Peanut allergy diagnosis and action plan — communication OSCE

Objectives

1. Confirm a new nut-allergy diagnosis with a structured history and appropriate testing, avoiding overdiagnosis of sensitisation. [14]
2. Explain sensitisation versus clinical allergy and the role of the oral food challenge in plain language. [14]
3. Co-design a written anaphylaxis action plan and prescribe and train the family in an adrenaline autoinjector. [12]
4. Address unnecessary blanket nut avoidance and reassure about nutrition and quality of life. [14]
5. Frame primary prevention for a younger sibling using the LEAP evidence. [1]

Candidate brief

12-minute station. Both parents are present and anxious; they have read online that peanut allergy is 'for life' and fatal. They have banned all nuts from the home. The child is well now and the reaction two days ago settled with an antihistamine. Establish rapport, confirm the diagnosis pathway, agree a plan, and correct misconceptions without dismissing their fear. [3]

Expected actions

• Acknowledge the frightening reaction and validate the parents' concern before correcting misinformation. [3]
• Take a structured history: the exact food, dose, timing, organ systems involved, cofactors, and response to the antihistamine. [14]
• Explain that testing confirms sensitisation and that a clear history plus supportive testing usually confirms the diagnosis, with a supervised oral food challenge reserved for uncertainty or to confirm resolution. [14]
• Agree avoidance of peanut specifically rather than all nuts, pending individual assessment of each tree nut. [14]
• Provide a written action plan, prescribe an adrenaline autoinjector with weight-based dosing, and train the parents in its use; recommend a second device for school and high-risk settings. [12]
• Address natural history honestly: most children do not outgrow peanut allergy, so the plan is for safe, long-term management with periodic reassessment. [3]
• Offer LEAP-based prevention advice for any younger or future sibling. [1]

Marking

Pass: sensitisation versus clinical allergy explained; oral food challenge as the tie-breaker; specific not blanket avoidance; written plan with autoinjector training and correct weight-based dose; honest natural history; LEAP prevention for siblings. [12] [14] Fail: labels allergy on history alone without confirming pathway; imposes blanket all-nut avoidance; cannot state the adrenaline dose or site; minimises the diagnosis as trivial or catastrophises it as inevitably fatal; offers no prevention advice. [3]