What’s in That Cookie?

Food allergies have more reactions and get less medicine than needed

(RxWiki News) Awareness of children’s food allergies has increased dramatically over the past few years. New research suggests that there is even more need for caregiver education about food allergies in children.

A recent study found that children with egg, milk and other food allergies had more frequent reactions than researchers anticipated when exposed to these triggers.

Caregivers were also less likely to give the children epinephrine, a medicine that helps control the reactions, than researchers expected.

"Ask your pediatrician about allergic reactions."

David M. Fleischer, MD, of the Department of Pediatric Allergy and Immunology at the Children’s Hospital at National Jewish Health, along with his colleagues in the Consortium of Food Allergy Research (CoFAR) led the study.

The investigators wanted to better understand how often children with food allergies have reactions, how serious those reactions are, how they got exposed to the foods and what medical actions the children’s caretakers take in response.

A total of 512 infants aged 3 to 15 months with documented or likely allergies to milk or eggs were enrolled in the study in five sites all around the US.

Caregivers were told to avoid feeding the babies the foods that caused their allergic reactions and the researchers provided them with a plan for how to recognize and manage allergic reactions if they did happen.

For the first two years of the three-year study, the patients visited the site clinics every six months for a medical evaluation; after that phone interviews were conducted yearly to collect data.

Caregivers were also asked to fill out questionnaires each time the infant had an allergic reaction and to call the site clinic to report it.

For each incident, researchers asked about what caused the reaction, how the infant came into contact with the trigger food, what the symptoms of the reaction were, how long it took for symptoms to develop and what actions, if any, the caregiver took.

Of all the infants, 72 percent had one allergic reaction during the study time period, and 53 percent had more than one. Most of the 1,171 total incidents were caused when the child ingested milk, egg or a peanut product.

Approximately 11 percent of the reactions were classified as severe, meaning the infant experienced swelling in the throat, difficulty breathing, a sudden drop in blood pressure, dizziness or fainting. Severe reactions can be life-threatening.

Despite the frequency of severe allergic reactions, only 30 percent of the caregivers gave the sick children epinephrine, the medicine that helps stop the reaction, during the incident.

Caregivers who did not give the medicine gave various reasons: the drug was not available, they were too afraid to administer it, they did not recognize the symptoms as those of an allergic reaction or they did not recognize the reaction as severe.

Almost 90 percent of allergic reactions to egg, milk or peanut occurred after a child ate the food by accident when the caregivers misread food labels, didn’t check ingredient lists, or let the child’s food touch the items they were allergic to. The remaining 11 percent of allergic reactions happened when a caregiver intentionally gave the allergenic food to the child.

"Intentional exposures to allergenic food are typically reported in teenagers, who tend to take more risks or who might be embarrassed about their food allergy," said Dr. Fleischer.

"What is troubling is that, in this study, we found that a significant number of young children received allergenic foods from parents who were aware of the allergy,"he said.

The researchers concluded caregivers need better education regarding how to avoid exposing allergic children to the foods they react to through better food label-reading and preventing cross-contamination from other foods.

Caregivers also need education on avoiding intentional exposure to the allergenic food and how to best medically treat life-threatening allergic reactions. The authors have put much of this information on their website.

This study was published online June 25 in Pediatrics. The research was funded by the National Institutes of Health, National Jewish Health, Mount Sinai School of Medicine, University of Arkansas, Duke University and Johns Hopkins University.

Co-author A. Wesley Burks, MD, has served on the advisory board or has financial connections to nine related corporations, including McNeil Nutritionals and Novartis, and is a member of the FDA Food Advisory Committee and various allergy-related medical organizations.

Three authors indicated no disclosures, and four have advised or consulted for multiple organizations and businesses related to allergies. Two authors are consultants for Sunovion.

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Review Date: 
June 27, 2012