Rate of Severe Reactions Higher Than Expected in Children with Food Allergies, Report UAMS-ACHRI Researchers

By Jon Parham

The multi-year study following children across the nation also found that when severe and potentially life-threatening reactions occurred, some caregivers were hesitant to give children epinephrine, a medication that reverses the symptoms and can save lives.

“The results are troubling, especially since these children had known food allergies and the parents and caregivers received extensive follow up and still most of them had an allergic reaction and the majority of them had more than one in a given year,” said study co-author Stacie M. Jones, M.D., professor of pediatrics in the UAMS College of Medicine and chief of the Pediatric Allergy and Immunology Section, who holds the Dr. and Mrs. Leeman King chair in Pediatric Allergy.

The study results appear online in the June 25 issue of Pediatrics (http://pediatrics.aappublications.org/) and are the latest findings from the Consortium of Food Allergy Research (CoFAR), a network established by the National Institute of Allergy and Infectious Diseases (NIAID) to conduct clinical trials, observational studies and basic research to better understand and treat food allergy.

The research is part of an ongoing investigation of 512 children who were enrolled at 3 to 15 months old and were allergic to milk or egg. Investigators are carefully following these children to see whether their allergies resolve or if new allergies, particularly peanut allergy, develop. The study is ongoing at research hospitals in Baltimore; Denver; Durham, N.C.; Little Rock, Ark.; and New York City.

CoFAR investigators advised parents and caregivers to avoid giving their children foods that could cause an allergic reaction. Study participants also received an emergency action plan, describing the symptoms associated with allergic reactions to foods and what to do if a child has an allergic reaction, along with a prescription and instructions on how to give epinephrine if a severe reaction occurred.

“We have a lot of work to do, whether it’s in education – working with parents, caregivers and health care providers to make sure we are providing appropriate information regarding allergen avoidance – or in treatment, to make sure caregivers know how to accurately assess food reactions and respond with appropriate therapy,” said study co-author Tamara Perry, M.D., assistant professor in the UAMS College of Medicine, division of pediatric allergy/immunology at Arkansas Children’s Hospital and an ACHRI researcher.

“Different types of educational settings may be necessary, such as hands-on, practical training sessions to augment written educational material,” Perry said. “And we must make sure the education is being reinforced across all settings: schools, day cares, primary care providers and others.”

Data compiled from patient questionnaires and clinic visits over three years showed that
72 percent of the children had a food-allergic reaction, and that 53 percent of the children had more than one reaction, with the majority of reactions being to milk, egg or peanut. This translated into a rate of nearly one food-allergic reaction per child per year.

Approximately 11 percent of the reactions were classified as severe and included symptoms such as swelling in the throat, difficulty breathing, a sudden drop in blood pressure, dizziness or fainting. Virtually all of the severe reactions were caused by ingestion of the allergen rather than inhalation or skin contact.

“This study shows, I think, that we’re somehow not conveying the practical part of this – learning to deal with and manage food allergies on a day-to-day basis,” Jones said. “We need to look for ways to bridge that gap and make sure we’re doing all we can to protect children with food allergies from accidental ingestion.”

In only 30 percent of the severe reactions did caregivers administer epinephrine, a life-saving drug that alleviates the symptoms of severe allergic reactions by increasing heart rate, constricting blood vessels and opening the airway. Investigators found that caregivers did not give children epinephrine for a number of reasons: the drug was not available, they were too afraid to administer it, they did not recognize the symptoms as those of an allergic reaction, or they did not recognize the reaction as severe.

Almost 90 percent of allergic reactions to egg, milk or peanut occurred after a child accidentally ate the food. The reasons for the accidental exposures included caregivers misreading food labels, not checking a food for an allergen, and unintentionally allowing a food allergen to come into contact with other foods (cross-contamination).
The study also found that about 11 percent of allergic reactions to egg, milk or peanut occurred after a caregiver — most often a parent — intentionally provided a child the allergenic food.

This was an unexpected finding because intentional exposures to allergenic food have typically been reported in teenagers, who tend to take more risks or who might be embarrassed about their food allergy, Perry said.

CoFAR investigators are exploring possible reasons for these intentional exposures, but they speculate that it could reflect parents’ at-home tests to determine if children have outgrown the food allergy. Because giving children allergenic foods could possibly result in life-threatening reactions, such testing should only be conducted under the direct supervision of a health care professional trained in performing food challenges. The study findings reinforce the importance of caregivers working closely with their doctors to understand how to effectively manage a child’s food allergy.

The study is to continue through 2015.

This work was funded by the NIH, the National Center for Research Resources and the National Center for Advancing Translational Sciences.

Parents and caregivers are encouraged to view the patient-friendly synopsis of the U.S. food allergy guidelines –(www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAguidelinesPatient.pdf), which summarizes the most important information from the guidelines published on Dec. 6, 2010, and provides a starting point for doctor-patient conversations about food allergy. For additional free resources, visit NIAID’s Food Allergy Web portal (www.niaid.nih.gov/topics/foodallergy).
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website at http://www.niaid.nih.gov.

Arkansas Children’s Hospital Research Institute is a collaboration of the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital (ACH). ACHRI provides a research environment on the ACH campus where research scientists conduct clinical, basic science and health services research for the purpose of treating illnesses, preventing disease and improving the health of children everywhere. The private, nonprofit health care facility boasts an internationally renowned reputation for medical breakthroughs and intensive treatments, unique surgical procedures and forward-thinking medical research – all dedicated to fulfilling the mission of enhancing, sustaining and restoring children’s health and development. ACH recently ranked No. 5 on FORTUNE 100 Best Companies to Work For. For more information, visit www.archildrens.org.

Arkansas Children’s Hospital is the only pediatric medical center in Arkansas and one of the largest in the United States serving children from birth to age 21. The campus spans 29 city blocks and houses 316 beds, a staff of approximately 500 physicians, 80 resident physicians in pediatrics and pediatric specialties and more than 4,000 employees.

UAMS is the state’s only comprehensive academic health center, with colleges of Medicine, Nursing, Pharmacy, Health Related Professions and Public Health; a graduate school; a hospital; a statewide network of regional centers; and seven institutes: the Winthrop P. Rockefeller Cancer Institute, the Jackson T. Stephens Spine & Neurosciences Institute, the Myeloma Institute for Research and Therapy, the Harvey & Bernice Jones Eye Institute, the Psychiatric Research Institute, the Donald W. Reynolds Institute on Aging and the Translational Research Institute. Named best Little Rock metropolitan area hospital by U.S. News & World Report, it is the only adult Level 1 trauma center in the state. UAMS has more than 2,800 students and 775 medical residents. It is the state’s largest public employer with more than 10,000 employees, including about 1,000 physicians and other professionals who provide care to patients at UAMS, Arkansas Children’s Hospital, the VA Medical Center and UAMS’ Area Health Education Centers throughout the state. Visit www.uams.edu or uamshealth.com.