The Food Allergy Management in Low Income Youth (FAMILY) Study: A family-centered approach to improving anaphylaxis knowledge and childhood food allergy management skills.

Abstract

Many food allergy action plans contain a controversial option to inject epinephrine for mild (''OptionA'') or no (''OptionB'') symptoms following allergen ingestion. There are no data on frequency/ criteria to select these options. METHODS: Surveys were administered in person/by email to a convenience sample of allergists and pediatricians. A chart review was conducted in a pediatric food allergy referral center to assess option use. RESULTS: Survey response rate was 35% (15 allergists, 43 pediatricians). All allergists and 74% pediatricians were familiar with OptionA; 93% and 72% for OptionB, respectively. Most allergists (80%) indicated that they used OptionA in 1-9% of plans, compared to 28% of pediatricians (p<.01). Most allergists (57%) used OptionB in 1-9% of plans, compared to 26% of pediatricians (p<.11). Cumulatively, 17% of allergists and 42% of pediatricians selected the options in over 9% of plans (p5.02). The top reasons to use the options for both allergists and pediatricians included past anaphylaxis, PICU admission, intubation, and cardiovascular collapse; the latter 3 were significantly more often identified by allergists (p <.05). Overall, 4.1% of chart review action plans indicated at least one option (OptionA-61%, OptionB-37%, both-2%), varying from 0% to 9% of plans among 9 allergists. Option selection was higher (p<.05) in patients with asthma, use of asthma treatments, prior anaphylaxis and prior epinephrine use, but not for atopic dermatitis and allergic rhinitis. CONCLUSIONS: Pediatricians endorsed use of epinephrine for mild/no symptoms more often than allergists. Severity of past reactions were drivers of selecting these options (more so for allergists than pediatricians). 738 The Food Allergy Management in Low Income Youth (FAMILY) Study: A family-centered approach to improving anaphylaxis knowledge and childhood food allergy management skills.