Managing childhood allergies.
Du Toit G, Fox A, Morris A. 2006. Managing food allergy in children. Practitioner 250;1683:45-52. The majority of food induced allergic reactions in children are unpredictable but not life threatening. However fatal anaphylactic reactions can occur and are preventable.
The prevalence of food allergy in the UK is increasing, particularly for peanut allergy, and is the most common cause of anaphylaxis in children. Other common allergy foods are cow and goat milk and hen's egg in young children, and shellfish, tree nuts, fin fish, some seeds (especially sesame, mustard and poppy), soya and wheat in older children.
The increase in allergic reactions has been attributed to factors such as increased awareness and reporting, dietary changes (i.e. peanuts and tree nuts) and the availability of novel foods such as Macadamia nuts and kiwi fruit.
Symptoms and signs commonly associated with anaphylaxis are hypotension, tachycardia, arrhythmias or complete vascular collapse with loss of consciousness; oral and pharyngeal swelling, hoarseness, laryngospasm, wheezing, cough, breathlessness and/or chest tightness; diarrhea, cramping and vomiting; and macular or urticarial rashes. Allergies manifest usually within minutes after ingestion of the food.
The only reliable predictor of future anaphylaxis is a documented history of prior anaphylaxis which is unlikely to be present with children. Allergic testing is helpful in identifying specific allergic triggers, however this is not often carried out by GPs due to lack of allergy training, time and cost.
Emergency treatment of food induced anaphylaxis always follows the basic life support ABC principles with the simultaneous intramuscular injection of adrenaline, followed by a fast acting antihistamine and a short course of oral steroids.
It is important for the GP to manage the patient and their family, use the expertise of a dietician, prepare a written emergency plan identifying medical contacts and a list of food allergies, consider the need for a pro-loaded injectable adrenaline device or salbutamol inhaler, register with Medic Alert with an identifying bracelet or necklace and maintain ongoing assessment.
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|Publication:||Australian Journal of Medical Herbalism|
|Date:||Sep 22, 2006|
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