This text can be used for patients who have either suspected or confirmed food allergies, based on testing or prior reactions. You can copy and paste it into your EMR system to use during well-child visits or follow up appointments.
There is concern that patient had food reaction to [LIST FOODS].
The patient has known food allergies to [LIST FOODS].
Food Reaction Evaluation (Food Reaction Assessment and Plan):
This text can be used to document that the family was provided guidance on their child’s suspected food allergy and that a referral will be placed for pediatric allergy. This section also includes information on what educational resources to provide the family and what dosage of epinephrine auto-injector to prescribe. You can copy and paste it into your EMR system to use during well-child visits or follow up appointments.
Based on the patient’s reaction, there is a concern for an IgE mediated food allergy. The patient should be referred to an allergist for further evaluation. The family was counseled to avoid [INSERT FOOD] as well as foods they have known allergies to including [LIST KNOWN FOOD ALLERGIES OR REMOVE IF N/A]. The family was counseled on label reading, cross contact avoidance and provided with relevant educational material in addition to an anaphylaxis action plan [NOTE TO DOCTOR TO PROVIDE LABEL READING, CROSS CONTACT PATIENT EDUCATION, AND ANAPHYLAXIS PLAN]. The family was counseled to continue to eat allergenic foods they are tolerating regularly so they do not lose their tolerance.
An epinephrine autoinjector two-pack [CHOOSE DOSE: 0.1 MG FOR WT LESS THAN 13KG OR 0.15 MG IF 0.1 MG NOT AVAILABLE; 0.15 MG FOR WT 13 to 25 KG; 0.3 MG FOR WT GREATER THAN 25 KG] was prescribed and should be available at all times. Epinephrine auto-injector training was provided and indications for use of epinephrine reviewed.
Your child’s immune system is still developing and learning what is safe. Sometimes, when babies try a new food, their immune system mistakes it for something harmful and reacts. This is called a food allergy.
Many food allergies fall under the category of IgE-mediated food allergies. (Non-IgE-mediated food allergies are another type). IgE is a protein made by the immune system. In people with food allergies, IgE reacts to certain foods and causes the body to release chemicals that lead to allergic symptoms.
Reactions usually happen quickly—within minutes to a few hours after eating. Serious reactions (called anaphylaxis) are uncommon in babies but can be life-threatening and need emergency treatment right away.
How to Avoid a Food Allergy Reaction
Once your child is diagnosed with a food allergy, there is a lot to learn. It’s normal to feel overwhelmed at first. The good news is that focusing on a few key basics can make a big difference.
Label Reading
Oral ingestion is the most common way to have an allergic reaction to food. Before eating, read labels to avoid allergens. Ingredients change without notice, so read labels every time.
The 3-Point Scan
1) Ingredients List – An ingredients list is usually found on the back or side of the package. This is where you will find everything used to make the product. Allergens may appear by their common name (like “milk”) or under another name (like “casein”).
2) Contains Statement – Contains statements are often printed in bold after the ingredients list. Example: Contains: Milk, Egg, Wheat. Not all products include this statement, so it should never replace reading the ingredients list.
3) Advisory statements – These are not required to be included on packaging and vary by brand. You may see:
“May contain…”
“Made in a facility that also processes…”
“Processed on shared equipment with…”
Advisory statements should never replace the ingredient lists.
Under U.S. food labeling laws, most packaged foods regulated by the FDA must clearly identify the 9 major food allergens when they are used as ingredients.
Cross Contact
If your child has a food allergy, ingredients are not the only thing you need to pay attention to. You also need to be mindful of how foods are made and handled. Even if a food does not contain your child’s allergen as an ingredient, it may still cause a reaction if it touches that allergen. This is called “cross-contact.” While this can feel overwhelming, there is good news. Once you understand how cross-contact happens and where it is most likely to occur, there are simple steps you can take to help prevent it.
Cross-contact occurs when a food allergen comes into contact with a food that is supposed to be safe and allergen-free. The part of food that causes allergic reactions (called proteins) can be so small that you cannot see it. Your child’s immune system can notice even tiny amounts of these proteins and start an allergic reaction. Cross-contact usually doesn’t happen because someone is careless. It often happens because people don’t realize what to watch for when cooking, serving, eating, or cleaning up after a meal.
There are three main ways cross-contact can happen:
Food-to-Food Contact
Food-to-food contact happens when an allergen touches another food. This can occur during storage, cooking, plating, or serving. It may happen directly when two foods come into contact, such as foods touching on the same plate or sharing a container. It can also happen indirectly, when allergen proteins get onto utensils, plates, or pans that are then used to prepare a food that is supposed to be safe.
Large spills or crumbs are easier to notice, but small amounts of allergens can spread to other foods or surfaces without anyone realizing it. Common ways this can happen include:
Steam or splatter from cooking on the stove landing on nearby foods.
Small crumbs being left behind in dips or spreads such as butter, jelly, or cream cheese.
Using the same knife, spoon, tongs, or other utensil for multiple foods without washing it in between.
It is important to know that once foods have touched, removing the visible allergen does not make the food safe. For example, if a slice of cheese is placed on a burger and then taken off, it may remove what you can see, but tiny amounts of dairy protein can still be on the burger and cause an allergic reaction.
Surfaces and Objects
Allergens can get left behind on surfaces and objects after food touches them. When your little one grabs that surface, the allergen can end up on their hands and sometimes into their mouth. Children may also put toys or surfaces directly into their mouths. This is especially common for babies and toddlers, who love to taste-test everything they see and cannot wash their hands as adults can.
Saliva
After eating, small amounts of allergen protein can stay in the saliva for a while. These proteins can be passed to your child if they share cups, utensils, or pacifiers with others, or if they receive kisses on or near the mouth. Pets can also spread allergens if they have recently eaten a food containing your child’s allergen and then lick your child or their toys.
