Finding a Path to Safety in Food Allergy Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy (2017) / Chapter Skim
Currently Skimming:
6 Management in the Health Care Setting
6 Management in the Health Care Setting
Pages 227-276
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 227... ...
This chapter covers management of diagnosed food allergy from the perspective of a health care setting and includes topics such as the impact of food allergy on affected individuals and families and the current understanding of food allergy treatment. Dietary issues with regard to prevention are discussed in Chapter 5.
|
From page 228... ...
Meta-analyses and systematic reviews were selected when available. ALLERGEN AVOIDANCE AND RECOGNITION OF AND PREPAREDNESS TO TREAT ALLERGIC REACTIONS AND ANAPHYLAXIS General Principles of Management, Avoidance, Cross-Contact, Hidden Ingredients, Routes of Exposure The primary advice for managing a diagnosed food allergy, whether immunoglobulin E (IgE)
|
From page 229... ...
Avoiding ingestion of a food allergen requires patient education about obtaining safe foods in numerous settings, for example reading labels on packaged foods,1 asking before ordering in restaurants and food service, and preparing safe meals at home. Standard cleaning procedures, such as using wet wipes and washing hands with running water and soap, typically suffice to remove allergen from surfaces.
|
From page 230... ...
A 2015 systematic review regarding unexpected allergic reactions in those older than age 12 years (Versluis et al., 2015) identified 18 observational and 6 qualitative studies.
|
From page 231... ...
Allergen Avoidance and Relationship to Comorbid Asthma, Atopic Dermatitis, and Allergic Rhinitis Food allergen avoidance is generally not recommended as a primary means to address treatment of asthma, atopic dermatitis, or allergic rhinitis. However, avoidance is warranted when a specific food allergy is diagnosed in a patient with those diagnoses (Boyce et al., 2010; Sampson et al., 2014)
|
From page 232... ...
The current U.S. labeling law, the Food Allergen Labeling and Consumer Protection Act of 2004, requires manufacturers to use plain English terms to identify milk, egg, wheat, soy, peanut, tree nuts, fish, and crustacean shellfish ingredients.
|
From page 233... ...
. In addition to managing the risks from packaged foods by replacing the current food allergen precautionary advisory labeling system, as recommended in Chapter 7, risks from consuming packaged foods should be communicated to individuals with food allergy and their caregivers by effective counseling in the health care setting.
|
From page 234... ...
Several studies have reported allergic reactions on airplanes based on self-report of having unintentionally ingested or been exposed to allergens (Comstock et al., 2008; Greenhawt et al., 2013; Sicherer et al., 1999)
|
From page 235... ...
. A discussion about approaches to providing a safe experience for children with food allergies when away from home, including the responsibilities of the school staff, is provided in Chapter 8.
|
From page 236... ...
intramuscular epinephrine is safe and, if a possibility of a severe allergic reaction exists, should be administered (side effects are mild and may include temporary fast heart rate, jitteriness, flushing, or paleness) (Sicherer et al., 2007, 2010)
|
From page 237... ...
Avoidance measures should be discussed and are reviewed in the CDC Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs (CDC, 2013)
|
From page 238... ...
. Another Web-based study of 407 primary care physicians noted a fair allergy and anaphylaxis knowledge base but specific deficits were noted, such as only 23 percent recognizing that cheese is unsafe for those with milk allergy and fewer than 30 percent indicating comfort with laboratory tests or caring for children with food allergies (Gupta et al., 2010b)
|
From page 239... ...
Risk factors identified in case series of fatal food allergic reactions include adolescence or young adult age group, comorbid asthma, ingestion of peanut or tree nuts (although fatal reactions can occur from other allergens, such as
|
From page 240... ...
. The motivation behind risk-taking behaviors may include poor understanding of risk, convenience, not wanting to feel different from peers, bullying, lack of recollection of allergic reactions, success having survived self-resolving reactions without the need for treatment, fear of injections, overreliance on emergency medications on hand to justify unsafe eating behaviors, and other behavioral and psychosocial factors (Akeson et al., 2007; Greenhawt et al., 2009; Macadam et al., 2012; MacKenzie et al., 2010; Marrs and Lack, 2013; Monks et al., 2010; Noimark et al., 2012; Sampson et al., 2006a)
|
From page 241... ...
The specific risk for each medication is not known. Vaccines also may contain food allergens, such as egg protein or gelatin.
|
From page 242... ...
Many alcoholic beverages are made from potential allergens, for example amaretto from almonds, frangelico from hazelnuts, and Irish cream from milk, but the residual allergenicity of these products has not been studied. EMERGENCY MANAGEMENT OF ALLERGIC REACTIONS The physician must counsel patients with food allergy, and their families, on recognizing and treating food-induced anaphylaxis.
|
From page 243... ...
. Biphasic reactions may be more likely with severe or undertreated reactions, but are unpredictable, and observation in an emergency department for at least 4 to 6 hours is recommended (Boyce et al., 2010)
|
From page 244... ...
Nonetheless, the conclusion was to recommend epinephrine auto-injectors as the most effective first-line treatment for anaphylaxis in the community, with a recommendation for trials comparing different doses and devices as well as syringe and ampule. According to the NIAID/NIH-supported Guidelines, a prescription for an epinephrine auto-injector, typically two doses, should be given to those who have experienced anaphylaxis as well as patients with diagnosed food allergy who have asthma and those with allergy to foods that typically cause severe reactions (e.g., peanut, tree nuts, fish, shellfish)
|
From page 245... ...
