To optimize care for food allergies, it is critical for healthcare professionals to manage patients based on published evidence and clinical guidelines. Unfortunately, there are many misconceptions about preventing, diagnosing, and managing patients with food allergies. Further complicating matters is the frequent use by patients and their families of a variety of sources for medical information, some of which are unreliable or inaccurate.
“Misconceptions in food allergy can adversely affect the management of patients and their quality of life,” says Aikaterini Anagnostou, MD (Hons), MSc, PhD. “For example, having all patients with peanut allergy avoid tree nuts—when tree nut allergy may not exist in some of these individuals—can result in significant diet limitations, as well as social, psychological, and financial burden.”
In a paper published in Children, Dr. Anagnostou described several of the most common misconceptions surrounding food allergies and clarified the optimal approaches to managing patients who are diagnosed with this chronic condition (Table). She says three of the most important misconceptions are in regard to:
- Delays in the introduction of allergenic foods
- Use of epinephrine auto-injectors during food allergic reactions
- Influenza vaccination in patients with egg allergy.
“The misconceptions about these issues should be addressed urgently, because they can have major impacts on the lives of patients,” says Dr. Anagnostou.
Delaying Introduction of Allergenic Foods
For years, experts have advocated delaying the introduction of allergenic foods into diets of high-risk infants after the first year of life. “In reality, avoiding allergenic foods early in life likely places patients at high risk for developing food allergies,” Dr. Anagnostou says. “This is a potentially lifelong diagnosis with a significant disease burden that is multifaceted.” Feeding guidelines for infants have changed significantly over the years, and many now recommend introducing food allergens early in life to expand food allergy prevention for many common allergenic foods.
Patients with food allergies should be educated on using epinephrine auto-injectors. However, epinephrine is often unavailable and underused when a severe allergic reaction occurs. “Underuse of epinephrine places the patient’s life at risk when they suffer severe allergic reactions,” says Dr. Anagnostou. Significant work is needed to improve patient knowledge on recognizing and treating anaphylaxis and to address the complex psychosocial dimensions of anaphylactic emergencies.
Egg Allergy & the Influenza Vaccine
Giving the influenza vaccine to egg-allergic children may raise concerns about risks of anaphylaxis, but studies show that the flu vaccine is safe for these patients and may be given with the usual precautions that are taken with any vaccination. Choosing a special egg-free vaccine, extending the usual period of observation, and administering the vaccine only in specialized settings are unnecessary actions and may delay vaccine uptake. “Misplaced concerns about vaccination can put children at risk for severe infections and undesirable outcomes,” Dr. Anagnostou adds.
Guidance on Fatality Concerns
Misconceptions about fatalities due to anaphylaxis associated with food allergies are also common. “Fatalities in food allergy are rare, and patients who are anxious about fatal anaphylaxis should be reassured about their very small chance of this occurring,” says Dr. Anagnostou. “All patients must be educated on the appropriate and prompt use of epinephrine in anaphylaxis to protect themselves from adverse outcomes.”
Considering the wide range of misconceptions surrounding food allergies, it is critical for clinicians to stay up to date and proactively address these issues with their patients and families. Healthcare professionals should be aware of frequent misconceptions and address them promptly during consultations to ensure that patients receive optimal, evidence-based care.
“Misconceptions in the management of food allergy can be addressed with patient education, increasing public awareness, and practicing good communication with patients and their families,” Dr. Anagnostou notes. “Being up to date with the most recent literature and regularly attending allergy conferences and educational events can help ensure that physicians are up to date with current evidence.”