Parents and caretakers may not be doing everything they can to protect young children from allergic reactions, according to a study published Monday in the journal Pediatrics.
The new research, conducted for the Consortium of Food Allergy Research (CoFAR) and funded in part by The National Institutes of Allergy and Infectious Diseases (NIAID), focused on children who have allergies to milk and egg and are “being observed for the development of peanut allergy.” Together, these represent three of the eight most common food allergens (along with fish, soy, wheat, shellfish, and tree nuts).
Researchers examined the experiences of 512 infants living near 5 universities and medical centers in New York, Maryland, Arkansas, Colorado and North Carolina over three years. Most of the children had a milk or egg allergy; 173 had neither, and 53 had both. (The children are part of an ongoing allergy research project.)
The study -– which is available in full online -- found that just over 11% of 834 recorded reactions resulted from intentional exposure to milk, egg or peanut. Researchers called this statistic “worrisome,” noting that the reasons for these intentional exposures were not completely clear. The practice “may reflect parental testing for resolution of allergy,” the study says, adding: “in some cases reactions occurred to a food that was given in a larger amount than before.” Researchers also speculated that the 11% statistic was artificially low, since “parents might have been reluctant to report reactions to purposeful exposures.”
The study’s lead author, Dr. David Fleischer of Denver's National Jewish Health, told ABC News that a follow-up study will “[go] back to families and [ask] exactly why caretakers were giving these foods on purpose.”
Reactions unrelated to intentional exposure occurred due to factors such as “lack of vigilance,” cross-contact (unintentional mixing of allergens with non-allergens), and the misreading of labels. In just over 50% of instances of allergic reaction, parents were not responsible for providing children with the food in question.
Research further found that improper or incomplete treatment following allergic reactions is surprisingly common. Participating parents were told to avoid allergens and given instructions for managing reactions, but the incidence of reaction was still high, and use of epinephrine to combat anaphylaxis was inconsistent. In fact, in more than 60 cases, caretakers “failed to administer epinephrine even though they felt it was indicated” -- some saying they did so out of fear. The study’s authors called this undertreatment a “substantial problem.”
Ultimately, the researchers called for “improved education” about the best ways to avoid allergens, and how to deal with reactions when they happen. In a press release, Dr. Scott Sicherer, who leads the Division of Allergy and Immunology at Mount Sinai School of Medicine and is one of the study’s authors, said, “This study reinforces the importance of educating parents and other caregivers of children with food allergy about avoiding allergenic foods and using epinephrine to treat severe food-allergic reactions. We must work harder to thoroughly educate parents about the details of avoidance and when and how to correctly use epinephrine to manage this life-threatening condition.”
CoFAR’s online resources include a basic allergy fact sheet (PDF) and allergy-management check list (PDF), both of which implore caretakers not to experiment with feeding children known allergens. CoFAR has also produced the following video, which offers general advice for understanding, living and dealing with allergies.