FCAAIA Notes: I do not want to see my patients with food allergy crippled by their dietary limitations.  They and their families should live entirely normal lives with exception of avoiding the offending food(s).

I know accidents happen, so like the Boy Scouts, it is important to “Be Prepared”.  Ask wait staff about ingredients in the food you are buying. If they are not sure, ask again until you are confident about its safety. Have your antihistamines and epinephrine autoinjector (if you need one) available.

Although many patients tolerate re-introduction at home, it might be a risk you should discuss with your allergist first.  Even then, well-meaning or uninformed relatives or friends often offer a forbidden food.

We cannot eliminate risk, but we can minimize it.

(Source: Feb. 13, 2018. For Medscape articles: User name: FCAAIA, Password: Allergies)

Parents of kids with food allergies often engage in behaviors that could trigger an allergic reaction in their child, a survey found.

Almost half of parents of kids with food allergies reported at least one risky behavior, such as not carrying epinephrine autoinjectors or not reading food labels.

These behaviors are likely due to knowledge gaps and misconceptions, as well as possible financial barriers, according to Dr. Julie Wang of the Jaffe Food Allergy Institute of Mount Sinai Hospital in New York City and her colleagues.

Wang’s team conducted the survey to better understand food allergy management behaviors and attitudes in their patients’ households.

“During our patient visits, we routinely counsel families about food allergy management to reduce the risk of allergic reactions. However, we noted that in some cases, our patients experienced allergic reactions that were associated with risk-taking behavior,” Wang told Reuters Health in an email.

“It is important to understand the barriers patients and their families face in managing their food allergies,” she said.

As reported online January 19 in The Journal of Allergy and Clinical Immunology, Wang and her colleagues surveyed 100 English-speaking parents of children ages 6 months to 18 years who had previously been diagnosed with food allergies and who came for follow-up visits at an urban allergy clinic.

Parents were asked about potentially risky food allergy management behaviors. For example, Wang said, “Risky behaviors include parents giving their child the allergic food to see if the child is still allergic and not always being prepared with emergency medication, epinephrine autoinjectors, in case allergic reactions occur.”

Over 70% of the kids had experienced food allergy reactions in the previous year, with almost 40% reporting at least three reactions.

About one in four children had been treated with epinephrine at some point. About one-third had been treated in an emergency department and about 5% had been hospitalized in the past.

The researchers found a correction between risky behaviors and having at least one food-induced allergic reaction during the past year. In addition, parents of kids with multiple food allergies were more likely to report risky behaviors than parents of kids with one food allergy.

About 11% of the parents gave allergy-inducing foods to their kids because they didn’t have time to read ingredient labels, and 7% said the cost of food was a barrier to avoiding those foods.

Nearly one in four parents said they intentionally exposed their kids to the food allergens to see if they were still allergic or to “treat” the underlying allergy.

“This article highlights the barriers families in an urban setting face when dealing with food allergies and stresses the need for us to better educate our patients and their families about food allergies,” said Dr. Rushani Saltzman, an allergist at Children’s Hospital of Philadelphia who wasn’t involved with the study.

“There were some concerning points raised in this study: 10% of respondents did not know how to eliminate allergic foods from the diet and 14% of respondents were confused about which foods to avoid. Furthermore, only 58% of respondents reported carriage of their epinephrine autoinjectors at all times,” Saltzman said in an email.

“It is imperative that all allergists and healthcare providers who see patients with food allergies take the time with each visit to review food allergen avoidance and label reading to avoid accidental exposures to food allergens,” she said.

In addition, families must be provided written food allergy action plans to recognize signs and symptoms of an allergic reaction, said Saltzman.

“In-office training for families on the proper use of epinephrine autoinjectors . . . is equally important,” she said.

Currently, strict food allergen avoidance remains the only proven therapy for treatment of food allergy, Saltzman said, although researchers are experimenting with ways to modify the body’s immune response to substances that trigger allergic reactions.

“If families are concerned about a possible food allergen, then consultation with an allergist is recommended for further evaluation,” she said.

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