Can the burden of disease due to food allergy be prevented?


F time immemorial, there have been early descriptions of harmful reactions seen after the ingestion of food that substantiate our continued interest and study of food allergy (FA) today. At no time has the potential for prevention and management of the condition been greater than in recent years. Despite these advances, there continue to be significant psychosocial and financial issues that contribute to the burden of illness associated with the condition. This issue leads off with a review article by Patel et al. who succinctly outlined the psychosocial and financial burden of illness attributable to FA. In children, this burden of illness is further compounded by comorbidities, e.g., atopic dermatitis, which can negatively impact quality of life. Patel et al. suggested implementing a multidisciplinary approach to help families cope with the emotional, social, and financial burden associated with FA. Peanut allergy is one of the most prevalent food allergies and is responsible for a substantial burden of disease. In this issue, Greenhawt provided a timely article that highlighted the new NIAID sponsored guidelines on the topic of preventing peanut allergy. This guideline introduces a new paradigm in food allergy prevention based on the Learning Early About Peanut Allergy study, which showed that early peanut introduction (between 4 and 11 months of life) was associated with a significant absolute and relative risk reduction in the development of peanut allergy compared with delayed introduction. Adherence to these new clinical practice guidelines holds great promise of reducing both the prevalence of peanut allergy and its associated psychosocial and financial burden of illness; however, one of the major challenges for the implementation of guidelines, in general, is nonadherence. Because of the importance of this article and its clinically useful implications, it was chosen for this issue’s “For the Patient” section. This segment, found in the final pages of the print version of this issue and also available online, consists of a one-page, article synopsis, written in a readily comprehensible fashion to help patients better understand the content of the full article. Another area in which nonadherence plays a significant role is the implementation of guidelines associated with allergy immunotherapy (AIT). In this issue, Karam et al. provided further insight regarding nonadherence with AIT labeling guidelines by performing an online survey of AIT administrators and physicians. Despite 90% of AIT administrators from 10 university health services agreeing that labels that contain all recommended practice parameter guidelines’ components would decrease error and increase workflow, efficiency, patient safety, and the comfort level of administrators, only 28.6% of AIT extract vial labels at university health services were in accordance with practice parameter guidelines. Despite 91% of surveyed physicians having familiarity with the guidelines, only 64% implemented practice parameter adherent AIT extracts labels. The authors stressed the importance of compliance with these recommended standards by allergists in both allergy and nonallergy office settings to provide the best clinical outcomes and ensure excellent and efficient care. Whereas nonadherence with guidelines is one inherent limitation of their value, another is that, despite their comprehensive nature, these guidelines cannot possibly address every clinical scenario that is encountered in the real world, particularly with more complex patients. It is in this context that physicians must “walk alone” by using their best clinical judgment. In an attempt to reveal how physicians face clinical challenges specific to their practice of venom immunotherapy (VIT) administration, Calabria et al. reported on the American Academy of Allergy, Asthma and Immunology’s membership experience with VIT in patients with chronic medical conditions, pregnant women, and young children. They reported that many allergists were comfortable using VIT in young children and continuing VIT, but not starting in pregnant women. VIT was commonly used in patients with hypertension, coronary artery disease, arrhythmias, cancer in remission, and stable autoimmune disease. Major problems associated with VIT were most frequently reported not only in patients with mastocytosis and elevated tryptase, but also in those with cancer still under treatment. Continuing with the themes of guidelines and issues associated with the more complex patient, two articles in this issue provided insight with regard to the diagnosis of the infamous masquerader of asthma, -1Copyright © 2017, OceanSide Publications, Inc., U.S.A.

DOI: 10.2500/aap.2017.38.4040

Cite this paper

@inproceedings{Bellanti2017CanTB, title={Can the burden of disease due to food allergy be prevented?}, author={Joseph A. Bellanti and Russell A. Settipane}, booktitle={Allergy and asthma proceedings}, year={2017} }