Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist, Fort Lauderdale
"How to C.A.R.E. for students with food allergies" is a free online course available at AllergyReady.com
Comprehend the basic facts about food allergies
Avoid the allergen
Recognize the symptoms of a reaction
Enact an emergency protocol (Epinephrine)
Mnemonic for the 3 ways of antigen sampling in the gut: DMD
Dendritic cells "capture" antigens from the lumen
M cells overlying Peyer’s patches take up antigens
Direct transport through epithelium by soluble antigens
Diagnostic algorithm for food allergy: SAD Child:
1. Symptoms: close relation between specific food intake and symptoms, often affect 2 or more organs
2. Allergy testing: skin prick testing or ImmunoCAP.
3. Diagnostic diet: restricted diet leads to symptoms disappearance or significant reduction
4. Challenge - oral food challenge.
References: Clinical review: ABC of allergies, Food allergy. BMJ 1998;316:1299, figure.
Eight top allergens which account for 90 % of all food allergies: TEMPS WFS
Tree nuts (almonds, cashews, walnuts)
Egg white (not egg yolk)
Shellfish (crab, lobster, shrimp)
Fish (bass, cod, flounder)
Another variation of the mnemonic is SWEPT FMS.
Manifestations of food allergy: GRAS
GI - N/V/D/pain
Respiratory - less common, usually in association with either skin/GI symptoms and seldom as an isolated manifestation
Anaphylaxis - most dangerous
Skin - most common
Skin manifestations of food allergy: AREA
Rash - morbilliform pruritic rash
3 Types of oral food challenges: DOS:
Double-blind placebo-controlled food challenge (DBPCFC)
Open food challenge (OFC)
Single-blind placebo-controlled food challenge (SBPCFC)
Dey Pharma is no longer shipping SINGLE EpiPen Auto-Injectors - only 2-PAKs will be available:
20% of patients need
2nd dose in anaphylaxis
Food Allergen Avoidance. V. Dimov, Oct 2008.