dr david coghlan consultant paediatrician national ... · dr david coghlan consultant paediatrician...

Dr David Coghlan

Consultant Paediatrician

National Childrens Hospital, Tallaght

Beacon for Kids, Beacon Hospital

Clinical Specialty Lead CHI

The most important ‘test’ in food allergy is a clear history!

Must establish relationship between food intake and the appearance of symptoms

Allows you decide ‘likely’ versus ‘unlikely’ food allergy

ONLY when identify likely culprit food from history, should SPT or Specific IgE looking for sensitisation be undertaken

If unsure refer but NO ‘food panels’ please

The most valuable information in identifying the culprit food in IgEallergy is the temporal relationship-minutes to 2 hours between the ingestion of food and onset of symptoms

Causes:

1. Genetic predisposition

2. Abnormal skin barrier function

3. Immune dysregulation

Eczema is a skin barrier disorder

Characterised by dry, itchy and inflammed skin

Prevalence 15-20% Irish children-INCREASING!

Chronic relapsing course

Resolves in majority, persists 20 %

Associated atopy

Food allergy associated in 30% of severe cases

Measurement Total serum IgE little value

Positive Allergen Specific antibodies ALONE do not confirm AR

Not all nasal obstruction is Rhinitis

Adenoid hypertrophy-mouth breather, discoloured secretions, snoring

Foreign Body-Unilateral discharge

Sinusitis-always have inflamed cavity, discoloured secretions, headache, halitosis, cough!

PITFALLS:

NB B N #

,.K./

J,.K

CAUSATION:

• Most atopic paediatric

patients do not follow

the “atopic march”;

multiple trajectories of

disease progression

exist

Figure based on Belgrave DC, et al. PLoS Med. 2014;11:e1001748.AD, atopic dermatitis.

Well recognised increased risk of progression from atopic dermatitis/eczema to other atopic diseases (Rhinits, FA, Asthma)-Atopic March

True allergy is a CLINICAL diagnosis supported by diagnostics and in some cases formal challenges

Temporal relationships to food ingestion and emergence of symptoms crucial

Many more people have sensitisations than have true allergy

No validation of IgG testing in children-

Any Questions

Allergy 4 All ClinicFor Appointments:

info@allergy4all.ie086-073-6297