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Paediatic Allergy - Coggle Diagram

- - - - IgE mediated
        
        Immediate
        
        urticaria
        
        Angioedema
        
        anaphylaxis
      - Non IgE mediated
        
        Delayed
        
        FTT
        
        eczema
        
        blood in stool
        
        loose stools
    - - 1%
      - Massive overdiagnosed
    - - IgE Mediated
        
        Support Breast feeding
        
        Prescribe AAF
        
        Refer to paediatric allergy team
        
        Avoid milk
      - Non IgE Mediated
        
        Support Breast feeding
        
        Consider trial of EHF or AAF for 6 weeks
        
        Followed by reintroduction
        
        If symptoms recur- restart EHF/AAF then introduce milk ladder from weaning (community dietician)
        
        If no symptoms then continue cow’s milk formula
    - - Allergen proteins are heat labile
        Therefore baked milk more likely to be tolerated
      - Progression aims to support/encourage the natural development of tolerance to milk protein
      - Start on whatever step is tolerated and work up
      - Need to consume at least 3x per week
      - Most will resolve by 2yrs old
  - - - The most common food allergy in Ireland
      - Most present before 1yr of age
      - Baked egg usually tolerated
      - Associated with the development of peanut allergy
      - Natural resolution- egg ladder
  - - - The most common nut allergy
      - Unlike milk and egg- majority will persist to adulthood (80%)
      - Presents with immediate type reactions
      - Increased risk of developing allergy to other legumes (peas, chickpea, beans etc) and to tree nuts
  - - - 30% of reactions occur on first exposure
    - - Predicting future reaction severity is very challenging
    - - Early introduction and regular consumption prevents allergy
    - - In children, hives are more commonly caused by viral infections. Hx is key to differentiate
    - - Eczema causes food allergy. Exclusion diets are rarely effective and risk sensitisation
  - - - Avoid known allergic foods
      - Introduce all non-allergic foods to prevent further allergies
      - Education on recognising and managing reactions
      - Mild->Antihistamines
      - Severe-> Adrenaline
    - - Early Introduction of egg and peanut esp if high risk
      - Need to eat heaped tsp 3 times per week
      - Timeline
        
        Solids should be introduced from 4-6 months of age
        
        Start with pureed fruit, veg and cereals
        
        Allergens (esp egg and peanut) should be introduced around this time
        
        Allergens need to be kept regularly in diet (3/week) to maintain tolerance
    - - Commonly used for grass and dust mite
      - Food oral immunotherapy is reaching mainstream practice
- - - - Symptoms
        
        Rash
        
        Wheeze
        
        SOB
        
        Vomiting
        
        Abdo pain
        
        Pallor
        
        Collapse
      - How soon after eating food
      - Eaten before?
      - Require treatment?
      - How long did symptoms last
- - - - Quick, non-invasive
      - Good sensitivity and specificity
    - - May get ideterminate results
      - Small risk of anaphylasxis
      - Vasovagal episodes
  - - - Tests many allergens simultaneously
      - Component testing
      - Good sensitivity
      - Can be done on saved serum
      - Can be performed by non-allergists
    - - Days-week for result
      - Risk of false positives especially in eczema
      - Invasive
      - Performed by non-allergists
  - - - Definitive test
      - Patient education during test
      - Education if reaction occurs
    - - Risk of anaphylaxis
      - Resource intensive
- - - - An unexpected abnormal or exaggerated reaction to an exogenous stimulus involving the immune system
    - - Presence of antibodies against a particular allergen - may not have reations
    - - Personal or familial tendency to develop asthma, eczema, allergic rhinitis and food allergy
    - - Secondary immune response occuring in a host with a pre-sensitised state
- - - - O2
      - Lie flat if tolerated
      - Consider early fluid resus
      - Consider salbutamol nebs for wheeze, adrenaline nebs for stridor, antihistamine for itch