Avoiding Food Allergens is a Formidable Task

Newswise — Parents of food-allergic children are often overwhelmed with the wide-ranging tasks and lifestyle limitations that help keep their child safe according to a report published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

Researchers found that stress levels and daily activities " especially meal preparation, social events and school attendance " were significantly impacted by food allergy management strategies.

"Maintaining a diet that strictly avoids food allergens is a formidable task," noted experts in pediatric allergic disease and child psychology who collaborated in this pilot investigation of 87 families at an allergy practice based at the University of Maryland Hospital for Children.

The Food and Drug Administration's Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA) now requires food manufacturers to disclose in plain language whether products contain any of the top eight food allergens, which are milk, eggs, fish, crustacean shellfish, peanuts (a legume), tree nuts, wheat and soy.

Food products without this new labeling may be found in stores for possibly a year or longer after FALCPA's January 1, 2006 effective date. As a result, parents must frequently contact the manufacturers to determine if a food is safe for their food-allergic child according to the investigators. Caregivers of food-allergic children also need to be aware of possible cross-contamination that may not be included in labeling.

"Providing safe and nutritious foods for children on multiple food allergen restricted diets is particularly challenging," says Mary E. Bollinger, D.O., an associate professor of pediatrics at the University of Maryland School of Medicine in Baltimore, who is one of the study's authors.

More than 60 percent of the study participants reported that food allergy significantly affected meal preparation. Approximately half of them reported food allergy affected family social activities, with 53 percent to 70 percent noting restrictions in playing at friends' houses, or attending birthday parties and sleepovers.

Investigators found that food allergy had a significant impact on school activities, limiting attendance (one third), field trips (59 percent) and school parties (68 percent). Ten percent of caregivers chose to home school their child due to food allergy.

Other studies show that accidental ingestions are likely to occur, particularly outside the home. Food allergy is the leading cause of anaphylaxis cases seen in U.S. emergency departments, with an estimated 30,000 cases per year.

The planning required to attend social events or eat out can cause anxiety and stress according to investigators. Parents' written comments on the questionnaires illustrate that simple activities often taken for granted may be so overwhelming for these families that they avoid them. A couple participating in the study commented that no one ever prepared any meals for their son other than themselves and one grandparent. One respondent did not work because of their son's allergies.

Another caregiver wrote, "We are unable to leave our daughter in the care of others, which greatly impacts on social relationships as well as our marriage. We are not able to let her play or sleep at friends' homes without one of us, and we as a couple have been unable to go out for an evening or a vacation without children."

The 32-item Food Allergy Impact Scale, designed for the investigation, uses a variety of survey tools for food allergy, chronic disease, quality of life and family impact of disease.

"Bollinger and colleagues are the first to develop a food allergy-specific questionnaire that measures parents' perceptions of the impact of food allergy on the daily activities of food allergic children and their families," Stacie M. Jones, M.D., and Amy M. Scurlock, M.D., at University of Arkansas for Medical Sciences in Little Rock, Ark., wrote in a guest editorial. "This ground-breaking work provides an important framework for future studies."

New food allergy guidelines also published this month in Annals of Allergy, Asthma & Immunology include recommendations for food allergy management in special settings and circumstances, where patients have an increased risk for unintentional food allergy exposure. Avoidance, risk factors, prevention and cross-reactivity of food allergy are also discussed in the guidelines.

The evidence-based guidelines, "Food Allergy: A Practice Parameter," were developed by the Joint Task Force on Practice Parameters of allergists representing the ACAAI, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Joint Council of Allergy, Asthma and Immunology (JCAAI).

Patient information on food allergy and other allergic diseases is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at www.acaai.org. For food allergy patient information or support, call FAAN at 800-929-4040 or visit online at http://www.foodallergy.org.

The ACAAI is a professional medical organization comprising more than 5,000 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.

Citations:Bollinger ME, et al. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol 2006;96:415-421.

Jones SM and Scurlock AM. Guest editorial. The impact of food allergy: the real "fear factor." Ann Allergy Asthma Immunol 2006;96:385-386.

Chapman JA, Bernstein IL, Lee RE, Oppenheimer J, et al. Food Allergy: A Practice Parameter. Ann Allergy Asthma Immunol 2006;96,No3(suppl):S1-S68.