Pediatric Food Allergy Case Scenario and Menu Modification

A 3-year-old boy, Johnny, is brought to the Pediatric Allergy and Immunology office for food allergy testing after recently experiencing anaphylactic shock. He has
history of eczematous rash since 6 months of life when bottle feeding started. A diagnosis of cow's milk allergy was confirmed by a positive CAP-RAST test for
milk specific IgE antibody. Mom avoided cow's milk and dairy products and provided soymilk formula feeding. From 1-2 years old, Mom noticed Johnny would
complain of stomach pain with occasional nausea and vomiting after eating scrambled eggs, French toast and certain noodles. At this same time, he developed
eczema after eating strawberries. At age 3, Johnny experienced urticarial, wheezing and difficulty breathing after eating a peanut butter cookie. Emergency
services were called, and he was treated with IV epinephrine, antihistamines and oxygen for anaphylactic shock.

1. Based on his history, what foods should Johnny avoid? Strawberries, dairy products with cow’s milk, eggs, wheat, peanuts_
List substitutions you would plan for him with a similar nutrient profile in Column 1 (ie. “Avoid ___, Choose___” Include link to recommended food).
2. Column 2-8: For each allergy listed, note the food that needs to be avoided and plan a substitution with a similar nutrient profile (“Avoid __, Choose__”).
You may repeat brands of foods, but you need to list different flavors or varieties. If a food does not need to be avoided, state “No need to avoid”.
3. Include at least 1 link to a new food per column in a variety of meals and snacks (i.e. Do not simply list the same ice cream link).
4. Avoid foods with a “contains” statement.

***All substitution products linked below.

3yo Pediatric 1.Johnny’s diet 2.Milk Allergy 3.Egg Allergy 4.Peanut 5.Tree nut 6.Wheat 7.Soy Allergy 8.Fish &
Diet Allergy Allergy Allergy Shellfish
Breakfast
vanilla yogurt, Avoid regular Avoid regular No need to No need to Avoid bread Avoid wheat Avoid toast No need to
strawberries, yogurt, choose yogurt, choose avoid. avoid. with tree nuts toast, choose (soybean oil avoid.
wheat toast SO Delicious, Almond Breeze (this bread Canyon and soy
with butter vanilla coconut vanilla yogurt specifically: Bakehouse lecithin),
milk yogurt alternative. walnuts, Gluten Free 7 choose BFree
alternative. hazelnuts, Grain Bread. Gluten Free
almonds), Seeded Brown
Avoid choose Sandwich
strawberries, Vermont Bread Bread Loaf.
choose Company
blueberries or Whole Wheat
raspberries (or Bread Soft.
another berry
that is
preferred).

Avoid wheat
 toast, choose
Quaker Rice
Cake.
Am snack
peanut butter Avoid peanut Avoid Ritz No need to Avoid peanut No need to Avoid crackers Avoid crackers No need to
cracker butter cracker peanut butter avoid. butter cracker avoid. (contains (contains soy), avoid.
sandwiches sandwiches, cracker sandwiches, wheat), choose choose Bobo’s
choose Back to sandwiches choose KIND Lance Gluten Peanut Butter
Nature Multi- (label reads Honey Almond Free Peanut and Jelly
Seed Rice Thin “may contain: Butter Filled Butter Stuff’d Oat
Crackers with milk”), choose Snack Bar. Sandwich Bites.
Justin’s Classic Back to Nature Crackers.
Almond Butter Peanut Butter
spread. Cream Cookies.
Lunch
fish sticks, Avoid fish Avoid fish Avoid fish No need to No need to Avoid fish Avoid fish Avoid fish
edamame, sticks (contain sticks (may sticks (may avoid. avoid. sticks (contains sticks (may sticks, choose
banana wheat and may contain contain wheat), choose contain baked chicken
contain milk statement statement dr. Praeger’s statement tenders.
and egg), about milk), about eggs), Rice Crusted about soy),
choose Ian’s choose Good choose dr. Fish Sticks. choose
Gluten Free Catch Breaded Praeger’s Gorton’s
Frozen Fish Fish Sticks. Lightly Crunchy
Sticks. Breaded Fish Breaded
Sticks. Haddock Fish
Sticks.

