Writing about food allergies from a pediatric allergist's perspective

Preparing For A Food Allergy Office Visit & Partnering with Your Clinic Team

Anne F. Russell, BSN, RN, AE-CAllergyHome is excited to re-introduce Anne Russell, BSN, RN, AE-C, an AllergyHome expert contributor who has specialized in food allergy for over 20 years after clinical and administrative experience in Pediatrics, Critical Intensive Care and Neonatology. She has shared her expertise and passion with countless children, families, members of allergy clinic teams and patient advocacy groups.  Her dedication to constant improvement to healthcare and patient/family education is awe inspiring. We are honored to have her insight. Thank you Anne for sharing.

Preparing For A Food Allergy Office Visit & Partnering with Your Clinic Team

Written by: Anne F. Russell BSN, RN, AE-C (click here for full bio)

“Bundling up a child and taking them in for a clinic visit can be stressful! Whether for a routine check-up or because they are ill – it can lead to anxiety.”

Plan Ahead!

Preparing beforehand, especially for new patient visits or routine follow-up visits, may help you maximize services received. It can also help to use the allotted time efficiently and productively for all involved.

Maximizing Food Allergy Clinical Services: Be prepared

  • Bring a list of questions & medical updates. This may include a written description of an allergic reaction to suspected food(s) that prompted a referral to the food allergy clinical team. This report may then be scanned and included in your child’s electronic medical record.
  • Bring a list of current medications (include name & dose), vitamin supplements, homeopathic or naturopathic therapies used at home
  • Bring a list of prescriptions needing refills
  • Bring a copy of the recipe and/or food ingredient labels of suspected allergy triggers. This information helps when determining diagnostic testing.
  • Bring business contact information if an allergic reaction occurred from restaurant, school or airline food. Members of the clinic team may need this information to contact the school and/or business directly. If unable to bring meal ingredient lists, bring a menu copy or cafeteria meal listing for the day.
  • Bring a family member or friend to hear clinic team recommendations and/or to provide support. When stressed or anxious you may not hear or absorb all being said.
  • If possible, leave siblings at home or in the waiting room so everyone can focus attention on one child during the appointment.
  • Avoid bringing snacks to use as a distraction with your child. Many clinics no longer allow foods in exam and waiting rooms to minimize allergen exposures & promote cleanliness. Bring toys or books instead!

More Tips to Help Increase Effectiveness of the Food Allergy Office Visit

  • Request a longer appointment if you have multiple questions & concerns.  Often, clinics have set time-frames for ‘new patient’ visits and ‘sick patient’ visits. Typically, the new patient visits are allotted more time. Ask about these pre-determined time-frames when you schedule your appointment.
  • Prioritize issues to address                                                        
  • Consider providing your question list prior to the appointment.
  • Provide medical records from other hospitals or clinics as needed prior to the appointment. When able to do so, it helps physicians and nurses review aspects of your child’s case before your clinic visit.
  • If possible, complete any new patient questionnaires and submit them before the appointment.
  • Bring materials to take notes.
  • Bring copies of school or camp forms that need completion by the clinic team. Be sure you have already filled in the parent/caregiver portions.
  • Make appointments for school physicals early in the summer. It takes time to complete food allergy related school forms. Aim to have all school paperwork and prescriptions complete several weeks before the academic year begins.

Food & Symptom Journal

food and symptom journalThere may be times a physician or nurse recommends you keep a journal logging any symptoms associated with food eaten (e.g. eczema flares, rashes, nausea).  It may be hard to know which food is causing a reaction. The completed journal can provide valuable information on consistent patterns. This can help with medical history taking and diagnosis. It also is helpful for organizing your thoughts and concerns to discuss at appointments with your food allergy clinic team.

If a food causes serious symptoms or anaphylaxis then follow your food allergy emergency care plan, strictly avoid the food and contact your clinic team.

For more information on a food and symptom journal, click here.

Ask questions!

Navigating the healthcare system can be tricky. It may appear massive and complex. It involves multiple professionals, departments, policies, hospitals, regulating agencies and more. Insurance coverage programs may create additional challenges – but that’s a different post!

Don’t be shy about asking questions and clarifying any assumptions. Your food allergy clinic team will want to partner with you to be sure you understand medical terms, procedures, medications, diagnostic tests and plans that can assist you with daily food allergy management.

Topics Covered During Food Allergy Office Visits May Include:

  • Referrals to specialists.  Accurate and timely diagnosis is critical. Multiple inter-disciplinary teams may need to co-manage children with allergies & asthma. Nurses may coordinate care between the separate teams.
  • Medications or procedures prescribed or provided during the appointment  
  • How to access your child’s medical records
  • When to return for routine follow-up appointments
  • What parameters should prompt a call for evaluation
  • Preferred form of communication.  Nurses, physicians & nutritionists may have direct email access as well as direct phone lines and/or pagers. Others prefer online communication through a clinic website or indirect communication through receptionists or medical assistants.
  • Hospital affiliations should your child ever need to be admitted
  • Payment and insurance coverage policies

Discussion Points During a Food Allergy Office Visit May Also Include:

