CSP CSP Pediatric Food Allergy & Dietary Management 2 — Questions and Answers
Question 1: Which extensively hydrolyzed formula is appropriate for an infant with confirmed cow's milk protein allergy who cannot breastfeed?
- Standard cow's milk-based formula
- Soy-based formula
- Extensively hydrolyzed casein or whey formula (Correct answer)
- Whole cow's milk
Correct answer: Extensively hydrolyzed casein or whey formula
Extensively hydrolyzed formulas break cow's milk proteins into small peptides, making them tolerated by approximately 90% of infants with CMPA.
Question 2: A 2-year-old with multiple food allergies (milk, egg, wheat, soy) is at risk for which nutrient deficiency most commonly?
- Vitamin C
- Calcium and vitamin D (Correct answer)
- Iron
- Thiamine
Correct answer: Calcium and vitamin D
Elimination of dairy removes the primary dietary source of calcium and vitamin D, placing these children at high risk for deficiency and bone health concerns.
Question 3: What is the gold standard diagnostic test for confirming food allergy in a pediatric patient with unclear clinical history?
- Serum-specific IgE (RAST) testing
- Skin prick testing alone
- Double-blind, placebo-controlled oral food challenge (DBPCFC) (Correct answer)
- Patch testing
Correct answer: Double-blind, placebo-controlled oral food challenge (DBPCFC)
The DBPCFC is considered the gold standard for definitively confirming or ruling out food allergy, minimizing bias from both patient and clinician.
Question 4: Which dietary intervention is now recommended by LEAP trial findings to prevent peanut allergy in high-risk infants?
- Avoid all peanut exposure until age 5
- Introduce peanut-containing foods early (around 4–6 months) in high-risk infants (Correct answer)
- Introduce peanuts only after all other allergenic foods
- Give peanut only if prior skin prick test is negative
Correct answer: Introduce peanut-containing foods early (around 4–6 months) in high-risk infants
The LEAP trial demonstrated that early introduction of peanut in high-risk infants (with severe eczema or egg allergy) reduces peanut allergy prevalence by up to 80%.
Question 5: A child with celiac disease is started on a gluten-free diet. Which grain is safe for this child to consume?
- Barley
- Rye
- Oats (certified gluten-free) (Correct answer)
- Wheat
Correct answer: Oats (certified gluten-free)
Most children with celiac disease can tolerate certified gluten-free oats, which are free from wheat, barley, and rye cross-contamination.
Question 6: Which symptom pattern best distinguishes eosinophilic esophagitis (EoE) from GERD in a pediatric patient?
- Projectile vomiting in infancy
- Food impaction, dysphagia, and failure to respond to acid suppression therapy (Correct answer)
- Watery diarrhea and weight loss
- Rectal bleeding and mucus in stool
Correct answer: Food impaction, dysphagia, and failure to respond to acid suppression therapy
EoE typically presents with food impaction and dysphagia in older children, and unlike GERD, does not respond to proton pump inhibitor therapy.
CSP CSP Pediatric Food Allergy & Dietary Management 2
Which extensively hydrolyzed formula is appropriate for an infant with confirmed cow's milk protein allergy who cannot breastfeed?