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