To lower the risk, avoid sharing cups, utensils, or saliva (such as kissing near the mouth) for a few hours after eating a food containing your child’s allergen. Brushing teeth and eating an allergen-free meal may help lower the amount of allergen in the mouth, but they do not get rid of it completely.
Note: You may also hear the word cross-contamination. This sounds similar but actually means something different:
Cross-contact: Allergen protein from one food gets on another food. This may cause an allergic reaction.
Cross-contamination: Bacteria or germs from one food get on another food. This may cause food poisoning.
Emergency Preparedness and Anaphylaxis for Food Allergies
IgE-mediated allergic reactions do not all look the same. Some are mild and stay in one part of the body. Others are more serious and involve more than one body system or affect breathing or circulation. Sometimes it can be easy to mistake an allergic reaction for normal behavior. Knowing what to look out for helps guide us on what to do next.
What are the signs and symptoms of a mild allergic reaction?
Mild reactions are usually limited to one body area and do not spread or get worse quickly. In this case, stop feeding your baby the food, watch for changes, and talk with your healthcare team about next steps.
Body System
AAP Allergy and Anaphylaxis Emergency Plan (all ages)
In young children, also look for…
1: Upper Respiratory / Mucus Membranes
Itchy nose, sneezing, itchy mouth
Pushing out the tongue (called thrusting), pulling on the tongue, repetitive lip licking or licking of hands or objects, throat itching, ear pulling, scratching, putting fingers in the ears, eye rubbing, eye itching
2: Skin
A few hives
Skin scratching or rubbing skin
3: Gastrointestinal (Gut)
Mild stomach nausea or discomfort
Hiccups, spit-up that is not routine and more intense than normal, arching of the back, putting knees to chest
What is anaphylaxis?
A serious allergic reaction is called anaphylaxis. It can happen when your baby or toddler eats a food they are allergic to. (Anaphylaxis can also occur with other types of allergens, like stinging insects and medications.) It can look something like:
Your child has mild symptoms but in more than one body area. For example, a small area of hives by itself is a mild symptom, and limited vomiting by itself is a mild symptom, but both hives and vomiting together can be considered early anaphylaxis. Or…
Your child has severe symptoms in one or more areas of the body. These severe symptoms can happen in different areas of the body, including the skin, stomach, breathing, and circulation. Or…
Your child starts with one mild symptom, but it gets worse as time passes, becoming a severe symptom, aka anaphylaxis. Or…
Your child starts with one mild symptom, but one or more new mild symptoms appear, which is then early anaphylaxis.
The first-line treatment for anaphylaxis is epinephrine.
What are the signs and symptoms of a serious allergic reaction – anaphylaxis?
This chart goes over the severe symptoms your baby may have if they are having a serious allergic reaction. These symptoms are grouped by the area of the body they can happen in. Remember, a reaction can also be considered anaphylaxis if the symptoms are mild (described in the mild symptoms chart above) but in more than one area of the body.
Body System
AAP Allergy and Anaphylaxis Emergency Plan (all ages)
In young children, also look for…
1: Respiratory / Airways
Shortness of breath, wheezing, or coughingTight or hoarse throatTrouble breathing or swallowingSwelling of lips or tongue that makes breathing more difficult
Belly breathing (in which the baby’s belly goes up and down in an obvious way), fast breathing, nasal flaring, chest or neck tugging (the skin around the chest or neck appears to suck in with breathing)Hoarse voice, hoarse cry, barky or croup-like cough, unexplained drooling
2: Cardiovascular (Heart)
Skin color is pale or has a bluish colorWeak pulseFainting or dizziness
Mottling of the skin (discolored patches or blotches on the skin), pale appearance in lighter skin or dusky appearance in darker skin, particularly on the lips, tongue or gumsFast heartbeat not related to crying or other causes, usually with other signs of an allergic reactionWobbly appearance, limp, floppy or poor head control
Hives that appear red on lighter skin or look darker, purplish or blend with skin tone in children with skin of color, obvious swelling on the face
4: Gastrointestinal (Gut)
Vomiting or diarrhea (if severe or combined with other symptoms)
Throwing up more than once or throwing up that occurs with other symptoms, large amounts of diarrhea or diarrhea that occurs with other symptoms
5: Neurologic (Behavior)
Feeling of “doom,” confusion, agitation
Lethargic or very tired, difficult to wake up, withdrawn, unexpected crankiness, inconsolable or nonstop crying
If your baby is having severe symptoms and they are diagnosed with a food allergy and have epinephrine, give epinephrine and follow your baby’s Anaphylaxis Emergency Action Plan. An easy way to remember what to do is to follow the REAct steps outlined below.
R – Recognize Anaphylaxis
Watch for serious symptoms like trouble breathing, vomiting, sudden sleepiness, swelling, or symptoms affecting two or more body systems. Use the above chart to see what symptoms might look like specifically in infants and toddlers.
E – Epinephrine
If your baby or toddler is experiencing some symptoms and you’re not sure it’s anaphylaxis, the best approach is to still give epinephrine. Early treatment can keep a reaction from getting worse and make your baby or toddler feel better quickly.
Position your baby after epinephrine. After giving epinephrine, position your baby based on their symptoms:
If there’s trouble breathing or coughing:
Hold your baby upright against your chest.
Support their head and make sure their legs aren’t dangling.
If the baby’s head and body are limp and floppy, or if they’re hard to wake up:
Lay your baby flat on their back with legs slightly raised.
Do not pick your baby up suddenly or let your baby move around too much.
If there’s vomiting:
Lay your baby on their side to prevent choking.
Give a second dose of epinephrine if:
Symptoms do not get better in about 5 minutes after the first dose, or
Symptoms come back or get worse
If you give a second dose of epinephrine, call 911.
Reminder: Keep two doses of epinephrine available at all times. Don’t forget to refill the prescription.
Act – Activate emergency plan
These days, guidelines allow a bit more flexibility on what happens after epinephrine is given for anaphylaxis. If your child’s anaphylaxis is treated early and symptoms quickly get better after a first dose of epinephrine, you may not need to call 911. Your healthcare team will discuss with you whether this is an option for your child.
