Peer Feedback Food Allergies-Jodie Brakstad

Food allergies are a hypersensitivity type 1 reaction where we see an immediate and exaggerated IgE immune response.

For a serious food allergy, the following symptoms can be experienced individually or together; hives, edema, flushing, nausea, vomiting, abdominal pain, diarrhea, wheezing, coughing, difficulty breathing, runny nose, and fainting. Some may also experience anaphylaxis, which is life threatening. Anaphylactic symptoms include constriction of the airway, difficulty breathing, shock with a drop in blood pressure, increased heart rate, dizziness, light-headedness, or loss of consciousness.

There are two separate types of food allergies: IgE mediated and non-IgE mediated. The initial exposure to the food is called the sensitization period. An APC or undifferentiated T cell sees the antigen, and determines that this is harmful to the body. T cells then differentiate into Th2, which further tells B cells to make IgE antibodies specific to the food allergen. Then, the specific IgE antibodies interact with the allergen and mast cell. Antibodies bind to mast cells which are full of histamine, and they bind at the FC region which is sensitizing the mast cell. At the next exposure, mast cells with IgE antibodies bind to the allergen. Depending on how many IgE interact with the mast cells, they can cause it to burst, releasing histamine; if we see enough mast cells burst, this causes anaphylaxis.

Testing and diagnosing can take many forms, but a patient history is crucial. One test is an IgE blood test. This includes taking the blood, mixing it with allergens, and measuring the amount of IgE antibodies produced. Someone can have allergies without having IgE therefore this is not a 100% result. Another test includes an allergen skin prick, then wait about 15 minutes to see if there are any signs of a reaction. This again is not a 100% result. With food, a stronger test tends to be the oral food challenge. A patient is given either the allergen or placebo, and they wait to see if symptoms develop. Monitoring is crucial in case a reaction does occur.

There is no cure, so prevention is key. Always having access to an EpiPen is crucial. Allergies can be managed in a few ways, one being by injectable medications that block the IgE response. This would be given every 2-4 weeks, and can increase tolerances. Their tolerance grows, but they cannot have the allergen food, prevention is still key.

Originally, I thought a gap may have been including more information from non-IgE mediated food allergies as it was mentioned early on that the focus was on IgE mediated. However, after listening to the podcast, I really appreciated that it was still incorporated throughout. I do feel as though it would have been beneficial to dive further into distinguishing the two apart, and possibly giving some examples of what a non-IgE mediated food allergy may be, or what it may look like in a patient. Would the symptoms change? I would assume it is normally less severe? Can someone experience both at the same time?

Furthermore, I think it could have been interesting to discuss cross reactivity that can be seen with food allergies. While this does go into non-food allergies, I think it would be a great addition to touch on to shed light on how some people develop these allergies to different foods. Considering how common latex allergy is, it would be a great point to integrate to further one’s knowledge with food allergies. In addition to this, it would have been interesting to discuss what happens with food allergies when we cook the food. Since we normally see reactions with raw food, when we cook it, we change the proteins which ends up causing the immune system to no longer recognize the food as an antigen. I also do recognize how the time limit can inhibit the ability to cover all the different avenues that can be taken with a large topic such as food allergies!

I really appreciated the flow of the podcast. It was very evident that it was well thought out and planned. I really liked how it was broad terms in the beginning, then it went to discussing overarching themes that would be talked about throughout the podcast; and then finally it was broken down into more digestible portions throughout the rest of it. I also really liked the incorporation of the case study that discussed Bobby and his allergy to peanuts. I find seeing specific cases and using examples really aids my learning and helps me understand different topics. It tends to make the content more relatable, and grasps us as listeners which in turn helps me focus throughout listening to the podcast. There was also a strong integration of the pathophysiology behind food allergies, but it was presented in a way that was very understandable. Sometimes it can be easy to get wrapped up into the details of what is going on at the cellular level with pathophysiology but I really liked how it was included, but relayed in a way that grasped listeners. It was also easy to follow which aided my learning and understanding of the materials.

After going back through the time stamp sheet, I also really liked that it was broken into sections so it was easy to refer to which part talked about symptoms, diagnostics etc. I think it will be a really beneficial study tool going into our final exam as well when reviewing food allergies because it is so well laid out and easy to navigate. Overall, the organization of the podcast was executed very well and really aided me with comprehending the materials discussed.

I think if I were to make one change, I would have included another case study in addition to Bobby’s peanut allergy. While I do understand that the time limit can hinder the ability to do this, I think that the integration of further case studies can really enhance the focus of listeners, and allow them to sit with the information presented, and relate to it. I would assume that most people know someone with a food allergy (whether it be severe or not) and they would really benefit from the content that was discussed throughout this podcast. I often find that information tends to stick more when we relate it to someone we know, or a case study that may hit close to home. I think this would have been a great tactic to include a few more case studies with different allergies whether it be mild or severe to paint a picture of what someone should expect during one of these crises. Using examples to enhance our reaction time in real life scenarios is crucial since food allergies happen so suddenly and require rapid treatment if they are severe.

I also think it would have been interesting to have one case study revolving around a non-IgE mediated food allergy to be able to better distinguish between the two. Including this into the podcast would have allowed the listeners to get a better insight into what a non-IgE mediated food allergy entails, whether or not the treatment would be different, or if there would be other signs and symptoms to look out for etc.

After learning more about food allergies, I think that this is content all of us can take into our future practice when we start working as registered nurses. I plan on going into the emergency department after I graduate therefore, I am sure that I will come across at least a few cases of food allergies throughout my time as a nurse. I really liked how detailed the signs and symptoms were, so I know exactly what to look for in my patients who might be experiencing a food allergy. Being able to detect these symptoms early on can really aid both us as nurses, and the patient from further discomfort if they are experiencing a food related allergic reaction. This information is also really important for families, so they are able to identify the symptoms their loved one may present with if they are experiencing an allergic reaction. I also really liked the point that discussed how patients can experience one, or many of the symptoms all at once or one at a time. Sometimes it is easy to disregard symptoms as we assume they are related to something else; for example, trouble breathing in a COPD patient may seem normal, but if they feel like something is in the back of their throat then this may be a further indication that they are experiencing a possible food allergy rather than a COPD exacerbation.

I also thought it was a great addition to focus the case study on the younger population as this is often a vulnerable population when it comes to food allergies. At lunch times kids tend to share snacks, or end up putting their fingers in something that may be contaminated. While prevention is key when it comes to food allergies, it is a really great reminder that sometimes kids forget, or do not realize that they may be endangering themselves. It is imperative that we look for food allergies with everyone, but we really need to keep an eye out for the kids that may be accidentally putting themselves in life threatening situations. While I do not plan on working in pediatrics, in the emergency department we see everyone therefore this is a key takeaway that really stood out to me throughout this podcast.