. Most of these adjunctive therapies would be available following first aid management and would be administered by emergency personnel or by emergency department staff.
|
From page 246... ...
A systematic review was undertaken with the intention to perform a meta-analysis to assess benefits and harms of glucocorticoid treatment during anaphylaxis, but no randomized or quasi-randomized controlled trials comparing glucocorticoids to any control were identified and so no meta-analysis could be undertaken (Choo et al., 2012)
|
From page 247... ...
When allergen avoidance is the one recommendation to minimize the risk of an allergic reaction, children could end up deficient on specific nutrients or calories if attention to their nutrition is not considered. The NIAID/NIH-supported Guidelines suggest nutritional counseling and regular growth monitoring for all children with food allergies (Boyce et al., 2010)
|
From page 248... ...
A systematic review of nutrient intake and growth in children with multiple IgE-mediated food allergies identified six studies and concluded that "children with multiple food allergies have a higher risk of impaired growth and may have a higher risk of inadequate nutrient intake than children without food allergies" (Sova et al., 2013, p.
|
From page 249... ...
QUALITY OF LIFE AND MENTAL HEALTH CONSIDERATIONS Daily management of food allergy is focused on avoiding trigger foods and recognizing and managing allergic reactions, some of which are lifethreatening. These considerations practically affect the routine of daily living and also carry psychological burdens that can result in anxiety and stress.
|
From page 250... ...
. The degree of impact on HRQL can vary based on knowledge of food allergies, age, having had experiences such as emergency room visit for anaphylaxis, an injection of epinephrine, or multiple food allergies, or allergies to specific foods (e.g., milk or egg compared to peanut or tree nut)
|
From page 251... ...
A systematic review and meta-analysis of 43 studies suggested a positive association between psychosocial factors and future atopic disorders and current atopic disorders and future poor mental health, but studies of food allergy were insufficient to comment on this disease separately (Chida et al., 2008)
|
From page 252... ...
Unfortunately, one study of mental health screening of families with food allergy failed to result in a greater consultation rate with a mental health professional compared to a referral by the patient's allergist (Shemesh et al., 2015)
|
From page 253... ...
These therapies are often evaluated in context of promoting "desensitization" to the targeted food allergen. That is, these treatment approaches may raise the threshold of reactivity while the therapy is in progress, while cessation of therapy may result in loss of protection.
|
From page 254... ...
. A 2014 systematic review and meta-analysis of milk oral OIT identified six qualifying articles and concluded that it was effective for treating IgE-mediated cow milk allergy because significantly more patients were desensitized on treatment compared to those on an avoidance diet.
|
From page 255... ...
Counseling about avoidance involves emphasizing key concerns, such as cross-contact and hidden ingredients and discussing foods related to the diagnosed allergens, which may need to be avoided upon a full food allergy evaluation. Counseling is directed to managing food allergies at home, reading labels (and knowing about products that are not included in mandatory labeling laws)
|
From page 256... ...
RECOMMENDATIONS Numerous clinical guidelines and parameters provide advice for health care providers and patients and their caregivers on diagnosing, preventing, and managing food allergy. The committee generally supports current guidelines and U.S.
|
From page 257... ...
For example, current evidence is insufficient to associate any of the following behaviors with prevention of food allergy: food aller gen avoidance diets for pregnant or lactating women, prolonged allergen avoidance in infancy, vaginal delivery, breastfeeding, infant formulas containing extensively or partially hydrolyzed protein, and supplementation with specific nutrients (e.g., vitamin D, folate, fatty acids) in children or adults.
|
From page 258... ...
• ounseling on food allergy management and anaphylaxis. C This includes identifying food allergies as well as man aging and treating them in various settings (e.g., home, school, restaurants)
|
From page 259... ...
to the general public and to first responders and first aid personnel in various professions and workplaces, include food allergy and ana phylaxis management in their curricula. RESEARCH NEEDS Health Care Settings Food allergy management primarily requires avoiding the trigger allergen(s)
|
From page 260... ...
To address those gaps in knowledge, the following research areas should be pursued on all affected populations (ages, sexes, ethnicities, comorbidities, socioeconomic strata) , especially on underrepresented populations: • Determine the effectiveness of evidence-based guidelines and evidence-based educational programs on food allergy management, including avoidance of allergens and emergency management of allergic reactions and anaphylaxis, for health care providers and for patients, particularly for high-risk groups.
|
From page 261... ...
J Allergy Clin Immunol Pract 2(5)
|
From page 262... ...
J Allergy Clin Immunol 130(1)
|
From page 263... ...
J Allergy Clin Immunol Pract 3(1)
|
From page 264... ...
J Allergy Clin Immunol Pract 1(3)
|
From page 265... ...
J Allergy Clin Immunol Pract 3(1)
|
From page 266... ...
J Allergy Clin Immunol Pract 3(1)
|
From page 267... ...
Curr Opin Allergy Clin Immunol 10(3)
|
From page 268... ...
J Allergy Clin Immunol Pract 3(3)
|
From page 269... ...
J Investig Allergol Clin Immunol 24(5)
|
From page 270... ...
J Allergy Clin Immunol 122(2)
|
From page 271... ...
J Allergy Clin Immunol 112(2)
|
From page 272... ...
J Allergy Clin Immunol 117(2)
|
From page 273... ...
J Allergy Clin Immunol Pract 4(2)
|
From page 274... ...
J Allergy Clin Immunol 130(5)
|
From page 275... ...
J Allergy Clin Immunol Pract 1(4)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.