Table 1 Objectives for each session

Once completed, dietitians should:

Know

Be able to:

• 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

• 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

• 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

• 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

• 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