Quality Improvement Project

Improving Access for Urgent Pediatric Food Allergy Patients

Our clinic is participating in a Quality Improvement Project, supported by Island health, for patients less than 2 years old referred for possible food allergy, with the goal of reducing wait times.

As part of this project, we are now sending information packages directly to caregivers and referring providers. Information packages are tailored to the referral, and include materials to support food allergy prevention through early introduction of common allergy causing foods, along with information to help you manage food allergy concerns while awaiting your visit.

This website contains all of the important handouts, links and videos.

Please refer back to the email you received to determine which category is applicable to your child.
Once you have reviewed the information within the applicable category below, we would be grateful if you could provide anonymous feedback to help us improve this process through a short survey.

+ Possible immediate type (IgE-mediated) food allergy (hives, swelling, breathing problems, vomiting, or signs of low blood pressure immediately after eating a food)

Avoidance

If your child has been referred because of concern for this kind of allergy, you should avoid the food that prompted the initial reaction.

If the reaction was to:

  • walnut OR pecan: avoid both walnut AND pecan
  • cashew OR pistachio: avoid both cashew AND pistachio
    • If you are uncertain which food(s) you should avoid, please contact our office for guidance via email at nursingdrcook@allergyvic.com

    Epinephrine Auto Injector

    If your child has experienced the above symptoms after eating a food having an epinephrine auto injector (EpiPen, Allerject or Emerade) is reasonable.

    If you do not have a prescription and would like one while your child awaits initial consultation please let us know via email: nursingdrcook@allergyvic.com

    Epinephrine is the only medication that will treat the life-threatening symptoms of anaphylaxis (breathing and blood pressure problems.)
    Antihistamines do not treat life threatening symptoms of anaphylaxis. Diphenhydramine (Benadryl) should not be used during allergic reactions, as it does not treat dangerous symptoms of anaphylaxis and has significant side effects.

    When and How to Use the Epinephrine Auto Injector

    Complete the training course at www.allergyaware.ca

    The following video's may be helpful

  • Youtube video of Dr. Scott Cameron administering EpiPen Jr
  • Youtube video of Dr. Scott Cameron administering EpiPen
  • How to use an EpiPen
  • How to use an Allerject

    • Free Training Devices

    You can order training devices shipped to your door: Free Epipen Training Devices

    + Food Allergy Prevention

    The best way to prevent food allergy is by introducing the common allergy causing foods ("priority allergens") into the diet early, at around 4-6 months of age (or whenever your child is developmentally ready) and then eating them regularly. This is particularly important for children who have eczema, asthma, environmental allergies and food allergies, or who have a family member with one of these problems. The sooner we introduce these foods, the lower the risk of reaction. Introducing foods early is very safe. The risk of reaction on initial exposure is extremely low (2-3%) and most reactions are mild involving the skin.

    How Food Allergies Happen

    Please see the following video outlining how food allergies happen and how we can prevent them.

    When trying new foods

    If your child develops any of the following symptoms after trying a new food:

  • Hives or swelling unrelated to contact
  • Breathing problems
  • Vomiting or diarrhea
  • Signs of low blood pressure (turning pale, limp and floppy, hard to wake-up)

    • Then complete the following:

    1. Treat any acute reactions
      For breathing, belly or blood pressure concerns, administer the epinephrine autoinjector if you have one and present to health care attention.
    2. Discontinue this food (or any cross-reactive foods as noted on the checklist)
    3. Take photographs of any reactions, and send to our office for review (nursingdrcook@allergyvic.com)

    Checklists and resources

    Please review the following resources:

    1. Food Allergy Canada - Eat Early, Eat Often
    2. Food Introduction Checklist
    3. Preventing Food Allergies in Infants: Early Introduction to Allergenic Solids
    4. Preventing Food Allergies in Infants at Increased Risk

    + Egg and milk ladders

    If your child experienced reactions with egg or milk, we may recommend that they start the egg or milk ladders.

    A food ladder is a tools designed to facilitate home-based dietary advancement in children with food allergies through stepwise exposures to increasingly allergenic forms of milk and egg.

    Resources

    Please review the following resources:

    1. Using the Canadian Food Ladders
    2. Egg Ladder
    3. Milk Ladder

    + Delayed food allergy - Food protein induced allergic proctocolitis (FPIAP) (blood and mucus in the stool)

    Food protein-induced allergic proctocolitis (FPIAP) is a type of delayed inflammatory non-IgE mediated gut food allergy. Please see the handout below that guides elimination and reintroduction strategies.

    Once your child is old enough to try solids, we recommend that they try the common allergy causing foods (see prevention of food allergy section above).

    Resources

    Please review the following resource:

  • FPIAP Handout

    • + Delayed food allergy - food protein induced enterocolitis syndrome (FPIES)

    Food protein-induced enterocolitis syndrome (FPIES), is a delayed (non-IgE mediated) gut allergic reaction to a food or foods. Please see the FPIES At-A-Glance Handout, and continue to avoid the food(s) that prompted your child's initial reaction.

    Once your child is old enough to try solids, we recommend that they try the common allergy causing foods (see prevention of food allergy section above).

    Resources

    Please review the following resource:

  • FPIES Handout

    • + Related conditions - eczema (atopic dermatitis)

    Eczema is a genetic condition with environmental influences (the microbiome plays a big role). Eczema is not caused by foods, but having eczema places people at increased risk of having immediate type (IgE-mediated) food allergy.

    Good control of eczema is an important part of allergy prevention

    Resources

    Please review the following resources:

    1. Eczema Action Plan
    2. Caregiver Education Education of Atopic Dermatitis in Children
    3. Pediatric Atopic Dermatitis: Caretaker Education

    + Related conditions - asthma

    Asthma is common in individuals with a history of eczema or family history of allergy problems (eczema, environmental allergies, asthma, food allergy).

    Asthma that is not well controlled, increases the risk of severe reactions to foods.

    Some signs and symptoms suspicious for asthma include:

  • Need to present to hospital for breathing difficulties
  • Coughing in the middle of the night
  • Coughing with laughing or crying or big emotions
  • Coughing until vomiting
  • Coughing with activity
  • Needing inhaled medications

    • If your child has any of the above, please track the type and frequency which can be reviewed at their initial visit.
    If you think your child has asthma that is not well controlled please contact our office via email at nursingdrcook@allergyvic.com

    Resources

    Please review the following resource:

  • Childhood Asthma: A Guide for Families and Caregivers