pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Food Allergy: Children Deliberately Exposed To Harmful Foods

A new study presented at the American Academy of Allergy, Asthma and Immunology (AAAAI for short) annual meeting reports that roughly 11% of allergic reactions in children with known food allergies are the result of caregivers intentionally exposing the child to the allergen.

What’s supposed to happen is that the parents bring a child to the doctor with symptoms then the doctor takes a meticulous history of responses to foods, does a thorough physical, performs focused laboratory testing, does some food challenges if warranted and makes a diagnosis. Then he sits down with the parents and explains the diagnosis, what dangers the child is in, what NOT to do and what TO DO to help the child.

All this effort because the diagnosis of food allergy is tough to live with – for everyone. What this new report reveals is that there’s a horrible disconnect between parents and doctors shown in one out of every ten visits to the doctor for allergic food reactions.

It’s hard to argue with reported results but it’s also hard to believe that a parent would knowingly put their child’s health in jeapordy. To my way of thinking, here’s got to be some kind of huge “disconnect” with the doctor, his/her staff and the patients. Obviously someone either isn’t giving the right message or the parents aren’t understanding what’s being said.

As part of a huge and difficult ongoing long term study of food allergy (Observational Consortium of Food Allergy Research – CoFAR) 1170 allergic reactions reported by 512 families over a three year period were analyzed. Most reactions (834) were to milk, egg, or peanut, and more than half of the families reported multiple reactions during the study period.

Based on how and where it occurred, its type and how it was treated the researchers described 11% of them as “purposeful.” So they – what else – devised a questionnaire.

What Are The Reasons

They wanted to know what the motivations were in the 40 families with 52 purposeful exposures. They found 64% was by the child’s mother, 21% the father, 14% the grandfather and the rest other caregivers.

Almost one third of those willing to respond said the child had not reacted to the allergen after a previous exposure, 25% said they thought the exposure would help resolve the allergy, and 24% said the child’s previous reaction to the allergen had not been severe in their opinion.

    Reasons for knowingly giving known allergen to child

  1. Thought a small amount would be safe – 46%
  2. Wanted to see if the allergy had resolved – 42
  3. Child had tolerated a baked form of egg or milk, so thought it would be safe – 38
  4. Child had not reacted to the allergen after a previous exposure – 29
  5. Thought the exposure would help resolve the allergy – 25
  6. In their opinion, thought the child’s previous reaction to the allergen had not been severe – 24
  7. Did not think the child’s diagnosis was accurate – 15
  8. Believed that a decrease in the child’s immunoglobulin E meant a resolution of the allergy – 14
  9. Wanted to test the severity of the allergic reaction – 8
  10. Had read an article that influenced their decision to try an at-home exposure – 4
  11. Child was scheduled for an in-office oral food challenge so they decided to try it first at home – 2

These sound like the doctor isn’t getting through to them. I’m sure it’s not because they don’t think it’s important. More likely, no one in the office is taking the time to communicate effectively. People don’t “get it” when they’re merely given a handout, or given some canned speech out of a manual by an aide. They do get it, I’ve seen, when the doctor takes the time to tell them personally how important it is.

The lead investigator from Johns Hopkins University, Kim Mudd R.N., feels that at the root of purposeful exposures is “a sense of frustration and impatience. We want to have our kids’ and their lives a normalized as possible.” And, did I say that food allergies are “tough to live with?”

    Common misconceptions about food allergies are:

  • Reactions can still occur despite low or improving immunoglobulin levels [IgE] found on testing.
  • It’s the food not the amount – eating even small amounts can trigger a reaction.
  • Tolerance to baked milk or baked egg does not indicate tolerance to unheated milk or egg – in fact, this difference is nearly always seen.
  • Any concerns about the diagnosis being incorrect should be discussed with the allergist. And,
  • It is unsafe to try foods of known allergy at home, even in small amounts.

What Are The Risks

Even though even a few are too many, comparatively, there isn’t a large number of deaths from food allergies – although those of us who have seen them remember them vividly.

Fortuitously, almost 100% of the deaths from food exposures are in persons whose allergy type is asthma – so we can narrow it down a little of where the danger is. And, it’s the tree nut, peanut and seafood allergies which are nearly always more intense.

Pediatricians always prescribe EpiPens if the child is both food allergic and asthmatic, OR if the child is tree nut, peanut, or seafood allergic. So, if you get sent home with a prescription for emergency measures – that should be a clue – this can be serious.

Although, even if you don’t get an EpiPen you’re still not out of the woods – talk to your doctor before laxing up on your efforts to protect from food reactions.

[American Academy of Allergy, Asthma & Immunology (AAAAI) 2013 Annual Meeting: Abstract 451. Presented February 24, 2013.]

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