foods

History: Symptoms and signs Amount of food ingested Timing of reaction to ingestion Most recent reaction Most severe reaction Treatment Personal history of atopy: Asthma, AD, AR Family history of food alergy and atopy

History and physical examination

Consistent with non-immune adverse food reaction

Consistent with IgE-mediated food allergy

Consistent with IgE-mediated or mixed mechanism (AD, AEE, AEG)

Consider testing to support nonimmune reaction; e.g. hydrogen breath test

Screen for food-IgE (prick skin test an/or RAST)

Biopsy; confirmatory serologic tests for celiac disease; consider supportive tests such as peripheral eosinophils; Hgb/Hct/albumin/total protein; stool for occult blood

Negative

Positive Consider screen for food-IgE (prick skin test and/or RAST) to identify potential food triggers

Reintroduction of food into diet; if convincing history of anaphylaxis, consider further evaluation and OFC No Consider OFC and reintroduction of food

No anaphylaxis and/or high positive predictive value of the test Yes

Trial of elimination diet; foods selected based on experience and results of screening tests Yes

Resolution after X weeks No

Anaphylaxis treatment plan Ep/Pen Rx Medic Alert bracelet

Strict dietary food avoidance; nutritional support

Review diet; reconsider foods; correct diagnosis? Period reassessments