Preventing serious food allergy reactions in children a top priority of allergists

LOUISVILLE, Ky. — Allergists ranked preventing serious allergic reactions among their pediatric patients as their top priority, followed by maximizing quality of life, according to study results.

Still, clinical factors weighed more heavily than psychosocial factors in allergists’ assessments of food allergy severity among their pediatric patients, results also showed.

“The objective of this study was to understand food allergy diagnosis and management patterns of allergists based in the United States,” Christina Ciaccio, MD, MSc, chief of the section of pediatric allergy and immunology at University of Chicago Medicine, said in her presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

Ciacco and colleagues emailed a survey to 2,850 practicing allergists in the United States in November 2021. Allergists were screened to ensure they managed more than one patient with food allergy each month and that more than 25% of their patients were children.

With 125 responses, 81% were community practitioners, whereas 19% were in academic practice. Respondents additionally included 97% from urban or suburban areas and 3% from rural areas, along with 89% who had 10 years or more in practice.

The responding allergists saw a mean of 74 patients (range, 1-200) with food allergy each month, 58% (range, 25%-100%) of whom were children.

Survey results showed that very significant barriers in managing food allergies among children included the widespread presence of causative foods in the patient’s environment (38%), patient or caregiver difficulty in modifying diets and/or procuring allergen-free food (26%), patient difficulties in carrying and/or self-administering epinephrine (22%) and difficulty in coordinating management plans with schools or daycare (23%).

When asked to rank their treatment goals, allergists responded that preventing serious allergic reactions was their No. 1 priority, followed by maximizing the patient’s quality of life, providing effective education about allergy avoidance and increasing food tolerance.

“Of note, allowing for a normal diet was the least ranked among these goals,” Ciaccio said.

The researchers also noted that only 40% of the respondents reported rating the severity of their patients’ food allergies, with the severity and types of symptoms following exposure the most significant factors used in doing so, followed by history of needed interventions, number of organ systems involved, levels of food-specific IgE on blood testing, history of ED visits and/or hospital admissions, size of wheal in skin testing, presence of comorbid allergic diseases and impact on quality of life.

“Less than half of allergists categorize food allergy severity for their patients, and reaction severity and other clinical factors rather than psychosocial factors weigh predominantly in how the overall disease severity is characterized,” Ciaccio said.

However, Ciaccio also pointed out that the World Allergy Organization is currently developing a formal unified method for characterizing food allergy severity that balances clinical and psychosocial impacts.

“This approach may provide balanced input to shared decision-making discussions with patients regarding management of food allergy,” Ciaccio said.