Paeds Cases · allergy-and-immunology
Explain a food allergy diagnostic plan and challenge to an anxious parent — OSCE
OSCE communication station: explaining the food allergy diagnostic pathway — the role of clinical history, targeted testing, component-resolved diagnostics, and oral food challenge — to a parent anxious about her child's positive allergy test, while addressing the difference between sensitisation and clinical allergy and planning a safe diagnostic pathway.
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Candidate instructions (2 minutes reading time)
You are the paediatric registrar in the allergy clinic. Mrs Chen has brought her 2-year-old daughter, Sophie, for review of a positive peanut allergy test. The GP ordered a food allergy panel because Sophie has moderate eczema. The SPT to peanut was 6 mm; all other foods were negative. Sophie has never eaten peanut. Mrs Chen has read online that a 6 mm wheal means a "severe allergy" and is anxious. [1]
Your task: explain what the SPT result means (sensitisation versus clinical allergy), outline the diagnostic pathway, address safety concerns, and agree on a plan. You have 8 minutes. [3]
References4ShowHide
- [1]Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol, 2010.PMID 21134576
- [2]Sicherer SH, Sampson HA Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol, 2018.PMID 29157945
- [3]Foong RX, Dantzer JA, Wood RA, et al. Improving Diagnostic Accuracy in Food Allergy. J Allergy Clin Immunol Pract, 2021.PMID 33429723
- [4]Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States. Ann Allergy Asthma Immunol, 2017.PMID 28065802