Peer Feedback Food Allergy – Giselle Fonseca

A food allergic reaction is when the body negatively reacts to a food item (an allergen) after consumption. This reaction can be either IgE mediated or non-IgE mediated. In an IgE mediated allergic reaction, a food allergen enters the body where antigen presenting cells (APCs) or undifferentiated T-cells recognize the allergen as harmful to the body. The APCs cause a reaction in the body where T-cells differentiate into Th2 cells which then signal B-cells to produce IgE antibodies that are specific to that food allergen (the peanut allergen in this case study). The IgE antibodies then bind to the mast cells, which contain histamine, at the FC region of the cell which sensitizes them to the peanut allergen. This initial phase of the food allergy response is the sensitization phase as the initial exposure to the peanut allergen causes the sensitization of the mast cell that is specific to the peanut allergen.

In the subsequent exposure of the allergen, the sensitized mast cells with IgE antibodies specific to peanuts will bind to the peanut allergen and cause the mast cells to burst. The rupture of the mast cells will release the histamine within them which can result in an anaphylactic response as histamine acts as a chemical mediator of the inflammatory response system. This inflammatory response can cause systemic symptoms such as hives, edema (swelling), redness, nausea, bronchoconstriction, difficulty breathing, vasodilation, and light-headedness.

Diagnostic testing for food allergies can be performed by gathering a patient’s medical history for previous reactions, blood IgE tests, skin prick tests, and oral food challenges. A blood IgE test looks at the amount of IgE antibodies produced in response to an allergen, however this is not always predictive of an allergy as not all food allergies are IgE mediated. Additionally, a skin prick test examines the amount of swelling present to an allergen that is introduced by a needle prick at the skin. Lastly, an oral food challenge is a controlled test where an allergist administers a small dose of the allergen orally and monitors the patient for allergic reaction symptoms.

Treatment of food allergies include the use of epinephrine (such as in Epi pens) and antihistamines to reduce the inflammatory response. Since there is no cure for food allergies, it is best for patients to prevent exposure to known food allergies to avoid an allergic reaction.

Overall, the project was completed thoroughly and clearly explained the pathophysiology of a food allergic reaction within the body. There were some potential additions that could have been included to enhance the viewer’s understanding of the process.

The first addition would be a brief description of what a non-IgE mediated response would involve as opposed to an IgE mediated response. Since these two different pathologies were mentioned, I believe it would have helped the reader understand the difference between the two responses, as well as any different signs and symptoms that would distinguish them from each other. However, since the project focused on the peanut allergen, which is an example of the IgE mediated response, I understand why the group focused on this pathophysiological pathway.

Secondly, I believe linking the pathophysiology of the allergic response to the signs and symptoms observed would have also been beneficial to the audience. For example, I would link the release of histamine from the mast cells to the causation of swelling and drop in blood pressure by describing its vasodilation properties within the blood vessels. Creating this link may allow the audience to have a better understanding of how the allergic response and inflammatory response are similar in clinical presentation.

Lastly, I would suggest including some specific examples of medications that are used to prevent IgE mediated allergic reactions. Including specific pharmaceutical examples (e.g., drug names we may see in practice) for anti-IgE medication or immunotherapy treatments would be beneficial for the viewers to relate the pathophysiology to the medications they may encounter in their clinical practice. Overall, I believe the group did an excellent job at clearly outlining the pathophysiology of an IgE mediated food allergic response.

The group did an excellent job in creating a narrative about a food allergic reaction that was easy for the audience to understand. One teaching strategy that the group implemented that supported my learning was the use of clear and layman terminology throughout the podcast.

When listening to an audio only source of media, it is important to use clear and simple language as there is no visual aid to help the listener retain the information. For example, complex terminology may confuse the listener and make them lose focus on what the presenters are saying as they are still thinking about the terminology that they did not understand. Keeping the terminology simple allows the listener to remain engaged in listening to the podcast as they are usually not caught up in thought trying to understand what a certain word means. Furthermore, the group did a great job in simplifying how to administer epinephrine in the case of an anaphylactic response by using an easy to remember phrase, “blue to the sky, orange to the thigh.” This helpful memory aide has solidified itself in my mind and I will likely remember this if I encounter an instance where I need to promptly deliver an epinephrine dose through an EpiPen.

Overall, I believe the group’s use of simple language and layman terms made it easier for myself to understand what was being taught during the podcast, as well as retain information without the use of visual aids. Furthermore, the use of simple phrases for EpiPen administrations also helped develop an easy way that I could recall information efficiently in my clinical practice.

Overall, the group did a great job in articulating a podcast case study that detailed the pathophysiology of a food allergy reaction. If I had the opportunity to make one recommendation it would be to change the order of the case study in such a way that incorporated the pathophysiology in a cohesive way. Particularly, I would trace the path of the food allergen as it is ingested by Bobby and detail the cells it contacts in a linear manner (e.g., the allergen then binds to the IgE receptors on the mast cell which causes a release of histamine… etc.). Furthermore, I would incorporate the signs and symptoms that Bobby would be experiencing by detailing how the histamine release causes the inflammatory response. The case study presented by the group started with signs and symptoms which made it a little confusing to follow how the food allergen would directly cause them as this part was explained later in the case study. I would then discuss the treatments used to combat Bobby’s anaphylactic reaction to the food allergy by following the team’s response in the emergency room to engage the audience in the case. Lastly, I would demonstrate how the healthcare team would diagnose Bobby’s food allergy by speaking in the healthcare team’s point of view. Ultimately, I would want to engage the audience into learning the pathophysiology behind a food allergy by using the case study as an interactive story that follows the food allergen pathway while detailing interactions along the way.

Through my experience as an employed student nurse at BC Children’s Hospital, I have encountered many patients with a variety of food allergies. While working with these children I must pay special attention to the food they are provided as a food allergic reaction can be rapid and life threatening in some cases. Furthermore, my last clinical placement will be with a pediatric population that is also likely to have patients with food allergies.

The content provided by the group has helped me understand how a food allergy develops and how to quickly recognize the signs and symptoms of an allergic reaction. Given that a severe anaphylactic reaction can be life threatening (e.g., loss of airway due to swelling and a dramatic drop in blood pressure), being able to recognize the signs and symptoms quickly will help me respond rapidly in this situation. Noticing signs of swelling, drops in blood pressure, redness, and hearing wheezing during my physical assessments will help me quickly respond to the reaction and provide epinephrine.

Furthermore, after listening to the podcast I feel more comfortable about knowing what medication to administer (epinephrine) and how to effectively deliver this medication to the patient. I have had little experience with using an EpiPen, however the podcast helped provide a memory aide that I will incorporate into my practice.

Lastly, I will be sure to collect a thorough patient history during my initial patient assessments by both asking the patient and their parents about any known allergies or reactions they have had in the past. Some patients may not know of their own allergies, however if I explain the signs and symptoms they may have experienced then it is likely that the patient or parents may be able to recall a time where they noticed those same symptoms occurring and hopefully know what it may have been in response to. As the podcast had mentioned, the easiest and most important way to prevent a food allergic reaction is to avoid known allergens, which I can assist in by collecting this information with a detailed patient history.

In conclusion, I will use the information on food allergies presented in the podcast for sign and symptoms recognition, quick anaphylactic treatment, and prevention with a thorough patient history in my practice.