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Table 1 Objectives for each session

From: The development and implementation of a training package for dietitians on cow’s milk protein allergy in infants and children based on UK RCPCH competencies for food allergies – a pilot study

Timing & Topic Competences/objectives
  Once completed, dietitians should:
  Know Be able to:
9.30-10.00 Background to allergy • the major categories of adverse reactions to foods • recognise that food allergy may present in a variety of ways ranging from immediate allergic reactions to more chronic presentations such as eczema or gastro-intestinal symptoms
• that food allergy may present in a variety of ways
• that many common childhood conditions e.g. eczema, gastro-oesophageal reflux may have an allergic aetiology
• that food allergy is more common in children with early onset eczema, particularly mild to moderate eczema • recognise the risk factors for allergic aetiology of presenting features such as family or personal history of atopy
• the common foods which are responsible for most food allergies in children • differentiate different types of adverse reactions to food based on findings from history and examination
10.00-11.15 Diagnosis & interpreting tests • that the level of sIgE varies and should not be used in place of oral food challenges to determine allergy e.g. cow’s milk • take and interpret an allergy focused clinical history
• that skin prick tests and sIgE have a poor predictive value for non-IgE mediated allergies • differentiate different types of adverse reactions to food based on findings from the history
• that atopy patch tests are available but that their role in the diagnosis of food allergy remains unclear • gather information on relevant exposures to other potential food allergens and take a dietary history including the interpretation of a food and symptom diary
• that complementary and alternative medicine allergy tests, including kinesiology, serum sIgG and vega tests have no place in the diagnosis and/or management of food allergy • interpret SPT results in the context of the clinical history
• interpret serum sIgE results in the context of the clinical history
11.30-12.45 Diagnostic diets & food challenges • which diagnostic diet is appropriate to use according to symptoms • advise about the safe reintroduction of cow’s milk following a negative food challenge
• which formulas are available for managing CMP allergy and lactose intolerance • recommend an appropriate formula according to symptoms and clinical history
• which oral challenges may be done as open challenges, which need medical supervision and which are suitable for home  
• when it is appropriate to challenge and how to decide on challenge outcome
13.30-14.30 Dietary management • what foods (including catering, manufactured ingredients and manufactured foods) are likely to contain trigger foods • advise on appropriate dietary exclusion and alternatives including practical individualised advice (e.g. appropriate to age, culture etc. )
• clinically relevant cross-reactivities • educate patients, parents and carers about effective food allergen avoidance including high risk situations e.g. eating out
• common situations when allergen exposure is most likely to occur (e.g. eating out) • advise patients, parents and carers of issues relating to risk in specific situations e.g. school
• the risks inherent to specific situations (e.g. home, school, eating out and hospital settings) • provide support to patients and families to help minimise the impact of food allergy on quality of life through education, ongoing access and patient queries
14.30-15.30 Nutritional issues & weaning • how to recognise that faltering growth is a result of food allergy • give practical advice on weaning the cow’s milk allergic infant
• when it is appropriate to refer to other health care professionals • provide details of resources including patient charities, websites and local support groups
• ensure the nutritional requirements of infants and children on a CMP free diet are met
• manage nutritional deficiencies and faltering growth
15.45-17.00 Case studies discussion and final assessment
  1. CMP; cow’s milk protein, sIgE; specific IgE, sIgG; specific IgG, SPT; skin prick tests.