Monitoring
Observation
Patients should be observed for 4-6 hours or longer for possible recurrence as the effect of Epinephrine wears off.
Re-evaluation of Patients with Food Allergy
A periodic re-evaluation is important to determine if the allergy to food has resolved or if tolerance has been obtained over time. The natural course of a specific food allergy should be considered when determining the frequency of follow-up evaluations as well as the patient’s age. Upon follow-up, if the skin prick test or the specific IgE test shows a negative result or has decreased to low levels, a food challenge should be recommended. If the food challenge is negative, the patient may introduce the food to his/her diet under the supervision of a physician.
Timing of Examinations
A food-specific IgE test may be done: Every 6 months for patients <3 years old; every 6-12 months for patients 3-5 years old; and at least every 12 months for patients >5 years old. A food challenge test may be done: Every 6-12 months for patients <3 years old; every 1-2 years for patients 3-5 years old; and every 2-3 years for patients >5 years old.
Complications
Food-induced Anaphylaxis
Food-induced anaphylaxis is a serious allergic reaction that has a rapid onset and may be life-threatening. Prompt assessment and treatment are critical as death can ensue rapidly. The clinical features include those seen in food allergy plus respiratory compromise and/or hypotension. Food allergy is the most common cause of anaphylaxis. Individuals at high risk for fatal food-induced anaphylaxis include adolescents, those with a history of allergic reactions, peanut/tree nut allergies, asthma, and those without skin manifestations. In cases of food-dependent, exercise-induced anaphylaxis, reactions occur depending on the temporal association between food ingestion and exercise (usually within 2 hours). Nuts, fish, shellfish, cow’s milk, soy and eggs most commonly trigger anaphylaxis, but fruits and vegetables have also been implicated. When evaluating the patient’s anaphylactic risk, consider the severity of prior symptoms and the possible triggering dose.
Please see Anaphylaxis
disease management chart for further information.