In these cases…
there needs to be more than one dose of epinephrine available
your baby cannot have severe or life-threatening symptoms
another person is present
you’re comfortable managing the situation
symptoms largely get better after treatment, and
the healthcare team previously approved this for your child
Call 911 if…
you don’t have a second dose of epinephrine
symptoms return or worsen after the first dose of epinephrine
symptoms do not go away quickly or completely after the first dose of epinephrine
a second dose of epinephrine is needed
Follow the Anaphylaxis Action Plan from your Healthcare Team
When to see a Food Allergy Specialist
While the conversation about your child’s food allergies will often start with a pediatrician, there may come a time when you want your child’s healthcare team to include a specialist.
Allergy specialists are experts in treating food allergies. They can be physicians (MD/DO), who are board-certified in allergy and immunology, Nurse Practitioners, or Physician Assistants/Associates. Many allergy specialists are trained to care for infants, young children, and even teens. Check with the office to confirm if your allergy specialist sees infants and toddlers. Allergy specialists are trained to:
Figure out what your child is reacting to and make a diagnosis.
Do allergy testing (like a skin test or blood tests).
Decide if your child needs a supervised oral food challenge.
Create a care plan to help your child stay safe and feel better.
Help decide if treatments like oral immunotherapy or biologics may be needed.
Work with you on whether an elimination diet is appropriate.
Decide if you have to remove specific foods from your child’s diet.
Prescribe epinephrine.
Create an anaphylaxis action plan.
They can also help when it’s unclear what’s causing your child’s reactions or when allergies affect daily life.
Building habits to avoid food allergens is a great way to keep your baby safe — and at the end of the day, it’s enough. You may choose to take additional steps and discuss the different food allergy treatments with your healthcare team. Below, learn more about the different treatments and medications that may come up during your child’s food allergy journey.
Types of food allergy treatments
Some young children with food allergies have very strong reactions to even tiny amounts of certain foods.
For these children, new treatments called biologics may help. Omalizumab (Xolair®) is an FDA-approved biologic medication for the treatment of food allergies. It is for children 1 year of age and older at risk for severe symptoms.
What is omalizumab?
Omalizumab is given as an injection to treat a child’s food allergy. It works by blocking a substance in the body called IgE, which plays a major role in allergic reactions. By lowering IgE, omalizumab can help calm the immune system and reduce allergic responses in case of an accidental exposure.
Omalizumab does not cure food allergies. Your child will still need to avoid their allergens and carry epinephrine for emergencies.
Before a visit with your allergy specialist, consider and gather information about the following regarding your child’s food allergies when discussing Omalizumab as a treatment option:
Your history of accidental exposures to your food allergens (number of times epinephrine was used, number of emergency room visits, and intensive care admissions as a result of anaphylaxis) and what happened during those reactions.
Whether avoiding your food allergens has been difficult or not been enough to stop accidental exposures.
Whether your attempts to avoid allergens are affecting your quality of life.
Whether the severity of your allergic reactions has changed over time.
Whether you are willing and able to follow the recommended at-home dosing schedule for omalizumab.
Oral immunotherapy (OIT)
Food allergy oral immunotherapy is a long word (often called OIT) for a type of treatment that helps build tolerance to common food allergens. In other words, it helps your baby slowly get used to the allergen. The goal is to make the immune system less likely to cause a severe allergic reaction if they are accidentally exposed to even a small amount. It works by giving a tiny amount of a known food allergen to your child, then gradually increasing the amount until a maintenance dose is reached. This helps desensitize the child to the food allergen.
Food allergy OIT must always be done with a trained healthcare provider. Do not attempt it on your own! OIT is a relatively newer treatment, and not all doctors offer it. It is usually done at special allergy centers that have experience with this therapy. Talk with your allergy specialist for more information regarding OIT.
More information on FAMP-IT Family, which is a support tool to help you navigate the early years of your baby’s food allergy with confidence and ease:
El sistema inmunológico de tu bebé aún se está desarrollando y aprendiendo qué es seguro. A veces, cuando los bebés prueban alimentos nuevos, su sistema inmunológico puede reaccionar de forma exagerada y considerarlos algo malo. Esto se llama alergia alimentaria.
Un tipo principal de alergia alimentaria se llama alergia alimentaria mediada por IgE. (El otro tipo de alergia alimentaria se llama no mediada por IgE, y se describe más abajo en la sección “Cuando las alergias alimentarias son difíciles de identificar”). La IgE es un anticuerpo que su sistema inmunológico produce para combatir alérgenos que considera dañinos. En algunas personas, ciertos alimentos pueden hacer que la IgE reaccione de forma exagerada y libere una gran cantidad de químicos, lo que causa los síntomas que se observan durante una reacción.
Las reacciones suelen producirse rápidamente, entre unos minutos y unas horas después de comer. Reacciones graves pueden poner en peligro la vida y requerir tratamiento de emergencia, pero, afortunadamente, son poco frecuentes en los bebés.
Cómo evitar una reacción alérgica a los alimentos
Una vez que a su hijo le diagnostican una alergia alimentaria, hay mucho que aprender a la vez: nuevas reglas, cosas a tener en cuenta y constantes situaciones de “qué pasaría si”. Es normal sentirse abrumado al principio. La buena noticia es que centrarse en algunos conceptos básicos clave puede marcar una gran diferencia.
Lectura de etiquetas
La ingesta oral es la forma más frecuente de desarrollar una reacción alérgica a los alimentos. Antes de comer, lea las etiquetas para evitar los alérgenos. Los ingredientes cambian sin previo aviso, así que siempre lea las etiquetas.
El escaneo de 3 puntos
1. Lista de ingredientes – Una lista de ingredientes se encuentra usualmente en la parte trasera o lateral del empaque. Aquí encontrarás todo lo que se usó para hacer el producto. Los alérgenos pueden aparecer con su nombre común (como “leche”) o bajo otro nombre (como “caseína”).
