Case histories

Nut allergy

A three year old boy was brought by his parents for allergy evaluation. He had developed lip swelling and facial rash following the ingestion of a proprietary chocolate bar containing nuts. He had a history of eczema in infancy and was prone to chest infections during the winter months. He was allergy skin tested and found to have allergy to peanuts and certain tree nuts. In addition, he was allergic to grass pollens and dust mites which raised the possibility of asthma. He was given a food allergy management plan and taught to use an adrenalin pen. His parent were given dietary advice on nut avoidance and offered a referral to a nutritionist. He was referred to a respiratory paediatrician who confirmed the diagnosis of asthma and recommended a treatment plan which consisted of dust mite avoidance measures, a preventative inhaler to be taken every day and a reliever inhaler. A follow up visit for allergy tracking was recommended for when he turned 5 years old, before he started in primary school, to determine whether his allergies were still active.


Immunotherapy for Dust Allergy

A 43 year old man was referred by an ENT surgeon. He gave a long history of recurring nasal congestion, sneezing and snoring. He had undergone surgery on his sinuses because of repeated episodes of sinusitis. He was using nasal saline washouts, a topical nasal steroid spray and a regular oral antihistamine. His skin tests showed strong dust mite allergy. House dust avoidance measures were recommended for his bedroom and he commenced on a 3 year course of sublingual immunotherapy with house dust mite allergen. He was well into his second year at his last review. He was continuing to use a nasal steroid spray. His other treatment had been discontinued. He nasal passages were much clearer and he had experienced no further episodes of sinusitis.


An 8 year old female was referred by her GP for asthma evaluation and possible nasal allergies. Her initial breathing tests were mildly abnormal but they corrected briskly following inhaled Ventolin. Her breath was analysed for nitric oxide and was found to be high. These results suggested that her asthma was not adequately controlled. Allergy skin tests showed strong dust and cat allergy. Her inhaled technique was adjusted, her preventative inhaler was increased, and dust mite avoidance measure recommended. It was recommended that the cat be removed from the household. She was commenced on a steroid nasal spray. At review 8 weeks later things were much improved.


A 14 year old female was referred for allergy testing in autumn. She had experienced severe hay fever symptoms from April to August of the previous summer. She was taking over the counter antihistamines and a steroid nose spray with only minimal improvement. The antihistamines were making her drowsy in class and her hay fever symptoms were disturbing her night’s sleep. All in all her parent s felt that she had had ‘a miserable summer’. Her parent were worried because she was starting into 3rd year and her junior certificate year. Her allergy skin tests showed exceptionally high grass pollen allergy only. Sublingual immunotherapy was recommended along with a prescription for a non-sedating antihistamine and more potent topical nasal steroid, both to be started in advance of the pollen season. She got on well that spring and summer and completed her junior certificate without any difficulties.


Mary is a 54 year from Kildare, she was referred by her gastroentologist for allergy/intolerance testing. After a series of medical investigations including a camera test of her bowel, she had been given a diagnosis of irritable bowel syndrome. She was convinced something in her diet was making her feel bloated and constipated. Her skin allergy tests were negative, meaning that she did not actually have a food allergy. Mary then had a sample of blood taken from her fingertip and this was sent from IgG food intolerance testing. She scored very highly to wheat which then excluded from her diet with excellent results.