Management of children with food allergies by allergists in the United States

Abstract

Background: Management of patients with food allergies is complex, especially in cases of patients with multiple and potentially severe food allergies. Although international guidelines exist for food allergy management, the role of the allergist in the decision-making process is key.

Objective: Our aim was to investigate the management patterns and educational needs of practicing allergists treating patients with food allergies.

Methods: An online survey was e-mailed to United States-based practicing allergists (N = 2833) in November-December 2021. The allergists were screened for managing 1 or more patients (including ≥25% pediatric patients) with food allergies per month. The allergists responded to questions regarding food allergy management in response to 2 hypothetical pediatric case studies, their familiarity with available guidelines and emerging treatments, and their future educational preferences. A descriptive analysis of outcomes was conducted.

Results: A total of 125 responding allergists (4.4%) met the eligibility criteria and completed the survey. The allergists prioritized written exposure action plans, patient-caregiver communication, prevention of serious reactions, and consideration of both food allergy severity and allergic comorbidities in the management of patients with food allergies. With regard to recommending biologics in the future, the allergists identified patient history of anaphylaxis and hospitalizations, food allergy severity, and allergic comorbidities as all being important factors to consider when deciding on appropriate treatment options. The allergists noted their ongoing educational needs, especially for current and emerging treatments for food allergies.

Conclusion: With the treatment landscape for food allergies evolving rapidly, the decision-making priorities and continuing educational needs of allergists will be important in optimizing the management of patients with food allergies.

Keywords: Allergists; anaphylaxis; children; continuing; education; food allergy; food hypersensitivity; medical; pediatric.

Fig 1

The case studies of pediatric patients with food allergies. The allergists were presented with 2 case studies: the case of a 3-year-old male patient with a new food allergy (A) and the case of a 12-year-old female patient with known food allergies (B).

Fig 2

Initial counseling provided to a pediatric patient with a new food allergy and the patient’s caregiver (case 1). The allergists were asked how likely (extremely, very, moderately, slightly, or not at all) they were to discuss each aspect of patient care with this patient and the patient’s caregiver. ^aThe response less likely includes responses of moderately likely, slightly likely, and not at all likely.

Fig 3

Factors determining severity of food allergy in a pediatric patient with a new food allergy (case 1). The allergists were asked whether they would rate severity of food allergy in this patient. If they answered yes, they were asked to select and rank 4 of the 9 factors provided, with 1 being the most significant and 4 being the least significant.

Fig 4

Biologics as potential treatments for a pediatric patient with known food allergies (case 2). The allergists were asked to consider a scenario in which biologics were approved for the treatment of food allergies in pediatric patients and state how significant (extremely, very, moderately, slightly, or not at all) each treatment-related factor was in determining whether to recommend treatment with biologics (A) and how significant each patient-related factor was in determining whether to treat a patient’s food allergies with biologics (B). ^aThe response less significant includes the responses moderately significant, slightly significant, and not at all significant.

Fig 5

Food allergy education and guideline use. A, Food allergy topics for future CME programs. The allergists were asked which topics (list 1 or list 2) they would be most interested in learning about in future CME programs. B, Clinical practice guidelines frequently used by allergists to manage pediatric patients with food allergies. The allergists were asked to select all responses that apply from a list of guidelines that they find useful or, alternatively, indicate “none of these.” Gray box indicates organizations and guidelines affiliated with the Joint Task Force on Practice Parameters (JTFPP), which was formed to develop guidelines for the diagnosis and management of allergic and immunologic diseases.ABIM, American Board of Internal Medicine.