patient's skin with diluted preparations of the influenza vaccine (ie, puncture skin testing and, if needed, intradermal skin testing). If skin test results with the vaccine are positive, the vaccine can be safely given in a graded, multidose scheme. If results are negative, the vaccine may be administered in the routine 1-dose manner.



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