In eosinophilic gastroenteritis, resolution of symptoms upon

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					                                            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
                                                                foods
                      Test negative
                     Provide Epi-pen     Avoid food
                     and observe for                         Avoid those
                                         or perform
                     future reactions                     most commonly
                                        blinded food
                                                           associated with
                                        challenge to
                                                           food allergy or
                                           confirm
                                                            perform chal-
                                          diagnosis
                                                          lenge to identify
                                                             culprit food

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.

PEARLS
  ❍    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