The Development of Age-Based Food Allergy Educational Handouts for Caregivers and Patients: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee.

BACKGROUND: Food allergy education is an ongoing process that must address unique safety concerns and psychosocial challenges at each developmental stage. Families require reliable information that is targeted to specific developmental stages to support the integration of food allergy management into daily life. OBJECTIVE: The purpose of this project was to develop age-specific, evidence-based patient education handouts with practical recommendations for managing and coping with food allergies at different developmental stages. METHODS: Handout content was based on: (1) practice guidelines for food allergy management; (2) literature addressing psychosocial and educational needs of patients with food allergy and their caregivers; and (3) clinical experience of the project team. Fifty-seven caregivers of patients (aged 0-21 years) with food allergy and 2 young adults with food allergy reviewed a draft of the handouts and completed an online survey to assess handout acceptability and usability and identify areas for improvement. Handouts were revised based on participant feedback. RESULTS: The majority of participants (79%) rated the amount of information in the age-specific handouts as "just right," versus "not enough" (9%) or "too much" information (12%). Sixty-three percent reported that they would be "very likely" to use the handouts as a resource and 35% "somewhat likely." Almost all participants (88%-100% by item) agreed that the handouts used elements of plain language writing and clear communication. CONCLUSION: Caregivers rated the age-based food allergy education handouts as understandable and useful. We anticipate that these handouts could be used during health care visits and directly accessed online by families.

Mapping Sequential IgE-Binding Epitopes on Major and Minor Egg Allergens.

INTRODUCTION: Molecular studies of hen's egg allergens help define allergic phenotypes, with IgE to sequential (linear) epitopes on the ovomucoid (OVM) protein associated with a persistent disease. Epitope profiles of other egg allergens are largely unknown. The objective of this study was to construct an epitope library spanning across 7 allergens and further evaluate sequential epitope-specific (ses-)IgE and ses-IgG4 among baked-egg reactive or tolerant children. METHODS: A Bead-Based Epitope Assay was used to identify informative IgE epitopes from 15-mer overlapping peptides covering the entire OVM and ovalbumin (OVA) proteins in 38 egg allergic children. An amalgamation of 12 B-cell epitope prediction tools was developed using experimentally identified epitopes. This ensemble was used to predict epitopes from ovotransferrin, lysozyme, serum albumin, vitellogenin-II fragment, and vitellogenin-1 precursor. Ses-IgE and ses-IgG4 repertoires of 135 egg allergic children (82 reactive to baked-egg, the remaining 52 tolerant), 46 atopic controls, and 11 healthy subjects were compared. RESULTS: 183 peptides from OVM and OVA were screened and used to create an aggregate algorithm, improving predictions of 12 individual tools. A final library of 65 sequential epitopes from 7 proteins was constructed. Egg allergic children had higher ses-IgE and lower ses-IgG4 to predominantly OVM epitopes than both atopic and healthy controls. Baked-egg reactive children had similar ses-IgG4 but greater ses-IgE than tolerant group. A combination of OVA-sIgE with ses-IgEs to OVM-023 and OVA-028 was the best predictor of reactive phenotype. CONCLUSION: We have created a comprehensive epitope library and showed that ses-IgE is a potential biomarker of baked-egg reactivity.

Food allergy.

Food allergies manifest in a variety of clinical conditions within the gastrointestinal tract, skin and lungs, with the most dramatic and sometimes fatal manifestation being anaphylactic shock. Major progress has been made in basic, translational and clinical research, leading to a better understanding of the underlying immunological mechanisms that lead to the breakdown of clinical and immunological tolerance against food antigens, which can result in either immunoglobulin E (IgE)-mediated reactions or non-IgE-mediated reactions. Lifestyle factors, dietary habits and maternal-neonatal interactions play a pivotal part in triggering the onset of food allergies, including qualitative and quantitative composition of the microbiota. These factors seem to have the greatest influence early in life, an observation that has led to the generation of hypotheses to explain the food allergy epidemic, including the dual-allergen exposure hypothesis. These hypotheses have fuelled research in preventive strategies that seek to establish desensitization to allergens and/or tolerance to allergens in affected individuals. Allergen-nonspecific therapeutic strategies have also been investigated in a number of clinical trials, which will eventually improve the treatment options for patients with food allergy.

Creation and validation of web-based food allergy audiovisual educational materials for caregivers.

Studies reveal deficits in caregivers' ability to prevent and treat food-allergic reactions with epinephrine and a consumer preference for validated educational materials in audiovisual formats. This study was designed to create brief, validated educational videos on food allergen avoidance and emergency management of anaphylaxis for caregivers of children with food allergy. The study used a stepwise iterative process including creation of a needs assessment survey consisting of 25 queries administered to caregivers and food allergy experts to identify curriculum content. Preliminary videos were drafted, reviewed, and revised based on knowledge and satisfaction surveys given to another cohort of caregivers and health care professionals. The final materials were tested for validation of their educational impact and user satisfaction using pre- and postknowledge tests and satisfaction surveys administered to a convenience sample of 50 caretakers who had not participated in the development stages. The needs assessment identified topics of importance including treatment of allergic reactions and food allergen avoidance. Caregivers in the final validation included mothers (76%), fathers (22%), and other caregivers (2%). Race/ethnicity were white (66%), black (12%), Asian (12%), Hispanic (8%), and other (2%). Knowledge tests (maximum score = 18) increased from a mean score of 12.4 preprogram to 16.7 postprogram (p < 0.0001). On a 7-point Likert scale, all satisfaction categories remained above a favorable mean score of 6, indicating participants were overall very satisfied, learned a lot, and found the materials to be informative, straightforward, helpful, and interesting. This web-based audiovisual curriculum on food allergy improved knowledge scores and was well received.

