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New Item on Pediatric Menu: Food Allergy

New Item on Pediatric Menu: Food Allergy Several years have passed, but pediatrician Ruchi Gupta, MD, MPH, still remembers a particular patient with severe eczema. Gupta prescribed high-dose steroid creams and, when the child's condition did not improve, she referred him to a dermatologist. Higher-dose steroid cream did not help. The mystery was solved when the child's mother mentioned that the eczema began to clear up when her son briefly stopped eating eggs. “I sent him to an allergist,” Gupta recalled. “He got tested and not only was he allergic to eggs, but to a number of other things that were probably in his diet.” Most physicians know that peanuts are among the 3 most common food allergens in children. Yet many feel they are not adequately trained to care for children with food allergies. Gupta, assistant professor of pediatrics at Northwestern University's Feinberg School of Medicine in Chicago, has since taken to heart parents' frustrations and physicians' misconceptions concerning food allergy in children. At a time when reports show that prevalence is increasing, Gupta and her colleagues have tried to pinpoint just how much pediatricians and family physicians really know about food allergies in their young patients. In a recently published survey, Gupta and her colleagues rated physicians' overall understanding of children's food allergies as fair (Gupta RS et al. Pediatrics. 2010;125[1]:126-132). The mixed-method survey recruited participants from the American Medical Association Masterfile and from attendees at the 2008 Pediatric Academic Society's annual meeting. The study included 407 pediatricians and family physicians who answered 46 items on a validated survey instrument (83% of participants were pediatricians). Survey items asked about diagnosis and treatment, symptoms, triggers, prevalence, stigma, quality of life, and policy issues. Participants answered 61% of 39 true/false and multiple choice items correctly. For example, 80% knew that children who are allergic to eggs should not receive the flu vaccine, and 90% recognized that the number of food-allergic children in the United States is increasing. But only 24% knew that oral food challenges can be used to diagnose food allergies. Just 12% knew that chronic nasal problems are not a symptom of food allergy, which Gupta called “an interesting misconception.” Many physicians who were surveyed said they feel inadequately trained to care for patients with food allergy (78%), and that they are not comfortable interpreting laboratory tests used to diagnose food allergy (72%). Karl von Tiehl, MD, assistant clinical professor at Cincinnati Children's Hospital Medical Center in Ohio, agrees that misconceptions and a lack of awareness among physicians about food allergies in children are pervasive (von Tiehl was not involved in the study). “The major problem is that we're playing catch-up,” he said. “There has not been as large an emphasis on outpatient allergy training to future general practitioners, which results in the kind of statistics you see in [this] study.” An understanding of pediatric food allergies, Gupta added, “is one thing that we didn't get in training.” At least two-thirds of physicians in the survey correctly identified eggs, milk, and peanuts as the 3 most common food allergens in children. But Gupta called it “surprising” that 84% of family physicians, who treat fewer children than pediatricians, knew that peanuts were among the top 3 compared with 76% of pediatricians. She noted that quite a few physicians surveyed thought shellfish were among the 3 most common food allergens in children. “That's the most common food allergy in adults, but not [as common] in children,” she added. In the meantime, federal researchers are trying to get a better handle on the prevalence of children's food allergies. Another recent study showed that over a 10-year period, food allergy in children increased by 18%, to 3.9% in 2007 from 3.3% in 1997 (Branum AM and Lukacs SL. Pediatrics. 2009;124[6]:1549-1555). “Even if the increase does seem slight, it should be somewhat alarming that there is an increase at all,” said lead author Amy Branum, MSPH, a health statistician with the US Centers for Disease Control and Prevention in Atlanta. “I can't think of anything else—maybe obesity—that's comparable to that kind of increase that I’ve seen on a population basis in a while.” Gupta said recent estimates show that food allergies affect 4% to 6% of US children. But she suspects the prevalence is much higher. She and her colleagues are surveying 40 000 US households to try to determine a more exact prevalence figure as well as whether allergies reported have been diagnosed by a physician or detected by a parent. A preliminary analysis of 8000 households has shown a 15% prevalence, with 9% diagnosed by a physician and 6% detected by a parent. “I think the numbers are going up, based on that preliminary work,” she said. But busy pediatricians cannot be expected to master all the intricacies of allergy and immunology. “They need a place to go, or a tool to help,” Gupta noted. She is working to develop such a tool, consisting of a patient scenario followed by a series of questions. Gupta envisions it being used online or published in a professional journal for continuing medical education credit. “[Food allergy] is an entity that we need to learn a little more about because it's new to have so many children who have it,” she said. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

New Item on Pediatric Menu: Food Allergy

Voelker, Rebecca
JAMA , Volume 303 (6) – Feb 10, 2010
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Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2010.73
Publisher site
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Abstract

