Babies and infants need frequent follow up while the diagnosis is being established, and the nutritional issues relating to milk substitutions, micronutrient supply etc., are stabilised.
Any follow up should be co-ordinated between Primary and Secondary Care.
Meetings with the allergy team in Secondary Care may include visits only to the doctor, nurse or dietitian.
Once stable, infants need review at a relatively high frequency (maybe 2 appointments at 3 monthly intervals) to assist parents in management and lifestyle adjustment.
Appointments can be spaced out to initially 6 monthly and longer thereafter.
The clinical intention is to interfere to the minimum degree while allowing identification as soon as possible of children whose food allergies may be resolving, as indicated by tolerance to accidental exposures or by changing SPT or specific IgE levels.
It is important from a family perspective to complete milk or egg challenges before entry to primary school, when these allergies have usually resolved and continuing avoidance, which is socially disruptive, can be stopped.
Similarly, but for slightly different reasons, diagnostic or repeat peanut or tree nut challenges should be completed by this major transition point. Once in the school system, a yearly appointment is adequate as allergies present then are unlikely to change quickly.
In children over about 8 years 2-yearly appointments with focused IgE testing, can work, but some families need more support.
Teenagers may want to be seen on their own and will often/usually need encouragement to carry their rescue meds and share information about their food allergies with their peers, including new friends and partners.
Transition to adult services needs planning with the family, Primary Care, school and the local or national allergy service, especially in the coming promising era of immunomodulatory therapies
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