Avoid
edamame,
choose
different
legume like
lima beans

Pm snack
cookie, milk Avoid regular Avoid milk, No need to Avoid cookie No need to Avoid cookie Avoid cookie No need to
cookies, choose Ripple avoid. (peanut butter avoid. (contains (contains soy), avoid.
choose Partake Dairy-Free cups), choose wheat), choose choose Aleia’s
Soft Baked Unsweetened Lesser Evil Maxine’s Gluten Free
 Chocolate Chip Original Milk. Almond Butter Heavenly Cookies,
Cookies. Chocolate Chip Cookies Peanut Peanut Butter.
Cookies. Butter
Avoid cow’s Chocolate
milk, choose Chunk.
Silk Original
Oatmilk.
Dinner
Meatloaf, Avoid meatloaf Avoid meatloaf Avoid meatloaf No need to No need to Avoid meatloaf Avoid meatloaf No need to
carrots, (eggs, milk, (contains milk), (contains avoid. avoid. (with if contains soy, avoid.
noodles breadcrumbs choose dairy eggs), choose breadcrumbs choose
that have free meatloaf eggless that contain Mama’s
wheat), choose recipe. meatloaf wheat), choose Allergy Free
Mama’s Allergy recipe. Betty Crocker Meatloaf.
Free Meatloaf. Gluten-Free
Avoid noodles Glazed Avoid noodles
Avoid wheat or (contain egg), Meatloaf (contains soy),
egg noodles, choose recipe. choose barilla
choose Creamette spaghetti
Tinkyada spaghetti Avoid noodles pasta.
Gluten Free pasta. (contain
Brown Rice wheat), choose
Spaghetti Banza penne
noodles. noodles.

EXAMPLE: Avoid ice Avoid ice Avoid ice Avoid ice Avoid ice Avoid ice Avoid soy- No need to
Ice cream cream, cream, cream with cream with cream with cream with based ice avoid
Choose SO Choose SO egg, peanuts, tree nuts, added wheat- cream Choose
Delicious Dairy Delicious Dairy Choose Choose Choose based bakery Breyers
free vanilla free Salted Breyers Breyers Mint Breyers ingredients, Natural Vanilla
(Link to food) Caramel Strawberry Choc chip Chocolate Choose Breyers
Vanilla Fudge
Swirl
Food list for referral of ingredients:

Wheat toast: https://www.walmart.com/ip/Arnold-Whole-Grains-Health-Nut-Bread-Baked-with-Simple-Ingredients-Nuts-Seeds-24-oz/

10403542#:~:text=Ingredients%3A%20Whole%20Wheat%20Flour%2C%20Water,Acid%2C%20Hazelnuts%20(Filberts).

PB cracker sandwiches: https://www.walmart.com/ip/RITZ-Peanut-Butter-Sandwich-Crackers-8-1-38-oz-Packs/10448059

Fish Sticks: https://www.walmart.com/ip/Great-Value-Breaded-Fish-Sticks-44-count-24-7-oz/10316632

Cookie: https://www.walmart.com/ip/CHIPS-AHOY-Chewy-Chocolate-Chip-Cookies-with-Reese-s-Peanut-Butter-Cups-9-5-oz/22210581

Meatloaf: https://www.allrecipes.com/recipe/16354/easy-meatloaf/

Noodles: https://www.walmart.com/ip/12-Pack-Creamette-Medium-Egg-Noodles-12-oz-Bag/953898931

MY SUBSTITUTIONS:

Breakfast:

SO Delicious Coconut Milk Yogurt Alternative: https://sodeliciousdairyfree.com/dairy-free-foods/dairy-free-yogurt-alternatives/coconutmilk-yogurt/vanilla-

4pack

Blueberries/Raspberries: https://www.walmart.com/ip/Fresh-Blueberries-11-oz-or-1-Pint/50912363?athbdg=L1200

https://www.walmart.com/ip/Fresh-Raspberries-6-oz/44391666

Quaker Rice Cakes: https://www.quakeroats.com/products/rice-snacks/rice-cakes/lightly-salted

Almond Breeze Vanilla Yogurt Alternative: https://www.bluediamond.com/brand/almond-breeze/almondmilk-yogurt/vanilla-almondmilk-yogurt

Vermont Bread Company Whole Wheat Bread: https://stopandshop.com/groceries/bread-bakery/sandwich-bread/wheat-sandwich-bread/vermont-bread-

company-whole-wheat-bread-soft-24-oz-bag.html

Canyon Bakehouse Gluten Free Bread: https://www.target.com/p/canyon-bakehouse-gluten-free-7-grain-bread-18oz/-/A-15386017#lnk=sametab

BFree bread: https://www.glutenfreepalace.com/bfree-gluten-free-seeded-brown-sandwich-bread-loaf-14-1-oz-case-3.html?

notsmart&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUCX-kL7NEM4XXv0MyYKxx8lI4pyDARpr7pWPHW8vthYdK5_cPjab3BoCg-0QAvD_BwE
AM Snack:

