Egg, wheat, soy, fish and shellfish allergy

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Target exams

Red flags

• Any reaction within minutes to two hours of eating egg, wheat, soy, fish or shellfish involving urticaria, angioedema, vomiting, wheeze, stridor, hypotension or collapse
• Biphasic or refractory anaphylaxis, which can recur four to thirty hours after the initial reaction and demands observation
• A food-allergic child with uncontrolled asthma, the single strongest risk factor for fatal anaphylaxis
• Adolescents, who carry the highest risk-taking and biphasic-recurrence fatality profile
• Wheat-dependent exercise-induced anaphylaxis: collapse during exertion one to four hours after wheat, driven by omega-5-gliadin
• Fish or shellfish reaction with respiratory features, as parvalbumin and tropomyosin are heat-stable and cross-reactive across many species
• Delayed profuse vomiting and lethargy two to four hours after egg, wheat or soy signalling food protein-induced enterocolitis syndrome (FPIES)
• A child on a long-term elimination diet without confirmed allergy, risking nutritional deficiency and impaired quality of life

Life stages

Care settings

Clinical exam formats

Board mappings

• Takes an allergic-reaction history and identifies the likely trigger food
• Orders and interprets skin-prick tests and food-specific IgE
• Recognises anaphylaxis and gives intramuscular adrenaline
• Uses component-resolved diagnostics to separate heat-labile from heat-stable allergy
• Counsels families on baked-egg and baked-milk ladders and natural-history prognosis
• Designs a supervised oral food challenge and an ASCIA action plan
• Recognition and emergency treatment of food-induced anaphylaxis
• Diagnosis of egg, wheat, soy, fish or shellfish allergy using SPT, specific IgE and challenge
• Differentiating IgE-mediated allergy from FPIES, coeliac disease and eosinophilic oesophagitis
• Long-case management of a child with multiple food allergies and nutritional risk
• Communication of an anaphylaxis action plan and adrenaline autoinjector training to the family and school
• Counselling on the prognosis of each food allergy and the timing of re-challenge
• Level 1: Recognises food allergy and anaphylaxis
• Level 2: Investigates and initiates management of common childhood food allergies
• Level 3: Leads oral food challenge and component-resolved diagnostic reasoning in complex allergy
• Major allergen proteins: ovomucoid, omega-5-gliadin, Gly m 5/6, parvalbumin, tropomyosin
• Heat stability and its relationship to baked-food tolerance
• Natural history and resolution rates of egg, wheat, soy, fish and shellfish allergy
• History-taking and interpretation of tests in a child with suspected food allergy
• Communication of an allergy action plan and dietary advice
• Assessment of the acutely allergic child
• Diagnosis of IgE-mediated food allergy by SPT, specific IgE and oral food challenge
• Recognition and management of food-induced anaphylaxis with intramuscular adrenaline
• Counselling on avoidance, cross-reactivity and natural history
• Recognition and resuscitation of food-induced anaphylaxis
• Risk-stratified outpatient allergy management and dietary counselling
• Identification and management of FPIES and other non-IgE food reactions
• Diagnosis and natural history of common paediatric food allergies
• Component-resolved diagnostics and supervised oral food challenge
• Anaphylaxis prevention, action plans and adrenaline autoinjector selection