IgE-mediated food allergy

substance
form
route
age at reaction
sx after what time
sx (cut resp gi card)
other exposures (ie substance, sting)
cofactors NSAIDs, exercise, alcohol, infection
treatment: where, what, response; epipen?
epipen carried all times?
exposed b4?
repeat exposure since?

> At this time, strict avoidance of:
> Rx: epinephrine autoinjector x2. Counseled to keep on oneself at all times, how to use it, and use in case of two-system involvement (skin/mucous membrane, respiratory, cardiac, GI) or if symptoms are severe in one category, following exposure to known or possible allergen
> Immunotherapy
> Consider baseline Tryptase testing if severe reactions consistently

*** In case of unclear food allergy & SPT/IGE not available / neg

> While the history is consistent with an IgE-mediated allergy, there is not current evidence of IgE sensitization on SPT - however, these tests are not 100% sensitive. We have offered serum IgE testing and/or a graded oral challenge at a later date. In addition, we have asked them to start/continue a food-symptom diary

*** if not allergic

> The clinical history is inconsistent with IgE-mediated food allergy, and skin testing was negative.
> Recommended a slow introduction at home. Once they have tolerated the food consistently, they no longer need to carry their epinephrine autoinjector
> However, given ongoing avoidance and concern around re-introduction we have arranged an oral challenge to liberate the patient from this label. They will continue to carry an epinephrine autoinjector until the challenge is completed

*** Their symptoms are most consistent with oral allergy syndrome, which is a type of reaction that typically remains localized and does not progress to systemic illness/anaphylaxis. Symptoms are characterized by predominantly oral itch, scratchy throat, mild rash or swelling of the lips and occasionally abdominal upset after eating certain fruits, vegetables or tree nuts. It results from cross-reactivity between tree pollens and several fresh fruits, nuts, and vegetables, and usually disappears with cooked foods. The patients skin test was positive for ***, which cross reacts with ***. Therefore, her/his reaction to cherries may be attributable to oral allergy syndrome. We recommend