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

The journey

Patient Family Food industry Community School

the home front

Young mother, much older father Closely surrounded by extended family 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

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

An accident waiting to happen

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

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

Bidat E. 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

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

Fighting the good fight

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

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

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

Growing older with food allergies

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

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

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

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