2. Contiene declaración – Las declaraciones que contienen suelen imprimirse en negrita después de la lista de ingredientes. Ejemplo: Contiene: Leche, Huevo, Trigo. No todos los productos incluyen esta declaración, por lo que nunca debe reemplazar la lectura de la lista de ingredientes.
3. Declaraciones de asesoramiento
Estos no son obligatorios en los empaques y varían según la marca. Puedes ver:
“Puede contener…”
“Hecho en una instalación que también procesa…”
“Procesado en equipo compartido con…”
Una vez más, las declaraciones de advertencia nunca deben reemplazar las listas de ingredientes
Bajo las leyes de etiquetado de alimentos de EE. UU., la mayoría de los alimentos envasados regulados por la FDA deben identificar claramente los 9 alérgenos alimentarios principales cuando se utilizan como ingredientes.
Contacto cruzado
Si tu hijo tiene una alergia alimentaria, los ingredientes no son lo único a lo que debes prestar atención. También debes tener en cuenta cómo se preparan y manipulan los alimentos. Un alimento que parece seguro aún podría causar una reacción si ha estado en contacto con un alimento que contiene el alérgeno de tu hijo. Esto se llama “contaminación cruzada”. Si bien esto puede parecer abrumador, hay buenas noticias. Una vez que entiendas cómo ocurre la contaminación cruzada y dónde es más probable que ocurra, hay pasos sencillos que puedes tomar para ayudar a prevenirla.
La contaminación cruzada ocurre cuando un alérgeno alimentario entra en contacto con un alimento que se supone que es seguro y libre de alérgenos. La parte del alimento que causa reacciones alérgicas (llamada proteínas) puede ser tan pequeña que no se puede ver. El sistema inmunológico de su hijo puede detectar incluso cantidades diminutas de estas proteínas e iniciar una reacción alérgica. La contaminación cruzada generalmente no ocurre por descuido. A menudo ocurre porque las personas no se dan cuenta de qué tener en cuenta al cocinar, servir, comer o limpiar después de una comida.
Hay tres maneras principales en que puede ocurrir el contacto cruzado:
El contacto de alimento a alimento
El contacto de alimento a alimento ocurre cuando un alérgeno toca otro alimento. Esto puede suceder durante el almacenamiento, la cocción, el emplatado o el servicio.
Puede ocurrir directamente cuando dos alimentos entran en contacto, como alimentos tocándose en el mismo plato o compartiendo un recipiente. También puede ocurrir indirectamente, cuando las proteínas del alérgeno pasan a utensilios, platos o sartenes que luego se utilizan para preparar un alimento que se supone que es seguro.
Los derrames grandes o las migas son más fáciles de notar, pero pequeñas cantidades de alérgenos pueden propagarse a otros alimentos o superficies sin que nadie se dé cuenta. Las formas comunes en que esto puede suceder incluyen:
Salpicaduras o vapor de la cocina en la estufa que caen sobre alimentos cercanos.
Pequeñas migas que quedan en salsas o untables como mantequilla, mermelada o queso crema.
Usar el mismo cuchillo, cuchara, pinzas u otro utensilio para múltiples alimentos sin lavarlo en medio.
Es importante saber que una vez que los alimentos se han tocado, eliminar el alérgeno visible no no haz que la comida sea segura. Por ejemplo, si una rebanada de queso se coloca sobre una hamburguesa y luego se retira, puede eliminar lo que se ve, pero aún pueden quedar diminutas cantidades de proteína láctea en la hamburguesa y causar una reacción alérgica.
Superficies y objetos
Los alérgenos pueden quedar en superficies y objetos después de que los alimentos entren en contacto con ellos. Cuando tu pequeño toca esa superficie, el alérgeno puede terminar en sus manos y, a veces, en su boca. Los niños también pueden llevarse juguetes o superficies directamente a la boca. Esto es especialmente común en bebés y niños pequeños, a quienes les encanta probar todo lo que ven y no pueden lavarse las manos como los adultos.
Saliva
Tras comer, pequeñas cantidades de proteína del alérgeno pueden permanecer en la saliva durante un tiempo. Estas proteínas pueden pasarse a tu hijo si comparte vasos, cubiertos o chupetes con otras personas, o si recibe besos en o cerca de la boca. Las mascotas también pueden propagar alérgenos si han comido recientemente un alimento que contiene el alérgeno de tu hijo y luego lamen a tu hijo o sus juguetes.
Para reducir el riesgo, evite compartir vasos, cubiertos o saliva (como besar cerca de la boca) durante unas horas después de consumir un alimento que contenga el alérgeno de su hijo. Cepillarse los dientes y comer una comida libre de alérgenos puede ayudar a reducir la cantidad de alérgeno en la boca, pero no lo elimina por completo.
Nota: También puede escuchar la palabra contaminación cruzada. Esto suena similar pero en realidad significa algo diferente:
Contaminación cruzada: Una proteína de un alérgeno de un alimento entra en contacto con otro alimento, lo que puede causar una reacción alérgica.
Contaminación cruzada: Bacterias o gérmenes de un alimento pasan a otro. Esto puede causar intoxicación alimentaria.
Preparación ante Emergencias – Reacciones Alérgicas y Anafilaxia
Las reacciones alérgicas mediadas por IgE no se presentan todas de la misma manera. Algunas son leves y se limitan a una parte del cuerpo. Otras son más graves e involucran más de un sistema corporal o afectan la respiración o la circulación. A veces, puede ser fácil confundir una reacción alérgica con un comportamiento normal. Saber qué buscar nos ayuda a guiar qué hacer a continuación.
¿Cuáles son los signos y síntomas de una reacción alérgica leve?
