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FROM THE AMERICAN ACADEMY OF PEDIATRICS: American Academy of Pediatrics, American Academy of Pediatric Dentistry, Charles J. Coté, Stephen Wilson the Work Group on Sedation Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update Pediatrics 2006; 118: 2587-2602 [Abstract] [Full text] [PDF]

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Food Allergies and Management for Diagnostic and Therapeutic Procedures

John W Gosbee, Laura Lin Gosbee   (5 January 2007)

Food Allergies and Management for Diagnostic and Therapeutic Procedures 5 January 2007
John W Gosbee, Physician and human factors specialist University of Michigan Health System, Laura Lin Gosbee Send letter to journal: Re: Food Allergies and Management for Diagnostic and Therapeutic Procedures jgosbee{at}umich.edu John W Gosbee, et al.	Dear AAP and Authors of this updated Guideline: For your next update I suggest a short section to be added on pro- active risk assessment for patients who have food allergies. Our daughter with multiple food allergies (tree nuts, peanuts, sesame) recently had a colonscopy and EGD procedure done with sedation and intubation. Prior and during this process my wife and I took steps to proactively identify any possible contact with substances (including medications) which could possibly contain food ingredients. As those with food allergy expertise or experience will tell you, there is no end of surprises as to what will contain food ingredients; and how difficult it is to get a full list of actual ingredients and cross-contamination ingredients. In our N=1 experience, here is a list of unexpected food ingredient items associated with pre- and post- procedure activities: - Two types of syrup for oral medication admixing - Flavored lip-balm to rub onto the O2 mask (including one with peanut butter cup smell) - Popsicles and juice in recovery We had time to attempt to check cross-contaminants for the syrups, but it was a multi-day activity given limited labeling requirements (sesame does not have to be listed as cross-contaminant) and distributor-manufacturer confusion (the distributor can use more than one manufacturer for apparently the same product). The lip balm was most likely okay per labeling, but shocking to see for a food allergy parent. As for post- procedure foods, many dessert items have cross contamination (most often, but not always prominently labeled) and a few juices now have peanut as an ingredient. It might be that when many pediatric procedure units do a full risk assessment that food allergy consideration ends up being very low on the "worry list". Even then, it might merit a sentence or two in your next Guideline. John and Laura Gosbee Human Factors Engineering and Healthcare Specialists Daily pro-active risk assessors for Katie jgosbee@umich.edu Conflict of Interest: None declared

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