Join Dr. John Leung, a gastroentergologist and allergy specialist at Boston Food Allergy Center, as he shares his step-by-step process for identifying and referring patients with food allergy symptoms.
Announcer: You're listening to ReachMD. Welcome to Cracking the Code on Peanut Allergies, brought to you through an independent educational grant from Aimmune Therapeutics.
On this episode, we'll hear Dr. John Leung, Director at the Center for Food Related Diseases at Tufts Medical Center in Boston, Massachussets. Dr. Leung speaks to the critical role of gastroenterologists in food allergy management. Here's Dr. Leung now.
Dr. Leung: When a patient comes in complaining of food allergies, the first step is to get a detailed history of what symptoms they have. Do they have swallowing difficulties? Do they have abdominal pain? Do they have bloating? Do they have diarrhea? Do they have constipation? Do they have skin finding? Do they have any other symptoms to suggest it is a food allergy that I have to worry about and have to refer to my allergy colleagues? For example, if someone described a severe reaction after eating peanuts; they pass out, their blood pressure becomes very low, and they develop anaphylaxis, then those patients will be referred to the allergist colleague directly. If someone comes in with some abdominal pain, some swallowing difficulties, then we may have to think about a diagnosis such as eosinophilic esophagitis, which is a food allergy affecting only the esophagus, but does not have any potential to develop into anaphylaxis. So, our approach is to take a very detailed history and ask about every single reaction. How soon after they eat their food do they develop a reaction? What is the reaction? And is there any other associated symptoms? What other organs are affected? The timing of the event; does it happen again, and again, and again? Does it respond to antihistamine? Do they need to use Epi pen? So, there’s a whole bunch of questions that we ask until we have a very clear picture of whether this food allergy can develop into anaphylaxis or this is a food allergy just affecting the GI tract. Sometimes, because I’m also an allergist, if the patient complains about symptoms that is consistent with reaction that can lead to anaphylaxis, then we may do some skin testing or blood testing to confirm the diagnosis. Sometimes we even have to do supervised oral challenge in cases that is not clear. For patient who have a food allergy that affecting only the GI tract such as celiac disease or eosinophilic esophagitis, we may obtain more labs, and sometimes endoscopy with biopsy may be needed to confirm the diagnosis. So, this is how the gastroenterologists can contribute to improve the outcome by correctly identifying those patients at risk.
Announcer: The preceding program was brought to you through an independent educational grant from Aimmune Therapeutics. To access other episodes in this series, visit ReachMD.com/PeanutAllergies.
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