Aparato
Plan de emergencia de la AAP para alergias y anafilaxia (todas las edades)
Picazón en la nariz, estornudos, picazón en la boca
Expulsar la lengua (lo que se denomina proyección), entrar la lengua, lamerse los labios repetidamente o lamerse las manos u objetos, picazón de garganta, tirarse de las orejas, rascarse, meterse los dedos en los oídos, frotarse los ojos, picazón en los ojos
2: Piel
Un poco de urticaria
Rascarse o frotarse la piel
3: Gastrointestinal (intestino)
Náuseas leves o malestar estomacal
Hipo, regurgitación que no es habitual y es más intensa de lo normal, arqueo de la espalda, llevar las rodillas al pecho.
¿Qué es la anafilaxia?
Una reacción alérgica grave se llama anafilaxia. Puede ocurrir cuando tu bebé o niño pequeño come un alimento al que es alérgico. (La anafilaxia también puede ocurrir con otros tipos de alérgenos, como insectos que pican y medicamentos). Puede verse algo así:
Tu hijo tiene suave síntomas, pero en más de una zona del cuerpo. Por ejemplo, una pequeña área de urticaria por sí sola es un síntoma leve, y el vómito limitado por sí solo es un síntoma leve, pero tanto la urticaria como el vómito juntos pueden considerarse anafilaxia temprana. O…
Tu hijo tiene grave síntomas en una o más áreas del cuerpo. Estos síntomas graves pueden ocurrir en diferentes áreas del cuerpo, incluyendo la piel, el estómago, la respiración y la circulación. O…
Tu hijo comienza con un síntoma leve, pero empeora con el tiempo, convirtiéndose en un síntoma severo, también conocido como anafilaxia. O…
Su hijo comienza con un síntoma leve, pero aparece uno o más síntomas leves nuevos, lo que entonces es anafilaxia temprana.
El tratamiento de primera línea para la anafilaxia es la epinefrina.
¿Cuáles son los signos y síntomas de una reacción alérgica grave, la anafilaxia?
Este gráfico repasa los síntomas graves que su bebé podría presentar si está teniendo una reacción alérgica seria. Estos síntomas están agrupados por el área del cuerpo donde pueden ocurrir. Recuerde que una reacción también puede considerarse anafilaxia si los síntomas son leves (descritos en el gráfico de síntomas leves anterior) pero se presentan en más de un área del cuerpo).
Aparato
Plan de emergencia de la AAP para alergias y anafilaxia (todas las edades)
En niños pequeños, también esté atento a…
1: Respiratorio/vías respiratorias
Dificultad para respirar, sibilancias o tosGarganta estrecha o roncaDificultad para respirar o tragarHinchazón de los labios o la lengua que dificulta la respiración
Respiración abdominal (en la que el vientre del bebé sube y baja de forma evidente), respiración acelerada, aleteo nasal, tiraje traqueal o de pecho (la piel alrededor del cuello o del pecho parece succionarse al respirar)Voz ronca, llanto ronco, tos perruna, babeo inexplicable
2: Cardiovascular (corazón)
Palidez en la piel o piel de color azuladoPulso débilDesmayos o mareos
Moteado de la piel (manchas o máculas en la piel de un color distinto al usual), apariencia pálida en pieles más claras o apariencia oscura en pieles más oscuras, particularmente en los labios, la lengua o las encíasLatidos cardíacos rápidos no relacionados con el llanto u otras causas, generalmente con otros signos de una reacción alérgicaInestabilidad o tambaleo, falta de fuerza (flacidez), flojedad o poco control de la cabeza
3: Piel
Mucha urticaria o enrojecimiento en el cuerpo
Urticaria que aparece roja en pieles más claras o que se ve más oscura, violácea o que se mezcla con el tono de piel en niños de piel más oscura, hinchazón evidente en la cara
4: Gastrointestinal (intestino)
Vómitos o diarrea (si son graves o se combinan con otros síntomas)
Vómitos más de una vez o vómitos que ocurren con otros síntomas, grandes cantidades de diarrea o diarrea que ocurre con otros síntomas
5: Neurológico (comportamiento)
Sensación de “fatalidad”, confusión, agitación
Aspecto letárgico o de estar muy cansado, dificultad para despertar, comportamiento retraído, irritabilidad inesperada, llanto inconsolable o que no cesa
Se les diagnostica una alergia alimentaria y tienen epinefrina., administra epinefrina y sigue el Plan de Acción de Emergencia para Anafilaxia de tu bebé. Una forma fácil de recordar qué hacer es seguir el REAct pasos que se describen a continuación.
R: Reconocer la anafilaxia
Preste atención a síntomas graves como dificultad para respirar, vómitos, somnolencia repentina, hinchazón o síntomas que afecten a dos o más sistemas del cuerpo. Utilice el cuadro anterior para ver cómo pueden ser los síntomas específicamente en bebés y niños pequeños.
E: Epinefrina primero
Si tu bebé o niño pequeño presenta algunos síntomas y no estás seguro de que sea anafilaxia, el mejor enfoque es administrar igualmente epinefrina. El tratamiento temprano puede evitar que una reacción empeore y hacer que tu bebé o niño pequeño se sienta mejor rápidamente.
Coloca a tu bebé en posición después de administrarle epinefrina. Después de administrar epinefrina, posicione a su bebé según sus síntomas:
Si tiene dificultad para respirar o tos:
Sostén a tu bebé en posición vertical contra tu pecho.
Sostén su cabeza y asegúrate de que sus piernas no estén colgando.
Si la cabeza y el cuerpo del bebé están flácidos y sin fuerza, o si es difícil despertarlo:
Acueste a su bebé boca arriba con las piernas ligeramente levantadas.
No levante a su bebé repentinamente ni deje que se mueva demasiado.
Si hay vómitos:
Acueste a su bebé de lado para evitar que se ahogue.
Administre una segunda dosis de epinefrina si:
Los síntomas no mejoran en unos 5 minutos después de la primera dosis, o
Los síntomas regresan o empeoran
Si administra una segunda dosis de epinefrina, llame al 911.