Back to Nature Multi-Seed Rice Thin Crackers: https://www.walmart.com/ip/Back-to-Nature-Plant-Based-Snacks-Gluten-Free-Multi-Seed-Rice-Thin-Crackers-4-

oz-Box/42751365?wmlspartner=wlpa&selectedSellerId=101078875&&adid=22222222227000000000&wl0=&wl1=g&wl2=c&wl3=42423897272&wl4=aud-
393207457166:pla-
51320962143&wl5=9014977&wl6=&wl7=&wl8=&wl9=pla&wl10=422569393&wl11=online&wl12=42751365&veh=sem&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUDS
QPnbh2yNgO-ygimtFa9_rDbuwLI7lf6DBtGX22cub_AcZ67o8HRoCmtkQAvD_BwE&gclsrc=aw.ds

Justin’s Classic Almond Butter: https://www.justins.com/products/classic-almond-butter/

Back to Nature Peanut Butter Cream Cookies: https://www.healthysnacksolutions.com/products/back-to-nature-cookies-peanut-butter-creme-cookies?

variant=19830782754875&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUEm_RmPhjz76jGYilf9Kf_stAoPZKHczgEQC2mbvwGA2Nuym00UrVhoCbGwQAvD_BwE

KIND Honey Almond Butter Filled Snack Bar: https://www.kindsnacks.com/nut-butter-filled-bars/honey-almond-butter-M27362.html

Lance Gluten Free Peanut Butter Sandwich Crackers: https://www.walmart.com/ip/Lance-Gluten-Free-Sandwich-Crackers-Peanut-Butter-Snack-Bags-8-Ct/

116912881

Bobo’s Peanut Butter and Jelly Stuff’d Oat Bites: https://eatbobos.com/products/peanut-butter-jelly-oat-bites-30-ct?

variant=11287578640420&campaignid=1585968701&adgroupid=58997764999&creative=298111597193&keyword=&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUARST
HNn_b_Vv9yiDFk8hG4b4P7PQwRPMrYWFCbX0NU_6kWiw7w-DhoCwRgQAvD_BwE

Lunch:

Ian’s Gluten Free Frozen Fish Sticks: https://www.target.com/p/ian-39-s-gluten-free-frozen-fish-sticks-family-pack-14oz/-/A-14760805?

ref=tgt_adv_XS000000&AFID=google_pla_df&fndsrc=tgtao&DFA=71700000012732781&CPNG=PLA_Grocery%2BShopping_Local
%7CGrocery_Ecomm_Food_Bev&adgroup=SC_Grocery&LID=700000001170770pgs&LNM=PRODUCT_GROUP&network=g&device=c&location=9014977&targeti
d=aud-554348709499:pla-
812299188630&ds_rl=1246978&ds_rl=1248099&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUECIWyfHBaDE3QiEf0F6jEJ6MLDxdCxhQY_JBuOvXm_cJuGb4bIS-
xoCDf4QAvD_BwE&gclsrc=aw.ds

Good Catch Breaded Fish Sticks: https://shopvejii.com/product/good-catch-breaded-fish-sticks-8oz/

dr. Praeger’s Lightly Breaded Fish Sticks: https://www.freshdirect.com/pdp.jsp?catId=fro_seafo&productId=fro_drpraeg_fishstick#panel-ingr

dr. Praeger’s Rice Crusted Fish Sticks: https://thrivemarket.com/p/dr-praegers-rice-crusted-fish-sticks-4-pack?
utm_source=google&utm_medium=pla_smart&utm_campaign=Shopping_Engagement_Smart_Members&utm_content=80868000626_4pack&utm_term=na&g
clid=CjwKCAiAlrSPBhBaEiwAuLSDUBaPom-qis0-FOCjK0sjOzS-4JIXdJJcIj-9A_GDxUXyaiiNOpiG1hoCNjAQAvD_BwE

Gorton’s Fish sticks: https://www.walmart.com/ip/Gorton-s-Crunchy-Breaded-Haddock-Fish-Sticks-4-servings/45924087?

wmlspartner=wlpa&selectedSellerId=0&wl13=1594&&adid=22222222227038497581&wl0=&wl1=g&wl2=c&wl3=80433509209&wl4=aud-1185573580265:pla-
177674350609&wl5=9014977&wl6=&wl7=&wl8=&wl9=pla&wl10=8175035&wl11=local&wl12=45924087&veh=sem&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUMYX5s
1ILQQvlupIpWDSetGzxPANQ4Wqbfc3l38CzB-QfaRRU-oUGhoCuwkQAvD_BwE&gclsrc=aw.ds

Lima Beans: https://www.target.com/p/frozen-baby-lima-beans-12oz-good-38-gather-8482/-/A-79580702?

