Paeds Cases · allergy-and-immunology
Peanut allergy diagnosis and action plan — communication OSCE
OSCE on confirming a new nut allergy diagnosis without overdiagnosis, explaining sensitisation versus clinical allergy, co-designing an action plan with an adrenaline autoinjector, and framing prevention for a younger sibling.
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Target exams
MRCPCH ClinicalRACP DCE
Prompt
Parents of a 2-year-old girl attend after she developed lip swelling and urticaria within minutes of eating peanut butter. They have stopped all nuts at home and ask for an allergy test and 'the strongest medication'.
Objectives
- Confirm a new nut-allergy diagnosis with a structured history and appropriate testing, avoiding overdiagnosis of sensitisation. [14]
- Explain sensitisation versus clinical allergy and the role of the oral food challenge in plain language. [14]
- Co-design a written anaphylaxis action plan and prescribe and train the family in an adrenaline autoinjector. [12]
- Address unnecessary blanket nut avoidance and reassure about nutrition and quality of life. [14]
- Frame primary prevention for a younger sibling using the LEAP evidence. [1]
References4ShowHide
- [1]Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med, 2015.PMID 25705822
- [3]Peters RL, Allen KJ, Dharmage SC, et al. Natural history of peanut allergy and predictors of resolution in the first 4 years of life. J Allergy Clin Immunol, 2015.PMID 25725989
- [12]Shaker MS, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations. J Allergy Clin Immunol, 2020.PMID 32001253
- [14]Santos AF, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy, 2023.PMID 37815205