Q&A: Teens benefit from conversations about food allergy self-management

Key takeaways:

• Adolescents attended an online allergist visit about recognizing and treating allergic reactions.
• Participants felt more comfortable navigating social events and attending college following the visit.

ANAHEIM, Calif. — Adolescents with food allergies benefitted from education about allergy self-management, according to a poster presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

Because adolescents have a higher risk for anaphylaxis and fatal reactions to food allergens, Jessica Macdougall, MD, director of the Burghardt Food Allergy Center at Oregon Health and Sciences University, and colleagues conducted a study to learn about the level of comfort teenagers and young adults have in their food allergy management.

The study included 50 participants aged 13 to 25 years with at least one food allergy. The participants attended an online education visit with an allergist and completed a survey before and after the visit.

Healio spoke with Macdougall to learn more about the survey results and how allergists can broach these topics with their patients.

Healio: Why are teens at a higher risk for anaphylaxis and fatal reactions to food allergens?

Macdougall: Based on recent literature, teens are more likely to engage in higher risk-taking behaviors and are less likely to carry their epinephrine auto-injectors, which can lead to increased accidental exposures to their food allergens without treatment being readily available.

Healio: Could you provide some details about the survey participants?

Macdougall: A total of 50 participants from a single academic center completed the first survey. Of those participants, 56% were aged 13 to 17 years and 44% were aged 18 to 25 years. Regarding the sex of participants, 44% identified as female, 54% identified as male, and 2% identified as non-binary.

Most participants (64%) identified as white or Caucasian. Other racial and ethnicity groups represented included American Indian or Alaskan Native (4%), Asian (12%), African American (20%), Latino or Hispanic (6%) and Native Hawaiian or Pacific Islander (2%).

Most participants (72%) had multiple food allergies, whereas 28% had a single food allergy. The main food allergens reported by the participants included peanut, tree nuts, cow’s milk, egg, soy, wheat, sesame, shellfish, fish and certain fruits.

Healio: What trends did you see in the pre-visit survey responses?

Macdougall: There were several important trends in the pre-visit survey responses.

First, less than half of teens (46%) reported always carrying their epinephrine auto-injector, and approximately one-third of teens (34%) had experienced an allergic reaction due to accidental exposure in the previous year.

Second, when participants reported self-management of food allergies, less than half expressed comfort using their epinephrine auto-injector and approximately one-third felt prepared for social events such as dinners, parties or dates. Approximately one-third did not feel prepared to manage their food allergies in college.

Healio: Why do you think teens feel uncomfortable managing food allergies and using epinephrine auto-injectors?

Macdougall: It is most likely a combination of factors. While counseling teens about living with food allergies both in my clinic and during this research study, I have observed that their parents have managed much of their food allergy care including reading labels, preparing food, treating reactions and use of epinephrine. Most of these teens have not had to use an epinephrine auto-injector on their own or have not had an anaphylactic reaction requiring treatment in many years, which then leads to anxiety around allergic reactions and use of the epinephrine auto-injector.

In addition, it can be difficult to review many of the important topics — including reading labels, grocery shopping, social events and college preparedness — during a typical clinical visit and these discussions may require additional tailored visits.

Healio: What did the allergist talk about with participants during their online visit?

Macdougall: The online education visits lasted approximately 45 minutes and covered a variety of topics including: how to recognize and treat an allergic reaction, reading labels while grocery shopping, eating out at restaurants, preparing for social events, dating with food allergies, impact of alcohol and drugs, preparing for college (dining halls, office of disability, housing), and medical care (requesting refills, scheduling appointments, locating nearest ED).

Healio: What did you learn from the post-visit survey responses?

Macdougall: The greatest differences in survey responses were seen in comfort using an epinephrine auto-injector, which increased from 48% before to 81% after and preparedness for social events which increased from 32% to 67%. The response that changed the least was preparedness for college with an increase from 66% to 86%; however this was still a statistically significant finding and there were participants in our study who had already graduated from college, making this more difficult to assess.

Participants were asked their preferred method of receiving this type of tailored education and a majority reported ideally this would be a group online education visit with peers their age. Additional feedback included having three separate age groups (13 to 15 years, 16 to 18 years, and 19 to 25 years) given differences in management and questions, as well as discussing alcohol, drugs and cross-contamination in more detail. Continuing with this study, we plan to create an interactive e-learning module based on the topics covered during this education visit and develop transition guidelines for teens to help bridge the gap in self-management of food allergies.

Healio: Do you have any recommendations for how physicians can improve communication with adolescent patients?

Macdougall: There are several tools that I am implementing in my own practice after talking with participants during this study. First, starting these conversations early with patients and their families allows them to slowly gain independence over time, making it easier when they are living away from home. Second, allowing space for the teen to openly ask questions and discuss uncomfortable topics with you. For example, physicians can ask parents to step out of the room for 5 to 10 minutes during visits to give patients the opportunity to ask these questions. Third, saving time for these topics or planning for a separate visit to discuss them more at length with the hope that making this a regular topic of conversation will improve communication between physician and patient.

Reference:

• Macdougall J, et al. Poster P2195. Presented at: ACAAI Annual Scientific Meeting; Nov. 9-13, 2023; Anaheim, California.