Food allergy OSCE — acute reaction drill and early-introduction prevention counselling

Station objectives

1. Manage a food-induced anaphylaxis drill with adrenaline-first reasoning. [14]
2. Build the written-action-plan and autoinjector ladder for discharge. [6]
3. Counsel a high-risk infant's family on early allergen introduction, using the LEAP evidence. [1] [4]

Candidate brief

You are the paediatric doctor in a mixed acute and allergy clinic. Station A is 8 minutes (acute reaction). Station B is 8 minutes (preventive counselling). Examiners score safety prioritisation, evidence use, and partnership with families. [6] [14]

Station A — Anaphylaxis drill

Setup: A six-year-old with known peanut allergy and mild asthma develops lip swelling, urticaria, wheeze and drowsiness within minutes of a biscuit at a party. A carer has a 0.15 mg adrenaline autoinjector. [14]

Expected actions:

• Declare anaphylaxis and call for help. [14]
• Give IM adrenaline into the anterolateral thigh first — not an antihistamine. [14]
• Lie flat with legs elevated if shocked, high-flow oxygen, IV fluids for shock, bronchodilator adjunctive. [14]
• Repeat adrenaline at five minutes if no response. [14]
• Plan observation for biphasic reaction (at least six hours); admit because of asthma and severity. [14] [6]
• Leave the family with a written action plan, two weight-banded autoinjectors, and a school plan. [6]

Station B — Prevention counselling

Setup: A parent of a four-month-old with severe early-onset eczema has read online that allergenic foods should be delayed to prevent allergy, and asks what to do. [1] [4]

Expected actions:

• Correct the misconception: delayed introduction increases, not reduces, allergy risk. [1] [13]
• Explain the LEAP evidence in plain language: early sustained peanut cut peanut allergy by roughly 80% relative risk. [1]
• Risk-stratify this high-risk infant (severe eczema) with a skin-prick test before introducing peanut; introduce early if low or negative, specialist-led if positive. [1] [4]
• Advise introducing common allergens around four to six months and keeping them in the diet (sustained intake). [4] [13]
• Confirm: no maternal diet restriction in pregnancy or lactation; continue breastfeeding. [13]

Marking anchors

Clear pass: adrenaline-first anaphylaxis with correct dose and repeat logic; biphasic-aware disposition; full action-plan ladder; correct early-introduction counselling with LEAP evidence and risk-stratified peanut. [1] [14] Borderline: right drug but delayed by waiting for antihistamine or IV access; or counsels early introduction but omits skin-prick risk-stratification in the severe-eczema infant. [4] [14] Fail: gives antihistamine first for a wheezing hypotensive child; or advises delaying allergens; or restricts the maternal diet. [1] [14]

Debrief pearls

• Adrenaline first, every time — antihistamines treat itch, not airway or circulation. [14]
• The question for the high-risk infant is not whether to introduce, but how early and whether to test first. [1] [4]
• Tolerance needs sustained intake — introducing then abandoning a food leaves the door ajar. [6]