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Sample Food Allergy Guideline |
By Jeffrey E. Keller MD |
Published: 11/19/2018 |
Today’s post is the second in a series of sample clinical guidelines. All of these sample guidelines will be placed under the “Guidelines” tab (above) as they are published. I view these sample guidelines as a group effort! If you have a suggestion, critique or simply a better way to phrase some concept, say so in comments. I wrote about food allergies previously on JailMedicine in “Food Allergies: Sorting Out Truth from Fiction”. Since then, I have had more email requests for a Food Allergy guideline than all other sample guidelines put together. It is clearly a BIG issue in corrections. This clinical guideline is intended to be used as a template to help clinicians and administrators create their own policy on personal footwear. This sample guideline must be modified to make it applicable to each unique correctional facility. This guideline is not intended to apply to all patients. Practitioners should use their clinical judgement for individual patients. Introduction. In a correctional setting, the ability to differentiate true food allergies from simple food aversion is essential. On the one hand, jails and prisons do not want someone with a true food allergy to be served that food and suffer an allergic reaction. On the other hand, some inmates who have no true food allergy may use the claim of an allergy to avoid foods they do not like, to gain status among other inmates and to manipulate staff. The goal is to accurately identify those individuals with a true food allergy and exclude those who do not have a true food allergy. Reference: The main reference for this guideline is “Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report.” National Institute of Allergy and Infectious Diseases. U.S. Department of Health and Human Services, National Institutes of Health. December 2010. Readers with questions or wanting more detail should refer to this document. Definitions. IgE Food Allergy refers to an IgE mediated allergic reaction to the glycoproteins in certain foods. These allergic reactions are characterized by urticarial rash, angioedema, breathing difficulties, and/or anaphylaxis. IgE food allergies are most common in infants but many of these patients lose their allergy over time. Most adults who report a food allergy are found by diagnostic testing to not, in fact, have an allergy. Most cases of true food allergy in adults are to peanuts, treenuts, shellfish, or fish. An estimated 100 people die each year from acute allergic reactions, most commonly to peanut or tree nuts. Almost all of these patients have had previous anaphylactic reactions to the food in question. Non-IgE food allergy refers to reactions to food that are not mediated by IgE, such as Celiac Disease. Non-IgE food reactions tend to have different symptoms, be more insidious and difficult to diagnose than IgE reactions. Food intolerance refers to non-allergic reactions to food, including:
Treatment. A patient with a positive IgE immunoassay but no documented history of anaphylaxis may require only a diet free of the particular food. Any other treatments for such a patient will depend on observed signs and symptoms. Treatment of a patient with a history of anaphylaxis should is two pronged, avoiding the food in question and being prepared for an acute allergic emergency.
Other articles by Keller |
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