Food Allergy Management and Prevention
Support Tool for Infants and Toddlers
For Early Food Introduction

Allergenic Food History:

This section can be used to document the patient’s history of exposure or reaction to the most common allergens. You can copy and paste it into your EMR system to use during well-child visits or follow up appointments.

Egg: [SELECT ONE: in diet and tolerated, never, tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Peanut: [SELECT ONE: in diet and tolerated, never tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Tree nut (e.g. almond, walnut, cashew, pecan, pistachio, hazelnut, brazil nut): [SELECT ONE: in diet and tolerated, never tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Dairy: [SELECT ONE: in diet and tolerated, never tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Wheat: [SELECT ONE: in diet and tolerated, never tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Soy: [SELECT ONE: in diet and tolerated, never tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Sesame: [SELECT ONE: in diet and tolerated, never tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Fish: (e.g. cod, tuna, salmon, haddock, tilapia, etc): [SELECT ONE: in diet and tolerated, never tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Shellfish: (e.g. shrimp, clam, lobster, crab, scallop, mussels): [SELECT ONE: in diet and tolerated, never tried, reaction from eating, reaction from touching, positive skin prick test, positive blood test, previously tolerated but no longer eaten]

Allergenic Introduction Assessment and Plan:

This text includes information on how to manage peanut introduction for infants at high risk of developing a peanut allergy, as well as how to guide parents on early food introduction for foods other than peanut. You can copy and paste it into your EMR system to use during well-child visits or follow up appointments.

[PLEASE LEAVE IN IF PATIENT HAS NOT EATEN PEANUT]
Food Introduction (Peanut)
Per the addendum NIAID/LEAP guidelines, babies at high risk for peanut allergy should be introduced to peanut between 4-6 months of age in an age appropriate way (i.e. no loose nuts until age 5 and use of thinned out peanut butter). The Guidelines define high risk as patients with severe eczema, egg allergy, or both. Per the NIAID guidelines, if the eczema is severe then a peanut specific IgE and/or peanut skin testing should be done before introduction. [FOR PROVIDER: PLEASE CONSIDERING SPEAKING TO COMMUNITY ALLERGIST TO DISCUSS IF BLOOD TEST SHOULD BE SENT BY PROVIDER OR THE PATIENT SHOULD BE REFERRED TO AN ALLERGIST FOR SKIN TESTING].

Pathway:
Referral to Allergist
The patient is considered high risk for peanut allergy due to their severe eczema or IgE mediated food allergy to another food. The patient will be referred to an allergist for peanut skin testing evaluation. Until the testing has been done the patient should avoid any consumption of peanuts. After the peanut skin test the allergist will decide if it is safe for the patient to eat peanut. The patient was given a hand out on how to read a label and cross contact patient education. [NOTE TO DOCTOR TO PROVIDE LABEL READING AND CROSS CONTACT PATIENT EDUCATION].

Blood test
The patient is considered high risk for peanut allergy due to their severe eczema or IgE mediated food allergy to another food. Peanut IgE with reflex components was ordered. If the testing is negative (<0.35), please introduce peanut into the child’s diet using the introduction resource as guidance. If the testing is positive, an appropriate epinephrine auto-injector two pack will be prescribed and a referral for Pediatric Allergy/Immunology evaluation will be placed as well as an allergy anaphylaxis plan. Instructions on allergen avoidance and label reading will be provided. [NOTE TO DOCTOR TO PROVIDE LABEL READING, ALLERGY ANAPHYLAXIS PLAN AND CROSS CONTACT PATIENT EDUCATION]. If the patient is able to introduce peanut at home the office will provide a hand out on peanut introduction at home.

Food Introduction (Allergenic Foods OTHER THAN Peanut)
The 2019 AAP Clinical Report recommends dietary interventions to prevent atopic disease, and states that there is no evidence that delaying introduction of other allergenic foods beyond 4-6 months prevents atopic disease. The dual exposure hypothesis theorizes that tolerance to a food is developed by exposure through the GI tract, whereas sensitization to a food is developed by cutaneous exposure. There is also data to show that the sensitization is increased by eczema and compromises in the skin barrier. Therefore the family was counseled that repeated cutaneous exposure to highly allergenic foods not yet eaten can lead to sensitization and if there are any concerns please call the office. Discussed that in order to limit the child’s cutaneous exposure to allergenic foods not eaten it is best to avoid them in the child’s play area; restrict eating to a table that is thoroughly cleaned after ingestion as well as dishware and wash hands after handling foods and before touching the child or applying creams or lotions.

We recommend food introduction in an age-appropriate (and culturally appropriate) manner free of choking hazards (i.e. do not give whole peanuts, tree nuts, and/or seeds; recommend thinned nut butter mixed in cereal/formula/breastmilk/pureed fruit or vegetables). We recommend gradual introduction, starting with a pea sized amount and doubling this every 10 to 20 minutes until they have reached about 2 tablespoons, but this can be done more slowly in a higher risk patient. When introducing foods at home the family was counseled to be aware of the signs of anaphylaxis. Symptoms of anaphylaxis can include hives, swelling, wheezing, cough, shortness of breath, nausea, vomiting, difficulty breathing, dizziness, or loss of consciousness. If foods are introduced and tolerated it is important to keep them in the diet at a regular interval.

If there is any concern please call our office at [INSERT PHONE NUMBER] or call 911.