1. The Food Allergy Patient
Presented by: Ned Rupp, MD

2. Accreditation Information:
The Lowcountry Regional Allergy Update
January 21, 2017
Roper St. Francis Healthcare CME Disclosure Policy:
As a continuing medical education provider, accredited by the South Carolina Medical Association, it is the policy of RSFH to require all individuals in a position to influence educational content and development of a continuing medical education activity to disclose all relationships with commercial interests. This information is disclosed to all activity participants.
The following relationships have been disclosed:
Dr. Ned Rupp, Dr. Patricia Gerber, Dr. John Ramey and Erin Copenhaver have received Grant/Research Support from:
Alcon Pharmaceuticals, Amphaster, Apotex, Astellas, AstraZeneca, Boehringer Ingleheim, Genentech, GlaxoSmithKline, Magna Pharmaceutical, MAP Pharmaceuticals, MedImmune, Merck, Novartis, Sanofi-Aventis, Sepracor (Sunovain), Teva Pharmaceuticals, Vecture, Inflamax, Aimmune, Regeneron, Baxalta.
The following Speaker has nothing to disclose with regards to financial relationships: Dr. Sangeeta Jain
The following Planners: Kara Melin and the CME Committee, Amber Murphy, have nothing to disclose with regards to commercial support.
Target Audience: Physicians and Other Allied Health Professionals
Accreditation Statement:
Roper St. Francis Healthcare designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Roper St. Francis is accredited by the South Carolina Medical Association to provide continuing medical education for physicians.
Educational Grant Support:
This activity is supported by an independent educational grant from Shire Immunology, Mylan Inc., Meda, Teva, Sanofi, AstraZeneca, CVS Specialty-Coram and Novartis, Boston Scientific, CSI Behring, Pronetics/Axelacare Infusion
To Receive CME Credit:
Fill out the evaluation and CME Attestation form given to you as part of the handouts. Turn the form in to the registration desk at the end of the meeting. A certificate of credit will be ed to you in 4-6 weeks. If the information on the attestation form is not filled out, a certificate cannot be issued to you. Please print clearly! If you have questions, please call Kara Melin in the CME Office at

3. “Here We Go Again”
Mother calls primary provider’s office with concerns about milk, soy, egg and gluten allergy for 2 ½ year old.
A few episodes of projectile vomiting
Skin rashes that quickly resolve with benadryl

4. Past Medical History AD onset at 6 months of age Wheezing at 18 months
Diagnosed with mild persistent asthma by allergist
Immunizations up to date
Tolerated the Influenza vaccine

5. “Here We Go Again” (cont.)
Records state you referred pt. for allergy evaluation for AD and wheezing at 18 months of age.
Consult Note: egg and peanut sensitivity
-Egg now integrated into diet
-Peanut and Tree Nut avoidance due to AD, wheezing and sibling with positive skin testing
Mother states patient was eating the following before episode
-2% lactose free cow’s milk
-Chicken nuggets
-Carrots with ranch dressing
-Hummus (daughter’s favorite food)

6. The Culprits Shellfish/Fish Peanuts/Tree Nuts Wheat/Other Grains
Milk/Egg/Soy
Seeds

7. Age Associations Younger Population Milk Egg Peanut Older Population
Shellfish
Tree Nuts

8. Reactions Most Severe: Tree Nuts (Adults) Peanuts (Children)
Most Frequent: Shellfish (Adults)
Peanut (Children)
Resolution: 20%- Peanut & Tree Nuts
- Fish & Shellfish
85%- Egg & Milk

9. Cannot Assess Risk Level
Food Allergy Warnings
Cannot Assess Risk Level
Better labeling
Better education
Better training

10. Treatment Avoidance: fear of accidental ingestion
Epi-injector: NECESSARY (equivalent to an auto airbag)
Desensitization: Oral and Epicutaneous

11. Why We Treat?
Safety
Psychosocial

12. Questions?