Lesson 1Prescribing and teaching epinephrine auto-injector use (who needs one, demonstration, action plans, carrying and storage)This section covers who should get epinephrine auto-injectors, device selection, dosing, and hands-on teaching, emphasising demonstration, practice, written action plans, safe storage, carriage, and overcoming hesitancy among patients and caregivers.
Identifying patients who need auto-injectorsSelecting device type and appropriate doseStep-by-step injection demonstrationCreating individualized emergency action plansCounseling on carriage, storage, and expiryAddressing fears and adherence barriersLesson 2Immunology of IgE-mediated and non-IgE food reactions (mechanisms, typical timing, co-factors)This section explains IgE-mediated and non-IgE food reaction pathways, including mast cell activation, cytokines, and effector organs, reviewing timing patterns, cofactors like exercise or NSAIDs, and links to clinical presentation and risk in local contexts.
Sensitization and IgE production to food proteinsEffector phase: mast cells, basophils, mediatorsNon-IgE mechanisms and mixed phenotypesTypical timing of immediate and delayed reactionsRole of cofactors: exercise, alcohol, NSAIDsImmunologic basis of reaction severity and thresholdsLesson 3Allergy testing strategy (indications and interpretation of skin prick testing, serum specific IgE, component-resolved diagnostics, limitations and false positives)This section reviews indications for allergy testing, compares skin prick testing, serum specific IgE, and component diagnostics, teaching interpretation, predictive values, pitfalls, limitations, false positives, and integration with clinical history.
When to order food allergy testingSkin prick testing technique and safetySerum specific IgE: uses and cutoffsComponent-resolved diagnostics in food allergyFalse positives and overdiagnosis risksIntegrating test results with clinical historyLesson 4Acute management in primary care (recognizing anaphylaxis, epinephrine indications, adjunctive medicines—antihistamines, corticosteroids, bronchodilators)This section details acute management of food-triggered reactions in primary care, including rapid anaphylaxis recognition, intramuscular epinephrine indications and dosing, and use of antihistamines, corticosteroids, bronchodilators, and observation.
Triage and early recognition of anaphylaxisEpinephrine dosing, route, and repeat criteriaAdjunctive antihistamines and corticosteroidsBronchodilators for lower airway involvementObservation periods and discharge criteriaWhen and how to activate emergency servicesLesson 5Food avoidance counselling and labelling literacy (reading menus, cross-contamination risk, restaurant safety communication)This section trains clinicians to counsel on strict food avoidance, interpret labels and precautionary statements, assess cross-contact risks, and communicate with restaurants, schools, and caregivers to prevent reactions in Singapore's diverse food scene.
Core principles of strict food avoidanceDecoding ingredient lists and allergen labelsUnderstanding precautionary advisory statementsPreventing cross-contact in home kitchensRestaurant risk assessment and safe orderingCounseling schools, camps, and caregiversLesson 6Referral and follow-up (when to refer for oral food challenge, allergy specialist workup, long-term monitoring)This section explains referral timing for allergy specialist evaluation, including oral food challenges and advanced testing, and outlines follow-up schedules, monitoring for resolution or persistence, and updating action plans and avoidance advice.
Indications for allergy specialist referralCriteria for supervised oral food challengeCoordinating care with dietitians and schoolsMonitoring for tolerance development over timeUpdating action plans and prescriptionsSupporting psychosocial and quality-of-life needsLesson 7Focused history for suspected food allergy (meal details, timing, reproducibility, dose, previous exposures, exercise/alcohol co-factors, prior reactions)This section builds skills for focused allergy history, covering meal composition, symptom timing, reproducibility, dose thresholds, prior exposures, cofactors like exercise or alcohol, and previous reactions to guide testing, counselling, and risk assessment.
Structuring the acute reaction interviewDocumenting meal contents and preparationOnset timing and symptom progressionAssessing reproducibility and dose dependenceExploring exercise, alcohol, and NSAID cofactorsCapturing prior reactions and baseline atopyLesson 8Differential diagnoses (food intolerance, scombroid, histamine toxicity, chronic spontaneous urticaria)This section outlines key mimics of food allergy, including food intolerance, scombroid poisoning, histamine toxicity, and chronic spontaneous urticaria, providing clinical clues, testing strategies, and management differences for each.
Distinguishing allergy from food intoleranceRecognizing scombroid and fish-related histamineOther causes of histamine toxicity syndromesChronic spontaneous urticaria and angioedemaMedication and infection-related mimickersTargeted investigations for alternative diagnosesLesson 9Physical exam and identification of anaphylaxis vs isolated urticaria/angioedema (airway, cardiovascular, respiratory signs, skin assessment)This section teaches focused physical exam for suspected anaphylaxis, emphasising airway, breathing, and circulation assessment, distinguishing anaphylaxis from isolated urticaria or angioedema, and recognising red flags for immediate epinephrine.
Rapid primary survey: airway, breathing, circulationKey skin findings in acute allergic reactionsRespiratory signs of evolving anaphylaxisCardiovascular and neurologic red flagsDistinguishing localized angioedema from anaphylaxisDocumentation of exam findings in emergencies
