Precautionary Allergen Labeling: Avoidance for All?

PURPOSE OF REVIEW: Precautionary allergen labeling (PAL) suggests the risk of unintended allergen presence (UAP) in food but is unregulated in most countries and inconsistently applied by food manufacturers. This review evaluates the current use of PAL, its relevance to allergic consumers, and weighs possible advantages and disadvantages of avoiding products with PAL. RECENT FINDINGS: In most countries, manufacturers are free to decide whether, when, and how to apply PAL resulting in inconsistencies and consumer confusion. Patients with food allergy often interpret PAL incorrectly and without guidance from their health care providers. Health care providers are also prone to misinterpreting PAL, indicating a need for better education. Consumers desire guidance on whether to avoid products with PAL or not. Until further regulatory guidance is available, shared decision-making between patient and provider is required to offer individualized, rather than one-size-fits-all, approaches to PAL.

Dietary Management of Food Allergy.

Worldwide food allergy prevalence is increasing, especially in children. Food allergy management strategies include appropriate avoidance measures and identifying suitable alternatives for a nutritionally sound diet. Individualized dietary intervention begins teaching label reading, which differs among countries or regions. Dietary intervention must result in a nutritionally sound plan including alternatives to support optimal growth and development. Inappropriate or incomplete dietary advice may increase the risk of adverse reactions, growth faltering, and nutrient deficiencies. Evidence indicates input from a registered dietitian improves nutritional outcomes. Nutritional input plays a critical role managing nutritional disorders related to food allergy.

Multidisciplinary interventions in the management of atopic dermatitis.

Atopic dermatitis (AD) is the most common pediatric skin disease. AD has a significant effect on patient and family quality of life caused by intense pruritus, sleep disruption, dietary and nutritional concerns, and psychological stress associated with the disease and its management. Multidisciplinary approaches to AD care have been developed in appreciation of the complex interplay among biological, psychological, behavioral, and dietary factors that affect disease control and the wide range of knowledge, skills, and support that patients and families require to effectively manage and cope with this condition. Common components of multidisciplinary treatment approaches include medical evaluation and management by an AD specialist, education and nursing care, psychological and behavioral support, and nutritional assessment and guidance. Models of care include both clinical programs and structured educational groups provided as adjuncts to standard clinical care. Available evidence suggests beneficial effects of multidisciplinary interventions in improving disease severity and quality of life, particularly for patients with moderate-to-severe disease. Additional research is needed to identify the best candidates for the various multidisciplinary approaches and evaluate the cost-effectiveness of these programs.

Predictors of clinical success in a multidisciplinary model of atopic dermatitis treatment.

Atopic dermatitis (AD) is one of the most common pediatric skin disorders. Because treatment involves allergen avoidance, dietary changes, and behavior modification, multidisciplinary treatment models have been used to complement conventional medication therapy. However, predictors of clinical response in these multidisciplinary models have not been studied. This study examined factors associated with a reduction in AD severity in a multidisciplinary outpatient pediatric AD treatment program providing medical, nutritional, and behavioral support. Data were collected from 170 patients between 2001 and 2006. The Eczema Area and Severity Index (EASI) score was determined at the time of each visit. Using a logistic regression model, we investigated the association of baseline demographic and clinical characteristics with clinical outcome. We also analyzed the association between improvement in the EASI score and behavioral changes. One hundred thirty-eight patients had significantly improved EASI scores, and 32 patients were nonresponders. Responders had a median improvement of 79% in their EASI score, whereas nonresponders had a 53% worsening of their EASI score (p < 0.0001) and a significantly worse absolute EASI score (p < 0.001). Predictors of clinical success included baseline EASI score, baseline age, and improved parental adherence to treatment recommendations. Improvement in the EASI score significantly correlated with quality-of-life measures: decreased itching and scratching, difficulty sleeping, and parental concerns about side effects. A multidisciplinary model of AD treatment has the best clinical outcomes in younger patients with severe AD. Ensuring parental compliance with treatment recommendations is important for clinical response.