  • Referrals to clinical nurse patient educators, nurse case managers and nutritionists. These medical professionals may only be available part-time or as consultants. They may also have multiple administrative, clinical and/or research responsibilities.
  • Personalized education on daily food allergy management from nurses and physicians – including review and sharing of take-home patient education materials and resources.
  • Information on whether the clinic runs group patient education classes and/or a support group. Physicians and nurses may also be involved as medical advisors to local food allergy support groups and can direct you to trusted resources. Clinical team members may also provide outreach community health education (e.g. for schools) and may be able to assist you with such needs.
  • Information on whether the clinic team utilizes social media or newsletters for general educational updates.
  • Opportunities for participation in food allergy clinical research.
  • When prescribed injectable epinephrine: Expect that a nurse or physician will discuss the medication with you and review its purpose, indications for use and how to use the device. By having you demonstrate back to them how to use the epinephrine autoinjector, it helps all involved to determine if more practice would be helpful prior to you leaving the clinic.
  • When provided a food allergy/anaphylaxis emergency care plan:  Expect that a nurse or physician will thoroughly review its contents and guidelines for steps to take should anaphylaxis occur. Discussion may include potential scenarios involving different settings, (e.g. home, restaurant, church). Do not hesitate to call back with questions and/or to request additional in-person education sessions if needed.
  • Prognosis: Expect that the physician and nurse will explain diagnostic test results, physical exam findings and significant medical history information when reviewing long-term outlook and medical management of specific food allergens. Anaphylaxis is always potentially life-threatening and requires thorough discussion.

Creating a Partnership with your Food Allergy Clinical Team

Food Allergy PartneringDiscuss shared decision-making as appropriate. Families have different values and lifestyles. Share what is important for your child and family.

Be a role model for your child. They will learn to interact with healthcare professionals from observing you! Practice good communication.

Think of it this way – you have hired a clinic team to provide health services for your child. You and the clinic team have a shared goal of optimal health for your child. You and your child are at the center of the team!

Author’s note: Clinic models vary. Tips shared in this article are meant as examples, not as complete listings.  Please see resources below for more information.

Selected Resources:

  1. Thanks for providing such a thorough resource, Anne!

  2. After my daughter had an ANA reaction to cashews, we saw an allergist. He tested her for other nuts (she’s also allergic to pistachios), talked to us about epi-pen usage and answered my questions. After that, he wanted her in every six months for skin testing for environmental allergies (of which she has none), and he never said another word about her food allergies. Needless to say, we stopped seeing him.

    Since then, our pediatrician has been giving us her epi refills, testing her levels annually and filling out school forms. She said there was no sense in us seeing an allergist because there’s nothing they can do.

    I recently had to take my son to an allergist, so I got a referral for my daughter also. After my son’s appointment I told the allergist that I would be bringing my daughter in to get her established as a patient. He said that I could if I wanted to, but there was really no need as long as we “had epi-pens and knew how to use them, and she doesn’t have any other reactions.” He said that if her levels ever come down to zero that we would try a food challenge then, but for now, there’s nothing he can do for her.

    I posted about this in a nut allergy Facebook support group that I’m in and basically got chewed out because I pretty much agreed that there was no need to see an allergist. No one could tell me what they could do for me that my pediatrician couldn’t (at this time I honestly have no questions and I constantly do my own research), and kept insisting that I make an appointment with a different allergist since this one “doesn’t seem to care”.

    So I ask you – do we NEED to see an allergist? And if so, what do I say at our first visit? Why do I tell him/her that we are there? What can they do for us? My daughter has never had another reaction, and we are managing her allergies well. Thank you in advance for any advice you can give.

    • Hi Lee Ann:

      Thank you for taking time to comment. Sorry to hear your daughter has tree nut allergy with history of anaphylaxis. It’s often a challenging diagnosis for families. I’m very glad to hear you sought initial evaluation by an allergist. It also sounds like your daughter is seeing a primary care pediatrics team that has been responsive and helpful.

      The questions you pose are ones I’ve been asked many times. Multiple factors are involved with why families seek out an allergy clinic team and/or change to other allergy clinic teams (eg, insurance coverage issues, personality styles).

      I highly recommend patients/families managing food allergy be seen regularly by a board certified allergist and specialty clinic team. Physicians and nurses specializing in Allergy/Immunology have advanced training/study in this specialty area. Thus, allergy focused medical history taking, determining allergy diagnostic testing, interpretation of test results, non-pharmacologic management (eg, ongoing personalized, developmentally appropriate patient education; monitoring age appropriate self-management; etc), close monitoring for development of asthma or other allergic conditions – are best done by physicians and nurses specializing in food allergy.

      The blog piece is specifically looking at those preparing for a 1st visit to an allergy clinic. Once initial allergy evaluation is complete, how often a patient/family returns to the Allergy clinic is based on a variety of individualized factors (type of food allergy; development or existence of other allergic disease; child’s age; changes in health in-between office visits; clinic guidelines; insurance issues). Some patients with food allergy receive yearly testing, others may go longer in-between. Determining if a child needs certain diagnostic testing and then interpreting those results are best done by a board certified allergist. Physicians and specialty nurses in Allergy will then determine candidacy for oral food challenges – best done in an Allergy office with specially trained personnel.

      If you decide to check out a different Allergy clinic team, I hope the tips and listed resources in this blog piece help!

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