Food Allergies 381
Anaphylaxis on Ingestion of Food
Food known Food unknown
Avoid the food Refer to an allergist for
and related foods diagnostic testing with
food skin tests of RASTs
Train patients in Test positively Test positively
the use of Epi-pen to a food to multiple
Provide Epi-pen Avoid food
and observe for Avoid those
future reactions most commonly
food allergy or
lenge to identify
Figure 94-1. An algorithm for evaluation of food allergy.
timing and doses of the food challenges. Resources for treatment of
anaphylaxis including epinephrine, antihistamines, corticosteroids,
and fluids must be available for food challenge. Elemental diets and
amino acid-based hypoallergenic formulations that provide total
nutrition may be useful for short-term treatment of infants with mul-
tiple food allergies.
In eosinophilic gastroenteritis, resolution of symptoms upon elim-
ination of the offending dietary protein from the diet may occur over
weeks or even months. Repeat endoscopy and biopsy may be useful
in some cases to document resolution of pathology.
❍ Mothers of children from atopic families should be encouraged
to breast feed so as to prevent or delay food allergy in infants.
❍ A working diagnosis of allergy to a specific food may be made
in any patient who develops symptoms of anaphylaxis after
food ingestion. That food should be avoided and the patient