ref=tgt_adv_XS000000&AFID=google_pla_df_free_local&CPNG=Grocery&adgroup=270-0

Baked chicken tenders: https://www.healthyseasonalrecipes.com/healthy-chicken-fingers/

PM Snack:

Partake Cookies: https://partakefoods.com/products/chocolate-chip-soft-baked-cookies?

variant=31355818147938&currency=USD&utm_medium=product_sync&utm_source=google&utm_content=sag_organic&utm_campaign=sag_organic&gclid=Cj
wKCAiAlrSPBhBaEiwAuLSDUKoy5J9_qZMi6wMqi1r25g3xBrY0lk5dakwV3Ik4j_y9zj5P93kYgBoCo-kQAvD_BwE

Silk Original Oatmilk: https://silk.com/plant-based-products/oatmilk/oatmilk/

Ripple Dairy-Free Unsweetened Original Milk: https://www.target.com/p/ripple-dairy-free-unsweetened-original-milk-48-fl-oz/-/A-50737590?

ref=tgt_adv_XS000000&AFID=google_pla_df&fndsrc=tgtao&DFA=71700000012732781&CPNG=PLA_Grocery%2BShopping_Local
%7CGrocery_Ecomm_Food_Bev&adgroup=SC_Grocery&LID=700000001170770pgs&LNM=PRODUCT_GROUP&network=g&device=c&location=9014977&targeti
d=aud-554348709499:pla-
122594422609&ds_rl=1246978&ds_rl=1248099&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUJUAK5OWNpyUEfwTWfsB_dPItGOoQB8I4TBA3MUuHlYEoKMCEl4ZhxoCRh
4QAvD_BwE&gclsrc=aw.ds

Lesser Evil Almond Milk Chocolate Chip Cookies: https://lesserevil.com/products/almond-butter-chocolate-chip-mini-cookies?variant=34535127187618

Maxine’s Heavenly Cookies Peanut Butter Chocolate Chunk: https://www.walmart.com/ip/Maxines-Heavenly-Cookies-Peanut-Butter-Chocolate-Chunk-7-2-Oz/

541948295?wmlspartner=wlpa&selectedSellerId=0

Aleia’s Gluten Free Cookies, Peanut Butter: https://www.garnersupply.com/aleia-s-gluten-free-cookies-peanut-butter-case-of-6-9-oz.html?

gclid=CjwKCAiAlrSPBhBaEiwAuLSDUF3VbYzRibEza92LESrEn3b7sU6GPuXrZmWWcV6SGWhJEkok3Q_YWBoC-5MQAvD_BwE
Dinner:

Mama’s Allergy Free Meatloaf: https://www.laurenkossack.com/mamas-allergy-free-meatloaf/

Tinkyada Gluten Free Brown Rice Spaghetti noodles: https://www.target.com/p/tinkyada-gluten-free-brown-rice-spaghetti-16oz/-/A-14767372

Dairy-free meatloaf: https://www.thespruceeats.com/classic-meatloaf-recipe-1001263

Eggless meatloaf recipe: https://mommyshomecooking.com/easy-eggless-meatloaf/

Creamette spaghetti pasta: https://www.instacart.com/landing?

product_id=39158&retailer_id=58&region_id=3713487795&utm_medium=sem_shopping&utm_source=instacart_google&utm_campaign=ad_demand_shoppin
g_rp_kroger&utm_content=accountid-8145171519_campaignid-10888296174_adgroupid-108550600553_device-
c&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUMHqmCmjIBSmw7CldZUZfoVJLMdDO1X_yeMzGH_GVhWnMHhtjYHgaxoCI_YQAvD_BwE

Betty Crocker Gluten Free Glazed Meatloaf: https://www.bettycrocker.com/recipes/gluten-free-glazed-meatloaf/39128993-c6ee-493a-b67a-0cdc8977f2fd

Banza penne noodles: https://www.eatbanza.com/products/banza-chickpea-penne

Mama’s Allergy Free Meatloaf: https://www.laurenkossack.com/mamas-allergy-free-meatloaf/

Barilla spaghetti pasta: https://www.meijer.com/shopping/product/barilla-spaghetti-pasta--16-oz/7680828008.html?

cmpid=SEM_LIA_All_Meijer_Products:General:all%5Cfood%2C_beverages_
%26_tobacco:GOOGLE&gclid=CjwKCAiAlrSPBhBaEiwAuLSDUHKjiCQPzdpERHDoq1SCW--3cMFA6f7M6fEYgG06Tpm9xg5eG2tXQxoCYI4QAvD_BwE