New food Allergy Consult - with testing results

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Chief Complaint

New Allergy Consult

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New Allergy Consult: [name] is a [age] old [gender] who was accompanied by ­[relation] [name], [relation] [name] to the [hospital] on [date]. Family physician: [title] [name] (referral [date]) Problems: 1. Food allergy. -[food_item]: at [age], given [food_item], hives within minutes on the face, lasted [duration]; initially had [amount] of [food_item], then [amount]; then stopped trying, but re-tried [age] and milder symptoms, and now no symptoms the past few months; now whole [food_item] in [food_preparation] (made with whole [food_item]) is what they give, also [food_item] cooked, has not given [food_item] on own but has [food_preparation] with [food_item] in it; whole [food_item] given [frequency] since [age] -[food_item]: [food_preparation], first time was Ok at [age], then given again at [age], vomiting [duration] after, no other symptoms; then [age] called [emergency_service] ([number] emesis rounds), taken to [hospital], [medication], they thought stomach flu; tried [number] times, most recent was [age]; [amount] each time with [food_preparation], no diarrhea -[food_item]: has a bit of [food_preparation] (doesn't like, tried [number] times); afraid to try other [food_group] -Ok with [food_item] in [food_preparation], Ok with [food_item], [food_item], [food_item], [food_item], [food_item] -no [medical_device 2. Eczema. -first [duration] was more severe -now better, mild, random spots, face or abdomen, buttocks; body [medication], face [medication]/[medication]; uses for a few days -seen Dermatology (online) for facial dermatitis when [age], who recommended [treatment], and topical medication, viral triggers; [title] [name] consulted online Dermatologist [title] [name] -saw a naturopath once but they found approach aggressive including [medication] (vomited with it) Past Medical History: -no history of asthma -birth history: born at [gestational_age], [weight], unremarkable -Immunizations up to date. Normal growth and development. -Review of systems unremarkable Family/environmental history: -[relation] does not have allergy/asthma, [occupation] -[relation] eczema + asthma young, [occupation], has extended health -At home, no pets; mold in [residence] Physical examination: Height/Length Measured: [height] ([date])Height Percentile: [percentile] ([date])Weight Measured: [weight] ([date])Weight Percentile: [percentile] ([date]) Examination of the ears, nose, throat did not reveal any abnormalities. The cardiovascular, respiratory examinations were unremarkable. [body_part] had a [size] area of discrete hyperpigmentation. InvestigationsFood/Environmental [date] Histamine Comment: Positive Saline Control Comment: Negative [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] [allergen] W: [value] L: [value] A: [value] Impression and recommendations: 1. Outgrown [food_item] allergy. -negative testing to [food_item] today -going forward continue to eat [food_item] weekly, to prevent future re-development of [food_item] allergy -some who outgrow cooked [food_item] allergy still react to raw [food_item] 2. [food_item] FPIES (food protein induced enterocolitis): -the history (delayed vomiting) and negative [food_item] skin test confirms this diagnosis -if they don't do some sort of re-introduction protocol there is a risk of conversion to IgE-mediated [food_item] allergy from prolonged avoidance -a [food_item] ladder was given to them for gradual re-introduction over months -no [medical_device] is needed for FPIES 3. Prevention of other food allergy: -the [food_item] result was a false positive as [pronoun] has tolerated eating [food_item] previously and the skin test size was very small and unconvincing -they should give [food_item] and other [food_group] regularly (e.g. weekly) to prevent future development of allergy to these foods, and the negative testing will hopefully give them more confidence for introduction -the same principle applies to other food allergens -they plan on having another baby, and the exact same advice would apply Follow-up: in [duration] for a virtual visit to see how the [food_item] ladder is going. Thank you kindly for your referral.