Halloween is just a few days away and your school-age patients will surely be getting ready to go trick or treating. It’s customary for parents to warn their children to bring home their candies to be checked for safety — this is especially important for children who have food allergies.
The danger with food-allergic patients is that often the ingredients they’re allergic to are either unrecognized or hidden in a seemingly innocent recipe. One of my peanut-allergic pediatric patients once attended a celebration at a local ice cream parlor. He and his mother were careful to order an ice cream sundae without nuts. However, half-way through his delicious treat he told his mother his stomach hurt and he soon began to vomit. The mother called my office and I immediately sent him to the nearest emergency room and met the family there. It turns out, at the bottom of the ice cream sundae were Reese’s pieces — chocolate candies with peanuts inside. My patient was developing an anaphylactic reaction but fortunately — with aggressive treatment — the attack was reversed.
It is not uncommon for allergic patients with a food allergy to react to more than one food. The AllerVision skin testing food panel in the basic kit is designed to help you identify reactions to some of the most common offenders. For a wider range of allergens, including the ones most likely to cause anaphylaxis, you should turn to the extended food allergen panel. This will allow you to pick from a variety of items and customize the test specifically for each patient. It is important to correlate the positive test scores with a thorough history to make sure genuine clinical allergy exists and not just sensitization, which is a positive test without a likely confirming history. If the food allergy testing leads to ambiguous clinical allergy, it is wise to refer to a specialist for further evaluation.
If you would like to read more about the latest in peanut allergy diagnosis, you may want to look at the October 2013 issue in Consultant for Pediatricians. I wrote an article discussing which are the key proteins that predict a more severe peanut allergy reaction.
Halloween can be a lot less scary for everyone if food allergy reactions are prevented!
– Dr. Dean Mitchell