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, paste, and modify as needed to utilize within your EMR system for 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, paste, and modify as needed to utilize within your EMR system for 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 considered before introduction. *Please note that this screening step has been scrutinized and may unnecessarily delay introduction.* Subsequent guidelines, A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition, do not require prior screening or allergy referral and suggest shared decision making with family.  [FOR PROVIDER: Goal is for early introduction of peanut between 4 and 6 months if wait time for allergist will delay then consider gradual introduction without screening].

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.