Traditional allergists believe that food hypersensitivities are primarily IgE-mediated and treat with avoidance diet and/or drug therapy. Diagnosis is by history, elimination diets, skin tests, or food challenge. Non IgE-mediated food intolerance is classified as non-immune adverse reactions to food of a pharmacologic (caffeine, histamine, tyramine, serotonin, dopamine, etc.); metabolic (lactose intolerance); or idiosyncratic nature, ., food dyes, preservatives (sulfites), flavor enhancers (MSG). The AAOA indicates that provocation-neutralization techniques were developed primarily for these delayed, less obvious, non-IgE-mediated food hypersensitivities and not for confirmation of immediate food allergy obvious by history. Test substances have also included chemicals such as formaldehyde and alcohol, histamine, tobacco, newsprint and inhalant allergens.
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The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.