Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Food Allergies 585

General Measures

■Consider non-immunologic causes for symptoms

■Perform diagnostic test, chosen based on severity of reaction/food

diary

■Referral to allergist or nutritionist for more advanced workup and

education about avoidance of particular groups of foods

specific therapy

■Based on recognition of disorder, cause and avoidance of offending

agent, use of antihistamines, steroids and/or epinephrine

■Side Effects & Contraindications

➣Glucocorticoids: Cushing’s syndrome, hyperglycemia, infec-

tions, psych disorders, insomnia, HPA axis suppression, glau-

coma, cataracts, hypertension, myopathy, osteoporosis, peptic

ulcer, electrolyte disorders

Contraindications: infection

➣Antihistamines: Drowsiness, anticholinergic effects, paradoxical

excitement, blood dyscrasias, hypotension

➣Epinephrine: hypertenison, headache, palpitations, cerebral

hemorrhage, tachycardia, pulmonary edema, anxiety

Contraindications: cardiac disease, organic brain damage

➣Elimination diet: maluntrition, eating disorders (solid diagnostic

criteria must be met before prescribing a strict elimination diet)

follow-up

■Proper education of patient and family members of what agents

to avoid, signs and symptoms to be watchful for, and emergency

treatments such as self-administered epinephrine

complications and prognosis

Complications

■Rash/pruritus

■Gastrointestinal bleed

■Weight loss

■Malabsorption

■Anemia

■Anaphylaxis: Cardiovascular and respiratory collapse

■Death

Prognosis

■Prognosis is good if serious reactions are recognized and treated early

■No alteration in lifespan of mild reactions