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.
These sections contain the same information as in the PDF handouts throughout this section, but are formatted for easier placement within EMR systems to place in after visit patient handouts.
Label Reading for Food Allergens
Read Every Label, Every Time
You never know what’s inside a product when visually inspecting, smelling, or tasting and this can be dangerous. Label reading is the only way to know if a food is safe.
Manufacturing, processing and ingredients of products can change at any time without giving warning.
Anyone serving or preparing food for a child needs to know how to read a food label.
The 8 Major Allergens Are:
Milk or Dairy Eggs Peanuts Tree nuts (almonds, hazelnuts, walnuts, pecans etc.) Soy Wheat Fish (cod, bass, salmon, tuna etc.) Crustacean shellfish (lobster, shrimp, crab, etc.)
Note: While the 8 major allergens are responsible for the majority of allergic reactions, ALL allergens must be taken seriously.
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 8 major allergens, which must be written in clear, plain language and labeled when in flavorings, colorings or other additives.
Note: FALCPA only applies to the 8 major allergens!
The allergens below are not included in the major 8 allergens and therefore are not included in the labeling law:
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 8 Allergens Can be Listed in 1 of 2 Way
1 WITHIN THE BODY OF THE INGREDIENTS Be aware that allergens may be written in plain language in the body of a products ingredient list.
OR
2 FOLLOWING A CONTAINS STATEMENT
A “Contains” statement:
Only applies to the 8 major allergens.
They are voluntary and are only present when a company chooses to add them to their label.
These should be located immediately under the list of ingredients.
Remember “contains” statements only apply to the 8 MAJOR allergens and companies can choose to not use them.
Advisory or Precautionary Statements
Advisory statements come in numerous formats and are not under State or Federal regulation.
Recommendations vary by allergen, physician, child and family considerations. Talk to your healthcare provider about what to do for your child.
If you are waiting for your pediatrician or allergist consultation, avoid foods with advisory statements as children may be sensitive to even small amount of the allergen.
For example: May contain, made in a facility that uses or processes, made on shared equipment with, contains traces of, not guaranteed to be free of, etc.
Note: For children with celiac disease or gluten sensitivities, it may be best to look for “gluten-free products” because labeling can be inconsistent. Wheat is one of the major eight allergens, but other sources of gluten such as barley, rye and oat are not.
Cross Contact
What is Cross Contact?
Cross contact is the unplanned presence of food allergens. It occurs when an allergen protein is unintentionally transferred to an allergen free food or object. Cross contact can be invisible to the eye and can come from many places. Even small amounts of an allergen can cause an allergic reaction.
This means that your child can accidently be exposed to an allergen through:
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.
Removing nuts from a salad or scraping cheese off a cheeseburger. It is important to avoid these types of short cuts.
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 for your child. Babysitters, siblings, grandparents, extended family, friends, teachers, etc. Routine teaching of all caregivers about sources of cross contact and prevention of exposure is essential.
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 food borne 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
Preparing
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, plate, cups, or utensils.
Saliva, whether from a person or a pet is another source of cross contact.
When grocery shopping store problematic foods in a 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
Allergens cannot be destroyed by cooking, frying or freezing. Avoid foods prepared on surfaces that cannot be cleaned in-between us.
Fried Foods (fryolators), deli slicer, seasoned wok, 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.
Consider carrying wipes with you and try not to rely on hand sanitizer products as they don’t fully remove food particles.
Keep it simple, limit multiple ingredient dishes, cook from scratch.
A pediatric allergist is a medical doctor who specializes in managing allergic issues for children. Allergists perform the following procedures to screen patients for allergies and can help patients interpret the results to proceed with allergy management:
Skin prick testing (SPT): also known as a scratch test, a tiny droplet of an allergen is placed on the skin, then lightly scratched. Allergists wait 15 minutes to observe for a reaction in the form of a hive
Blood testing: a blood test called Immunocap Specific IgE, measures the concentration of antibodies created in response to the presence of antigen that the body deems harmful
Oral Challenges: a procedure where a patient is administered incrementally increasing doses of a food or drug to assess if they are tolerant to it.
When experiencing any of the following allergic issues, an allergist can also assist patients in determining the best course of treatment:
Anaphylaxis, a severe allergic reaction involving one or more bodily symptoms
Food Allergies, in which a patient may experience any of the following symptoms, including but not limited to urticaria, angioedema, itching, wheezing, or gastrointestinal symptoms, if they are exposed to a food allergen they are allergic to. Drug allergies, such as to different medications
Environmental allergies, to things common in different environments, including pollen, dust, pet dander, and mold.
Stinging insect allergies, such as to bees
Pediatric allergists also help managing non-IgE mediated allergies and various atopic conditions, including the following:
Allergic rhinitis, inflammation of the nose in response to allergens in the air and surroundings. This may cause symptoms including stuffy nose or rhinorrhea (a runny nose)
Asthma, and related issues including therapies,, reliver medications, and associated rhinitis or sinusitis
Atopic Dermatitis (eczema), and all other issues related to eczema including, contact dermatitis, environmental allergies, etc.
Eosinophilic GI disorders, and helping patients determine what foods may be causing GI issues
DOWNLOAD AAP Specialty Consult Request form
Older populations can participate in studies that utilize immunotherapies (including oral immunotherapy, subcutaneous immunotherapy, or sublingual immunotherapy), which may help research subjects decrease the likelihood of reacting to foods that they are allergic to.
For infants and toddlers specifically, pediatric allergists assist families to determine when and in what form to introduce commonly allergenic foods into the diet, and what strategies and steps to take in the lifestyle and in the home to prevent the development of food allergies. Allergists work closely with families to determine the best course of action for their child’s health needs and help guide families on how to integrate foods back into an infant or toddler’s diet over time and/or in a controlled setting. They are able to update families on the most up to date science when it comes to food allergies in this population.
The American Academy of Pediatrics Specialty Consult Request is a referral form that general pediatricians can use to refer their patients to see a pediatric specialist. If you would like to refer your child to see a pediatric allergist, pediatric dermatologist, pediatric gastroenterologist, or any other pediatric specialist, please complete this form and send it to the applicable specialist.
On these sheets, there are sections where you as the primary care provider can specify what clinical problems your patient may be experiencing where you would like a pediatric specialist to also assess. If you have specific questions related to your patient’s care that you would like addressed with the specialist, those can also be specified on this form. Directives to the specialists for care can also be provided on this sheet, including any prior interventions and relevant patient history.
