Managing

  1. The most important feature of management is the avoidance of the suspected food, and foods that may contain it. 2 3
  2. All those with suspected cow’s milk allergy or an allergy to more than one food should be referred to a Community Dietitian.
  3. Children with suspected delayed food allergy should follow a 4-6 week exclusion diet supervised by a Community Dietitian followed by reintroduction of the suspected food.
  4. Allergy Medication: rationale and recommendations.
    1. All food allergic children should have non sedating h1 antihistamines available in liquid form at all times.
    2. The treatment of acute asthma requires spacer device inhaled beta-2- agonists, however for more severe symptoms they cannot be relied on solely.
    3. Indications for prescribing adrenalin autoinjectors: 4
      Any child with a prior severe allergic reaction to the food.
      Children who have had anaphylaxis or who are considered at high risk of anaphylaxis should be prescribed adrenalin auto injectors.
      Any child with food allergy and more than mild asthma (>BTS step 2)
      Children living remote from medical facilities.
      Most children with peanut allergy.
    4. The dose of adrenalin is 150mcg for children A child should always have 2 auto injectors with them in case the first fails or isn’t used correctly.
      When adrenalin auto injectors are prescribed there must be a clear explanation of when and how to use them.
  5. Mild moderate allergic reactions (not involving airway or cardiovascular systems) should be treated with an oral, non-sedative antihistamine 4
  6. An allergic reaction with any respiratory or circulatory compromise is defined as Anaphylaxis.
  7. The treatment for anaphylaxis is intramuscular adrenalin followed by immediate transfer to hospital.
  8. Children with suspected food allergy and/or anaphylaxis should be referred to a paediatrician for confirmation and further management.