Recordatorio: Mantenga dos dosis de epinefrina disponibles en todo momento. No olvide surtir la receta lo antes posible.
Activar – Activar plan de emergencia
Hoy en día, las pautas permiten un poco más de flexibilidad sobre lo que sucede después de administrar epinefrina para la anafilaxia. Si la anafilaxia de su hijo se trata a tiempo y los síntomas mejoran rápidamente después de una primera dosis de epinefrina, es posible que no necesite llamar al 911. Su equipo de atención médica hablará con usted sobre si esta es una opción para su hijo.
En estos casos…
Es necesario que haya más de una dosis de epinefrina disponible
su bebé no puede tener síntomas graves o potencialmente mortales
otra persona está presente
te sientes cómodo manejando la situación
los síntomas mejoran en gran medida después del tratamiento, y
el equipo de atención médica aprobó esto previamente para su hijo
Llame al 911 si…
no tienes una segunda dosis de epinefrina
los síntomas regresan o empeoran después de la primera dosis de epinefrina
los síntomas no desaparecen rápida o completamente después de la primera dosis de epinefrina
se necesita una segunda dosis de epinefrina
Siga el plan de acción para la anafilaxia de su equipo de atención médica
Cuándo consultar a un especialista en alergias alimentarias
Si bien la conversación sobre las alergias alimentarias de su hijo a menudo comenzará con un pediatra, puede llegar un momento en el que desee que el equipo de atención médica de su hijo incluya a un especialista.
Los especialistas en alergias son expertos en el tratamiento de las alergias alimentarias. Pueden ser médicos (con título de MD/DO) certificados por la junta en alergia e inmunología, enfermeros practicantes (Nurse Practitioners) o asistentes médicos (Physician Assistants/Associates). Muchos especialistas en alergias están capacitados para atender a bebés, niños pequeños e incluso adolescentes. Consulte con el consultorio para confirmar si su especialista en alergias atiende a bebés y niños pequeños. Los especialistas en alergias están capacitados para:
Descubrir la causa de la reacción de su hijo y llegar a un diagnóstico.
Hacer pruebas de alergias (como una prueba cutánea o un análisis de sangre).
Decidir si su hijo necesita una prueba de provocación alimentaria oral supervisada.
Crear un plan de atención que sirva de ayuda para mantener seguro a su hijo y que se sienta mejor.
Ayudar a decidir si pueden ser necesarios tratamientos como inmunoterapia oral o biofármacos.
Trabajar con usted para determinar si una dieta de eliminación es adecuada.
Decidir si debe quitar alimentos específicos de la alimentación de su hijo.
Recetar epinefrina.
Crear un plan de acción ante la anafilaxia.
También pueden ser de ayuda cuando no esté clara la causa de la reacción de su hijo o cuando las alergias afectan la vida diaria.
Crear hábitos para evitar los alérgenos alimentarios es una excelente manera de mantener seguro a tu bebé, y al final del día, es suficiente. Algunas familias pueden optar por tomar medidas adicionales y discutir los diferentes tratamientos para las alergias alimentarias con su equipo de atención médica. En esta página, aprende más sobre los diferentes tratamientos y medicamentos que pueden surgir durante la trayectoria de tu bebé con alergias alimentarias, incluyendo:
Tipos de tratamientos para las alergias alimentarias
Los tratamientos para la alergia alimentaria pueden ayudar al cuerpo de su hijo a ser menos sensible a los alérgenos alimentarios.
Para estos niños, nuevos tratamientos llamados biofármacos pueden ser de ayuda. El omalizumab (Xolair®) es un biofármaco aprobado por la FDA para el tratamiento de las alergias alimentarias. Está destinado a niños de 1 año de edad o más con riesgo de presentar síntomas graves.
¿Qué es el omalizumab?
El omalizumab se administra mediante inyección para tratar la alergia alimentaria de un niño.
Actúa bloqueando una sustancia en el cuerpo llamada IgE. La IgE juega un papel importante en las reacciones alérgicas. Al reducir la IgE, el omalizumab puede ayudar a calmar el sistema inmunitario y reducir las respuestas alérgicas en caso de exposición accidental.
El omalizumab no cura las alergias alimentarias. Su hijo todavía deberá evitar sus alérgenos y llevar epinefrina para emergencias.
Antes de la consulta con su especialista en alergias, considere y recopile información sobre los siguientes aspectos relacionados con las alergias alimentarias de su hijo al hablar sobre el omalizumab como opción de tratamiento:
Sus antecedentes de exposiciones accidentales a los alérgenos alimentarios (número de veces que se utilizó epinefrina, número de visitas a urgencias e ingresos en cuidados intensivos debido a anafilaxia) y lo que sucedió durante esas reacciones.
Si evitar los alérgenos alimentarios ha resultado difícil o insuficiente para prevenir exposiciones accidentales.
Si sus intentos por evitar los alérgenos están afectando su calidad de vida.
Si la gravedad de sus reacciones alérgicas ha cambiado con el tiempo.
Si está dispuesto y es capaz de seguir la pauta de dosificación recomendada para la administración de omalizumab en casa.
Inmunoterapia oral (ITO)
La inmunoterapia oral para alergias alimentarias es una frase larga (a menudo llamada ITO) para un tipo de tratamiento que ayuda a desarrollar tolerancia a alérgenos alimentarios comunes. En otras palabras, ayuda a tu bebé a acostumbrarse lentamente al alérgeno. El objetivo es hacer que el sistema inmunológico tenga menos probabilidades de causar una reacción alérgica grave si se expone accidentalmente incluso a una pequeña cantidad. Funciona administrando una cantidad minúscula de un alérgeno alimentario conocido a tu hijo, luego gradualmente cantidades mayores hasta que se alcanza una dosis de mantenimiento. Esto ayuda a desensibilizar al niño al alérgeno alimentario.