Several years have passed, but pediatrician Ruchi Gupta, MD, MPH, still remembers a particular patient with severe eczema. Gupta prescribed high-dose steroid creams and, when the child's condition did not improve, she referred him to a dermatologist. Higher-dose steroid cream did not help. The mystery was solved when the child's mother mentioned that the eczema began to clear up when her son briefly stopped eating eggs. “I sent him to an allergist,” Gupta recalled. “He got tested and not only was he allergic to eggs, but to a number of other things that were probably in his diet.” Most physicians know that peanuts are among the 3 most common food allergens in children. Yet many feel they are not adequately trained to care for children with food allergies. Gupta, assistant professor of pediatrics at Northwestern University's Feinberg School of Medicine in Chicago, has since taken to heart parents' frustrations and physicians' misconceptions concerning food allergy in children. At a time when reports show that prevalence is increasing, Gupta and her colleagues have tried to pinpoint just how much pediatricians and family physicians really know about food allergies in their young patients. In a recently published survey, Gupta and her colleagues rated physicians' overall understanding of children's food allergies as fair (Gupta RS et al. Pediatrics. 2010;125[1]:126-132). The mixed-method survey recruited participants from the American Medical Association Masterfile and from attendees at the 2008 Pediatric Academic Society's annual meeting. The study included 407 pediatricians and family physicians who answered 46 items on a validated survey instrument (83% of participants were pediatricians). Survey items asked about diagnosis and treatment, symptoms, triggers, prevalence, stigma, quality of life, and policy issues. Participants answered 61% of 39 true/false and multiple choice items correctly. For example, 80% knew that children who are allergic to eggs should not receive the flu vaccine, and 90% recognized that the number of food-allergic children in the United States is increasing. But only 24% knew that oral food challenges can be used to diagnose food allergies. Just 12% knew that chronic nasal problems are not a symptom of food allergy, which Gupta called “an interesting misconception.” Many physicians who were surveyed said they feel inadequately trained to care for patients with food allergy (78%), and that they are not comfortable interpreting laboratory tests used to diagnose food allergy (72%). Karl von Tiehl, MD, assistant clinical professor at Cincinnati Children's Hospital Medical Center in Ohio, agrees that misconceptions and a lack of awareness among physicians about food allergies in children are pervasive (von Tiehl was not involved in the study). “The major problem is that we're playing catch-up,” he said. “There has not been as large an emphasis on outpatient allergy training to future general practitioners, which results in the kind of statistics you see in [this] study.” An understanding of pediatric food allergies, Gupta added, “is one thing that we didn't get in training.” At least two-thirds of physicians in the survey correctly identified eggs, milk, and peanuts as the 3 most common food allergens in children. But Gupta called it “surprising” that 84% of family physicians, who treat fewer children than pediatricians, knew that peanuts were among the top 3 compared with 76% of pediatricians. She noted that quite a few physicians surveyed thought shellfish were among the 3 most common food allergens in children. “That's the most common food allergy in adults, but not [as common] in children,” she added. In the meantime, federal researchers are trying to get a better handle on the prevalence of children's food allergies. Another recent study showed that over a 10-year period, food allergy in children increased by 18%, to 3.9% in 2007 from 3.3% in 1997 (Branum AM and Lukacs SL. Pediatrics. 2009;124[6]:1549-1555). “Even if the increase does seem slight, it should be somewhat alarming that there is an increase at all,” said lead author Amy Branum, MSPH, a health statistician with the US Centers for Disease Control and Prevention in Atlanta. “I can't think of anything else—maybe obesity—that's comparable to that kind of increase that I’ve seen on a population basis in a while.” Gupta said recent estimates show that food allergies affect 4% to 6% of US children. But she suspects the prevalence is much higher. She and her colleagues are surveying 40 000 US households to try to determine a more exact prevalence figure as well as whether allergies reported have been diagnosed by a physician or detected by a parent. A preliminary analysis of 8000 households has shown a 15% prevalence, with 9% diagnosed by a physician and 6% detected by a parent. “I think the numbers are going up, based on that preliminary work,” she said. But busy pediatricians cannot be expected to master all the intricacies of allergy and immunology. “They need a place to go, or a tool to help,” Gupta noted. She is working to develop such a tool, consisting of a patient scenario followed by a series of questions. Gupta envisions it being used online or published in a professional journal for continuing medical education credit. “[Food allergy] is an entity that we need to learn a little more about because it's new to have so many children who have it,” she said.

Journal

JAMA – American Medical Association

Published: Feb 10, 2010

Keywords: food allergy,pediatrics

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