Survey: Preventing serious reactions comes first in treating children with food allergy
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Key takeaways:
- Sample cases included a boy with new food allergy and a girl with previous allergy.
- Additional priorities included maximizing quality of life and patient education.
ANAHEIM, Calif. — Allergists prioritized the prevention of serious reactions in a new food allergy case, according to a survey presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
Maximizing quality of life and patient and caregiver education followed in prioritization, Aikaterini (Katherine) Anagnostou, MD (Hons), MSc, PhD, professor of pediatrics in the division of immunology, allergy and retrovirology at Baylor College of Medicine and a Healio Allergy/Asthma Peer Perspective Board Member, said during her presentation.
Anagnostou and colleagues surveyed 2,756 practicing allergists in the United States in November and December 2021. With a 4.5% response rate (n = 125), the researchers included allergists who managed one or more patients with food allergy per month and whose patient populations were more than 25% children.
“The survey included questions that were specific to two pediatric cases,” Anagnostou said. “The objective of the survey was to understand the priorities of allergists as well as the challenges faced in managing patients with food allergies.”
The first case was a boy aged 3 years who was referred after an episode of urticaria as well as a swollen tongue and difficulty breathing after ingesting peanut butter. This boy also had a history of mild atopic dermatitis.
Peanut skin testing yielded an 8 mm wheal, with 500 U/mL total IgE and 15 kU/L peanut-specific IgE. The boy was diagnosed with peanut allergy and received a prescription for an epinephrine autoinjector.
In the second case, a girl aged 12 years who already had been diagnosed with peanut allergy and tree nut allergy, in addition to comorbid asthma and atopic dermatitis, presented for follow-up care.
An accidental exposure to peanut in the previous 2 years required an epinephrine injection, and the girl had anxiety about additional accidental exposures. A physical examination yielded rhinitis and dry skin with isolated areas of excoriation.
She had a 10 mm wheal with peanut skin testing, along with 650 kU/mL of total IgE and 30 kU/L of peanut sIgE, and 150 cells/µL in peripheral blood eosinophils.
Most of the allergists estimated that the boy had low likelihood of 30% or less for accidental peanut exposure, including 24% who thought the likelihood was between 0% and 10%, 18% who thought the likelihood was between 11% and 20%, and 18% who thought the likelihood was between 21% and 30%.
The prevention of serious allergic reactions was the top priority for allergists managing children with a new food allergy, such as the boy described in the survey, followed by maximizing quality of life, providing effective education about allergen avoidance, increasing food tolerance, and allowing for a normal diet.
“The likelihood of recommending a food allergy action plan was high,” Anagnostou said.
Specifically, 87% said they were extremely or very likely to recommend a food allergy action plan. Similarly, 96% said they were extremely or very likely to discuss proper use of an epinephrine autoinjector.
The allergists also said they were more likely to recommend investigational biologic treatments for patients with comorbid asthma, AD or multiple food allergies, such as the girl in the second case, compared with other comorbidities such as chronic urticaria, environmental allergy, chronic rhinosinusitis or drug allergy.
The main strategies for managing patients with food allergy, the researchers concluded, included developing a food allergy plan and patient education about epinephrine use.
“Tailored educational tools for patients might provide a valuable resource in patient-allergist conversations,” Anagnostou said.