Development and validation of educational materials for food allergy.

OBJECTIVE: To develop and validate a food allergy educational program. STUDY DESIGN: Materials developed through focus groups and parental and expert review were submitted to 60 parents of newly referred children with a prior food allergy diagnosis and an epinephrine autoinjector. The main outcome was correct demonstration of an autoinjector. RESULTS: The correct number of autoinjector activation steps increased from 3.4 to 5.95 (of 6) after training (P < .001) and was 5.47 at 1 year (P < .05). The mean score for comfort with using the autoinjector (7-point Likert scale) before the curriculum was 4.63 (somewhat comfortable) and increased to 6.23 after the intervention (P < .05) and remained elevated at 1 year (6.03). Knowledge tests (maximum 15) increased from a mean score of 9.2 to 12.4 (P < .001) at the initial visit and remained at 12.7 at 1 year. The annualized rate of allergic reactions fell from 1.77 (historical) the year prior, to 0.42 (P < .001) after the program. On a 7-point Likert scale, all satisfaction categories remained above a favorable mean score of 6: straight-forward, organized, interesting, relevant, and recommend to others. CONCLUSIONS: This food allergy educational curriculum for parents, now available online at no cost, showed high levels of satisfaction and efficacy.

Food allergy educational needs of pediatric dietitians: a survey by the Consortium of Food Allergy Research.

OBJECTIVE: To determine pediatric dietitians' self-reported proficiency, educational needs, and preferences regarding food allergy (FA) management. DESIGN AND SETTING: An Internet-based, anonymous survey was distributed to the Pediatric Nutrition Practice Group (PNPG) of the American Dietetic Association. PARTICIPANTS: Respondents (n = 311) were registered dietitians and members of the PNPG. ANALYSIS: Results are presented using descriptive statistics. Chi-square tests were applied for subgroup analyses. Percentage responses were calculated per question based on the number of respondents answering the question. RESULTS: On a 4-point scale of proficiency ("high," "moderate," "low," and "none"), respondents primarily rated themselves "moderate" for educating families, creating diets, and evaluating safe food items, and "low" for creating diagnostic food challenges. Education was primarily self-taught (75%). Preferences for future resources included handbooks (77%) and Web-based instructional programs (53%). On a 4-point scale ("very" to "not at all" needed) among practices that included >10% patients with FA, ratings of "very" were defined as need resources to update FA knowledge (87%) and need for a FA "tool kit" (84%). CONCLUSIONS AND IMPLICATIONS: Pediatric dietitians manage FA for a substantial patient base although their self-reported proficiency is overall only moderate. Dietitians would prefer and likely benefit from Internet-accessible management handbooks and patient handouts.

Food allergy education for school nurses: a needs assessment survey by the consortium of food allergy research.

Food allergy is increasing in school-age children. School nurses are a primary health care resource for children with food allergy and must be prepared to manage allergen avoidance and respond in the event of an allergic reaction. An anonymous survey was administered to school nurses attending their association meetings to determine their educational needs regarding children with food allergy. With 199 school nurses responding, their self-reported proficiency for critical areas of food allergy knowledge and management varied, with weaknesses identified particularly for emergency plan development, staff education, delegation, developing guidelines for banning foods and planning school trips. Nurses reported a high interest in obtaining educational materials in these areas and prefer video and Internet resources that could be promoted through professional organizations.

Development of a food allergy education resource for primary care physicians.

BACKGROUND: Food allergy is estimated to affect 3-4% of adults in the US, but there are limited educational resources for primary care physicians. The goal of this study was to develop and pilot a food allergy educational resource based upon a needs survey of non-allergist healthcare providers. METHODS: A survey was undertaken to identify educational needs and preferences for providers, with a focus on physicians caring for adults and teenagers, including emergency medicine providers. The results of the survey were used to develop a teaching program that was subsequently piloted on primary care and emergency medicine physicians. Knowledge base tests and satisfaction surveys were administered to determine the effectiveness of the educational program. RESULTS: Eighty-two physicians (response rate, 65%) completed the needs assessment survey. Areas of deficiency and educational needs identified included: identification of potentially life-threatening food allergies, food allergy diagnosis, and education of patients about treatment (food avoidance and epinephrine use). Small group, on-site training was the most requested mode of education. A slide set and narrative were developed to address the identified needs. Twenty-six separately enrolled participants were administered the teaching set. Pre-post knowledge base scores increased from a mean of 38% correct to 64% correct (p < 0.001). Ability to correctly demonstrate the use of epinephrine self injectors increased significantly. Nearly all participants (>95%) indicated that the teaching module increased their comfort with recognition and management of food allergy. CONCLUSION: Our pilot food allergy program, developed based upon needs assessments, showed strong participant satisfaction and educational value.

Risk of severe allergic reactions from the use of potassium iodide for radiation emergencies.

Potassium iodide (KI) may be prescribed for widespread use in the event of a radiation emergency to prevent the uptake of radioactive iodide by the thyroid gland. The available literature was reviewed and expert opinion sought among members of the Adverse Reactions to Foods and the Adverse Reactions to Drugs and Biologicals Committees of the Academy to assemble evidenced-based conclusions regarding the risks of an allergic reaction to this therapy. This article describes the information leading to the following conclusions: (1) anaphylactoid reactions to radiocontrast media should not be considered evidence of KI allergy, (2) allergic contact dermatitis from iodine-containing antibacterial preparations should not be considered evidence of IgE antibody-mediated KI allergy or sensitivity, (3) IgE antibody-mediated allergy to seafood should not be considered evidence of KI allergy or sensitivity, and (4) physicians should ensure that persons are not allergic to inactive ingredients or components of the KI formulation prescribed.