CPD – Casebook: Allergy

Case 1

The rather anxious mother of a two-year-old boy presents with concerns about his ‘multiple food allergies’. She describes a number of symptoms, some of which (temper tantrums and being picky with food) do not sound allergy related, some of which (episodes of urticaria, once or twice with lip swelling) probably do, and many of which, including cough, constantly runny nose and occasional diarrhoea, could be. She is keen to have him ‘allergy tested’ and wonders if he should have an adrenaline autoinjector, as suggested by a casualty officer on one occasion when he was seen in A&E.

1. In a case like this, when many symptoms are presented, how can the GP work out whether allergy is likely to be the problem (or a significant part)?

The most worrying possibility is IgE-mediated food allergy, which would be highly likely if the urticaria and lip swelling occur minutes after eating specific foods. His gastrointestinal and respiratory symptoms could be due to recurrent infections, but non-IgE food allergy, respiratory allergy and other conditions are possible. There is enough here to justify referral to a paediatrician with an interest in allergy who can test for immediate hypersensitivity and consider other diagnoses. The clinical history of typical allergic symptoms with close temporal relationship to triggers is of key importance. A careful allergy-focused clinical history is essential.¹

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