Food Allergy Food allergy Bottle Feeding by benbenzhou

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Food Allergy Food allergy Bottle Feeding

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									                             Food allergy
History
    What were the symptoms?
    Which food triggers your symptoms?
    How much you eat from that food?
    How much time was between eating, appearance of symptoms?
    Did these symptoms appeared previously from the same food?
    Any other factors involved like exercise?
    Did alcohol or medicines (e.g.: b-blockers) trigger your symptoms?
    When the last symptoms appeared?

Examination
    General 9hypotention)
    Skin (urticaria, rash, angioedema, flushing, atopic dermatitis, pruiritis)
    GIT (abdominal cramps, vomiting, diarrhea)
    Nose (congestion, rhinorrhea)
    Chest (wheeze)

Investigation
    SIgE
    SPT
    Food diary
    Food elimination
    Food challenge test

Primary Prevention:
    Start during pregnancy, infancy (first 3-6 mounth) by early avoidance
    Specially in high risk infants (FH of allergy)
    Infancy
          -avoid cows milk
          -use non-allergic milks (best is mothers milk, soya, special formula milks)
          -in lactating mothers (avoid eating cows millk, egg, fish, peanut)
          -weaning:
                       Start at 4 mounth
                       Start to give solid food (pea size)
                       Double the amount till you reach to amount suitable to age
                       Stop the food if you notice any SE
                       Add another solid food after 3 free days
                       Continue, don’t stop
                       Solid foods that you start with are (-‫التفاح-الكمثري-الرز-البطاطس‬
                         )‫القرع-الجسر-الكوسة-الدجاج-لحم الخروف-لحم الديك الرومي‬
                       Avoid citrus fruits (give after 9 mounth)
                       Avoid fish (give after 10 mounth)
                       Avoid egg (give after one year)
                       Avoid peanut (give after 2 years)
Management
   1. general notes:


                                                                                        1
  management has to be under (allergist, dietitian) supervision
2. avoidance
  difficult not easy
  the cornerstone of the management
  it affects the patient life, so no avoidance except with solid diagnosis
  avoid only (one or two) foods only not more
  you must use counseling skills (sharing technique)
3. anaphylaxis due to certain food
  avoid that food for life
  give adrenaline auto injector in emergency
  frequent regular visits to the clinic
  bracyles
  use support groups
4. in mild non life threatening food allergy
  gradual return of the causative food after 2 years
  in hospital
5. extensive education
  education after diagnosis of the causative food
  under allergist, dietitian care
  education about the replacement food
  educate about all the causative foods of the allergy
  educate about the (food labeling)
  avoid eating outside (restaurants, fast food, delicatessens) better eat inside
   homes
6. food allergy in children
 under allergist, dietitian care
 after full diagnosis of the causative food
 you have to share the mother, give here options
 malnutrition happen in children more than adults
 milk avoidance in infants is very sensitive issue:
        -mother milk is better than bottle feeding
        -but most mothers depend on dried cows milk (bottle feeding) which is
          commonest allergy cause
        -if infant is sensitive to cows milk (avoid cows milk, give soya milk or
          special milk formula, if mother milk stopped you have to give calcium
          replacement)
7. effects of avoidance
 malnutrition
 high cost for the replacement food
 family anxiety
 overprotection (specially children)
 depression if allergy happen after avoidance
 social isolation
8. drugs:
 antihistamines for urticaria
 adrenaline auto injection for anaphylaxis




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