Food Allergy Assessment Note - English

Clinician Specialty: Allergy and Immunologist **ID:** PATIENT001 **RFC:** Assessment of suspected peanut allergy following recent adverse reaction. **Ref MD:** Dr. Sarah Jenkins **PMHx:** Childhood asthma, well-controlled on salbutamol PRN. No other significant medical history. **Atopic Hx:** Asthma (Most recent PFT: FEV1 2.5L, FVC 3.2L, ratio 78%) Allergic rhinitis: Seasonal, managed with OTC antihistamines. Eczema / Urticaria: Intermittent patches of eczema on elbows, controlled with topical corticosteroids. Medication: Salbutamol inhaler PRN, Loratadine PRN. Undergoing allergy immunotherapy: no **FHx Atopy:** Maternal grandmother with hay fever. Paternal uncle with peanut allergy. **Social:** Occupation: Student (Year 7) Home environment: Lives with parents and younger sibling. No pets. **Habits:** Smoking: Never smoked. EtOH: Denies alcohol intake. Drugs: Denies recreational drug use. **Meds:** Salbutamol inhaler PRN, Loratadine PRN. Has private insurance: yes **HPI:** Details of food reaction symptoms: On 1 November 2024, patient consumed a small portion of a pre-packaged snack bar containing peanuts. Within 10 minutes, developed facial swelling, generalised urticaria, and difficulty breathing with wheezing. Subsequently experienced abdominal pain and vomiting. Food ingredients ingested, quantity and preparation: Approximately 10g of a commercially prepared 'Nutty Crunch' snack bar, clearly labelled as containing peanuts. Ingested raw peanuts. Associated symptoms: Facial angioedema, generalised erythematous urticaria, wheezing, dyspnoea, abdominal cramps, vomiting. Timing of onset/resolution of symptoms: Onset 10 minutes post-ingestion. Symptoms progressed rapidly. Resolved partially after self-administration of antihistamines and hospital treatment with adrenaline. Medications required: Patient self-administered Loratadine. Required intramuscular adrenaline and corticosteroids at the emergency department. Frequency of symptoms associated with ingestion and consistency of manifestations: This was the patient's first known exposure to peanuts. Reaction was severe and consistent with anaphylaxis. Cofactors: NSAID use: Denies NSAID use. Exercise: No exercise immediately prior to reaction. Stress: No unusual stress. EtOH: Denies alcohol intake. Fever: No fever. Food diary: Patient reports no other new foods introduced around the time of the reaction. Typical diet recorded as varied and healthy. **O/E: deferred** General: Alert and oriented, no acute distress. Vital signs stable. (Examination deferred as the incident occurred previously and patient is currently asymptomatic). Chest: Clear to auscultation, no wheezes or crackles. Good air entry bilaterally. Skin: No active lesions, urticaria or angioedema resolved. **Skin prick testing:** Inhalants: Positive for: House dust mite, grass pollen Negative for: Tree pollen, cat dander Foods: Positive for: Peanut (wheal 8mm, flare 25mm) Negative for: Tree nuts (almond, walnut, cashew), cow's milk, egg, soy, wheat **Other Ix ** Specific IgE to peanut: 45.2 kU/L (High, consistent with sensitisation). **Diagnosis** IgE mediated hypersensitivity reaction to peanut **Plan:** **Anaphylaxis** – Patient educated on allergen avoidance and instructed on anaphylaxis recognition and management. Instructed on how to use an Epipen and to carry at least one at all times, preferably two. Can use second generation non-sedating antihistamines alongside for additional symptom relief. Written action plan provided. Printed resources provided to patient. **MedicAlert bracelet** application made. **Follow up in** 3 months for review and further education.