The other side of food allergies

1. The other side of food allergies Dr. Elizabeth Kiragu Paediatric Allergy Specialist Aga Khan University Hospital, Nairobi KPA Conference 10th April 2019

2. The journey

4. the home front

5. 2 year old girl • Severe cow milk allergy on EHCMF • Multi trigger wheezer controlled on ICS • Young mother, much older father • Closely surrounded by extended family • English reading and oral skills limited • Issue – frequent accidental exposure to milk in the home

6. Allergen avoidance • Educate all care givers • Define the allergen • Forms of that allergen • Reading labels • Hidden antigens • Age appropriate behaviour modification

7. An accident waiting to happen

8. 4 year old boy • Severe cow milk allergy • Uncontrolled asthma not on treatment • Family of 2 boys, older child also has asthma not on any treatment and food allergies • Dad is a doctor

9. Issues • Parties, outings, restaurant visits present a risk of reaction • Delay in recognition of severity of reaction • Unprepared to manage a reaction • False sense of security

10. The ability of a parent to assess risk and manage their child’s condition is highly dependent on their own knowledge, attitude and beliefs about food allergy Bidat E.

11. Take home • Family education • Regular follow up- • Assess food allergy status • Manage associated conditions • Re evaluate use of emergency medication

12. Fighting the good fight

13. 9 year old boy • Ex prem 34/ 40 • Severe uncontrolled asthma on maximal therapy • Anaphylaxis to egg, moderate immediate reactions to fish, beans • EOE – dairy, • FTT • Eczema, Allergic rhinitis

14. Model food allergic patient • Particular about his food • Recognise an allergic reaction immediately • Institute emergency treatment

15. Challenges at school • School acceptance – administration, parents and other children • Policy to prevent exposure to allergens • System to manage acute reactions • Class parties, trips, games, fun days, hospital admissions • Bullying

16. Growing older with food allergies

17. 14 year old girl • Uncontrolled asthma • Allergic rhinitis • Moderate atopic eczema • Severe allergy – Peanut, Hazelnut, shell fish

18. issues • Poor adherence to asthma & rhinitis treatment • Deliberate exposure to food allergens • Delay in using emergency treatment

19. High risk group • Getting more independent • Easily influenced by peer pressure • Desperate to fit in • Risk taking behavior • Food allergies in later childhood are more severe • Augmenting factors

20. Way forward • Engage them in their management • Figure out their priorities • Re - emphasize the dangers • Involve family and friends • Counselling