La OIT para la alergia alimentaria siempre debe realizarse con un profesional de la salud capacitado. no ¡Inténtalo por tu cuenta! La inmunoterapia oral (ITO) es un tratamiento relativamente nuevo y no todos los médicos la ofrecen. Hable con su especialista en alergias para más información sobre ITO.
Más información en FAMP-IT, que es una herramienta de apoyo que le ayuda a pasar los primeros años de la alergia alimentaria de su bebé con confianza y facilidad.
Educating families on how to avoid an allergic reaction can greatly reduce the risk of accidental exposures requiring epinephrine or emergency services. Reading food labels and preventing cross-contact are important skills for families to develop.
To help families address all aspects of avoidance, consider using the ACT acronym. The ACT acronym is a simple method to help families remember some of the basics of allergen avoidance and stands for Avoid allergen, Communicate, and Teach.
Avoid Allergen
Oral ingestion is the most common way to have an allergic reaction to food. Before eating, read labels to avoid allergens. Ingredients change without notice, so read labels every time.
Getting allergens on the skin can cause a local rash and hives. Prevent severe reactions by keeping hands out of the eyes, nose, and mouth.
Inhaling cooking fumes, dust, and crushed or powdered forms of food allergens can cause a reaction.
Cross-contact occurs when an allergen is accidentally transferred to an allergen-free food or object. Exposure by cross-contact is a common cause of allergic reactions. It can occur through contact with surfaces, other foods, or transferred saliva.
Prevent cross-contact by cleaning surfaces with dish soap and water or a kitchen spray cleaning agent. Soap + water or hand wipes work well to clean hands, but hand-sanitizing gels do not work.
Communicate
Communicate all necessary allergen information to all caregivers.
Always have a way to reach emergency services: 911.
Teach
Teach avoidance strategies and emergency preparedness to any caregivers responsible for the infant or toddler.
Anyone responsible for serving or preparing food must know how to read a label and how to prevent cross-contact.
DOWNLOAD ACT for Prevent Allergic ReactionsDOWNLOAD AAAAI Ages and StagesDOWNLOAD Author Manuscript – Ages and Stages of Food Allergy
Food Label Reading
The most important take-home points when discussing how to read a label are:
Read every label, every time. Manufacturing, processing, and ingredients can change at any time without warning.
It is impossible to know what’s inside a product by visually inspecting, smelling, or tasting it. Label reading is the only way to know if a food is safe.
Anyone serving or preparing food for a child needs to know how to read a food label.
Food Allergy Labeling Law
The Food and Drug Administration (FDA) enforces the Food Allergen Labeling and Consumer Protection Act (FALCPA) labeling law. FALCPA applies to all domestic and imported packaged foods and the 9 major allergens, which must be written in clear, plain language and labeled when in flavorings, colorings, or other additives.
FALCPA only applies to the 9 major allergens:
Milk or Dairy
Egg
Peanuts
Tree nuts (almonds, hazelnuts, walnuts, pecans etc.)
Note: While the 9 major allergens are responsible for the majority of allergic reactions, ALL allergens must be taken seriously.
The following items are not regulated by the FDA or FALCPA:
Fresh meat and poultry products
Certain egg products
Alcoholic beverages
Non-food items such as lotions and cosmetics
Gluten-containing grains (other than wheat, barley, rye, and oats).
The following items are not regulated by the FDA or the labeling law:
Fresh meat and poultry products
Certain egg products
Alcoholic beverages
Non-food items such as lotions and cosmetics
Gluten-containing grains (other than wheat barley, rye, and oats)
Major 9 allergens can be listed in two different ways
1. Within the body of the ingredients: Allergens can be written in plain language in the body of a products ingredient list.
or
2. Following a “contains” statement: These statements only apply to the 9 major allergens, and companies can choose not to use them.
What About Advisory or Precautionary Statements?
Examples of advisory statements include:
May contain…
Made in a facility that also processes…
Made on shared equipment with…
Contains traces of…
Advisory statements come in numerous formats and are not under State or Federal regulation.
Recommendations on how to manage these statements vary by allergen, physician, and family.
If a patient is waiting for allergist consultation, advise avoidance of foods with advisory statements, as children may be sensitive to even a small amount of the allergen.
Only avoid cautionary statements for allergens that the patient reacted to in the past. Such recommendations may change after seeing a pediatric allergist.
Cross-contact is the presence of unintended food allergen.
It is a common cause of allergic reactions.
Allergens can withstand heating and drying.
Even tiny amounts of allergens are enough to cause a serious allergic reaction.
If a mistake is made when preparing a food, throw out the item and start over.
Routine training for all caregivers about sources of cross-contact is essential.
Common sources of cross-contact:
The following are just a few examples of common sources of cross-contact. See the table at the end of this page for more examples of cross-contact and potential alternatives.
Objects: Utensils, cooking surfaces, highchairs, pacifiers, sponges, bib, apron, etc. Using the same tongs to flip shrimp and a chicken breast. Without properly washing the tongs in-between use, allergens may be transferred to the chicken breast.
Food: Steam, splatter, accidental contamination, frying oil Removing nuts from a salad or scraping cheese off a cheeseburger.
Saliva: People, pets, binky, Sophie the Giraffe, musical instrument, etc. Sucking on another baby’s pacifier after they had a bottle of milk-based formula.
Who needs to know about allergen cross-contact?
Any caregiver, including babysitters, siblings, grandparents, extended family, friends, and teachers. Routine teaching of all caregivers about sources of cross-contact and prevention of exposure is essential.
Things to Consider with Infants/Toddlers:
Children explore their environments with their hands and often put them, or other objects, in their mouths.
Younger children are more likely to put their hands in their mouths and noses; therefore, caregivers should have increased awareness and wash their children’s hands often.
Avoid sharing of food, utensils, water bottles, and anything else that may go in their mouth, such as musical instruments.
Cross-Contamination vs Cross-Contact
Cross-contamination occurs when microorganisms such as bacteria contaminate food and result in a foodborne illness. Unlike cross-contact, the risks of cross-contamination may be eliminated with proper cooking techniques, whereas proper cooking does not reduce or eliminate the chances of a food allergy reaction.
