Jon B. Tingelstad Conference: Practical Pediatrics 2025

Here's a brief bullet point list for "Allergy Testing: To Test or Not To Test in pediatric patients":

Consider Testing When:

• History suggests IgE-mediated reactions (rapid onset, hives, swelling, breathing issues) to specific foods.
• Persistent moderate to severe eczema despite optimized topical therapy.
• Suspected respiratory allergies (rhinitis, asthma) with specific triggers.
• Guiding introduction of allergenic foods in high-risk infants (with caution and provider guidance).
• Monitoring resolution of known food allergies (following specific protocols).
• Documenting allergic sensitization for school or daycare.

Consider Not Routinely Testing When:

• Mild, non-specific symptoms without a clear allergic trigger.
• Solely for food avoidance without a history of reaction.
• Screening general population without clinical suspicion.
• Positive test is likely to lead to unnecessary food restriction and anxiety.

Factors Favoring Testing:

• Clear history of an allergic reaction.
• Need to confirm a suspected allergy for management and avoidance.
• Guiding OIT candidacy or monitoring progress.

Factors Against Routine Testing:

• High rate of false positives (sensitization without clinical allergy).
• Testing can be anxiety-provoking and costly.
• May lead to unnecessary dietary restrictions impacting nutrition and quality of life.

Testing Methods:

• Skin Prick Testing (SPT): Quick, relatively inexpensive, good for IgE-mediated allergies.
• Specific IgE Blood Tests: Useful when SPT is not feasible (e.g., severe eczema, antihistamine use).
• Oral Food Challenge (OFC): Gold standard for diagnosing or ruling out food allergies, done under medical supervision.

Importance of Clinical Correlation: Test results must always be interpreted in the context of the patient's history and physical exam. A positive test alone does not equal a clinical allergy.

Shared Decision-Making: Discuss the risks and benefits of testing with the family to make an informed decision.

Source: Google Gemini

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Here are 10 common questions Primary Care Physicians (PCPs) often ask about managing pediatric obesity:

1. How do I effectively screen and diagnose pediatric obesity beyond just BMI? (e.g., waist circumference, growth charts, considering body composition).
2. What are the first-line lifestyle modifications I should recommend for families? (e.g., dietary changes, physical activity goals, screen time limits).
3. How can I have sensitive and productive conversations with children and families about weight? (Avoiding blame, focusing on health, motivational interviewing techniques).
4. When should I consider pharmacotherapy for pediatric obesity, and what are the current guidelines and approved medications?
5. What are the indications and contraindications for bariatric surgery in adolescents, and what is the PCP's role in referral and follow-up?
6. How do I address common co-morbidities of pediatric obesity in primary care? (e.g., prediabetes, hypertension, dyslipidemia, NAFLD).
7. What are some practical strategies for supporting families with limited resources or cultural differences in making healthy changes?
8. How often and what should be included in follow-up visits for children with obesity? (Monitoring progress, adjusting plans, addressing barriers).
9. What community resources and specialists should I be aware of for referral and collaborative care? (e.g., dietitians, behavioral health professionals, exercise physiologists).
10. How can I stay up-to-date on the rapidly evolving guidelines and research in pediatric obesity management?

Source: Google Gemini

Items 1-10 of 10 (Display the 10 citations in PubMed)