Tips for Preventing Cross-Contact When Serving and Preparing Food
Wash your hands with soap and water after coming into contact with any allergens.
Talk to anyone who serves or prepares food for your child, as they need to understand the concepts of cross-contact.
Keep allergen-free foods away from other foods while they are being stored in the refrigerator or pantry.
Do not allow children with a food allergy to share food, drinks, plates, cups, or utensils.
When grocery shopping, store problematic foods in a separate bag in your cart.
Avoid foods in bulk bins, the deli counter, and hot and cold salad bars as these are common sights for cross-contact.
Cooking
If possible, prepare allergen-free foods first and then prepare food for the rest of the family.
Use separate utensils and serving spoons
It is important to remember that allergens cannot be destroyed by cooking, frying, or freezing.
Avoid foods prepared on surfaces that cannot be cleaned in-between use, examples include a deep fryer, deli slicer, seasoned wok, or common grill surface.
Cleaning
Carefully wash contact items and surfaces with soap and water or in the dishwasher before and after each use.
Wipe down tables, highchairs, toys, pacifiers, menus, salt/pepper shakers, or any other item your child could touch with their hands or put in their mouths.
Do not rely on hand sanitizer products as they do not fully remove food particles.
Common Sources of Cross-Contact
Objects
Source
Examples
Ways to Avoid
Kitchen Utensils, Serving Spoons
Using a knife to spread peanut butter, not cleaning it properly, and then using it to spread jam.
Serving mac and cheese, and then using the same spoon to serve green beans.
Wash utensils and serving spoons in the dishwasher or with soap and water in between each use.
Use separate sets of serving spoons during meals for allergen vs non-allergen food items.
Cooking Surfaces, Cutting Boards, Countertops
Cooking fish or shellfish on the same grill as steak.
Scrambling eggs and then cooking a grilled cheese on the same griddle.
Cutting cheese and then fresh fruit on the same cutting board.
Clean grill surface with soap and water in between uses.
Prepare the allergic child’s food first.
Consider having separate cooking surfaces and cutting boards as allergen-safe.
Clean counters with soap and water or commercial wipes before and after cooking.
Deep Fryers, Cooking Oils, and Seasoned Wok
French fries that have been fried in the same oil as shrimp.
Cooking allergen-safe foods in a seasoned wok.
Avoid food cooked in a common deep fryer.
Consider simple dishes cooked on surfaces that are easily cleaned.
Pots, Pans, Cooling Racks, Small Appliances
Making wheat bread in a bread pan, and then making gluten-free bread.
Blending a smoothie with cow’s milk, and then one with plant-based milk.
Clean properly in-between uses or designate specific pans and small appliances as allergen-free.
Consider cooking the allergy-safe foods first.
Saliva
Source
Examples
Ways to Avoid
Saliva
Kissing your child or cleaning their binky with your mouth after you eat a granola bar with allergens.
Sharing toys, teething rings, pacifiers with other infants.
Sharing utensils, cups, plates, water bottles, food, or drinks.
Pets eat treats with milk and then lick child’s face, or babies eating dog food.
Do not share food, drinks, cups, plates or eating utensils.
Wash properly or wipe down toys, pacifiers, and teething rings regularly.
Keep pet food and treats out of reach of children.
Food
Source
Examples
Ways to Avoid
Airborne
Steam from cooking allergens, such as shellfish in a pot on the stove.
Allergic child inhaling wheat, peanut, etc. flour while preparing baked goods.
Consider not cooking allergens that could travel through steam while the allergic child is home, or avoid these allergens in your home.
Do not prepare or cook allergens in your home.
Hands
Failing to wash your hands after handling nuts, and then preparing your child’s meal, or setting them up in their highchair.
Siblings playing with a toy after eating allergen, and then handing it to an allergic child.
Wash hands with warm water and soap before and after preparing each meal and setting up highchair.
Regularly wipe down toys to decrease risk of exposure from child to child.
Sponges, Dish Towels, Oven Mitts, Aprons
Used a sponge to clean a mac and cheese baking pan, and then the child’s sippy cup.
Wiping hands on apron instead of washing them in between each task.
Considering using disposable wipes, paper towels, or designating specific cleaning instruments for allergen-free cookware and dinnerware.
Wash hands properly in-between tasks.
Avoiding Cross-Contact While Dining Out
Clear Communication:
Talk to the manager and/or chef, not just the server, to ensure they understand your child’s food allergies.
Avoid restaurants with language barriers that make communication difficult.
Call ahead to discuss your child’s allergy with a manager if possible.
Avoid High-Risk Foods:
Do not order combination dishes like stews, soups, and sauces, as they may contain hidden ingredients or be pre-prepared.
Avoid fried foods, salad bars, and buffets, which are common sources of cross-contact.
Research restaurant types beforehand, as certain places (e.g., ice cream parlors) may pose higher risks for specific allergies.
No Sharing:
Never share food that wasn’t prepared specifically for your child with food allergies, as other dishes may not have been made with the same precautions.
When dining out with a child who has food allergies, clear communication is key. Talk to the manager and/or chef, in addition to your server, to ensure that they understand your child’s needs. It’s best to avoid restaurants where there is a language barrier, and clear communication is difficult. If possible, call ahead and discuss your child’s allergy with a manager.
To minimize the risk of cross-contact, avoid ordering combination dishes like stews, soups, and sauces, as they often contain hidden ingredients and may have been prepared before your arrival. Fried foods, salad bars, and buffets are also common sources of cross-contact. Note that certain types of restaurants may be riskier for those with specific allergies (like an ice cream parlor for a child with dairy, peanut, or tree nut allergies), so research beforehand can help mitigate risks.
Finally, never share food that was not prepared specifically for your child with food allergies. The precautions taken in the preparation of your dish may not have been taken for others.
