Leaving the nest: Improving food allergy management on college campuses

Does Informal Education Training Increase Awareness of Anaphylaxis among Students of Medicine? Before-After Survey Study

Allergies are among the most common chronic diseases in Europe. The most serious complication is anaphylactic shock. Most cases occur outside the hospital; thus, knowledge of symptoms and first aid is crucial. This study aimed to evaluate the awareness of anaphylaxis and the ability to use adrenaline auto-injectors among medical students, and to determine an improvement after training based on non-formal education. The research was conducted among 364 medicine students (years 1–5) from the Medical University of Gdańsk, with year-specific curriculum-based general medical knowledge. Training consisted of pre-test, practical training and post-test. Descriptive statistics were used to reveal the characteristics of students from different grades. A Mann–Whitney U test was used for statistical analysis. The tested students did not have sufficient knowledge to provide first aid in cases of anaphylaxis before training. There was an increase in knowledge (on average, 28.6%, p = 0.005) after training. Almost all (99.4%) of the respondents believed that they would be able to use an adrenaline auto-injector in case of emergency after the training. The training based on non-formal education was effective. The use of the subject-performed task method helped students to remember the stages of action in stressful situations.

Food Allergy from Infancy Through Adulthood

Food allergies are the result of immune responses that cause adverse reactions to foods. Immune responses to foods may produce a spectrum of symptoms and disorders, including acute allergic reactions and anaphylaxis, food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome, food-dependent, exercise-induced anaphylaxis, and oral allergy syndrome (pollen-food allergy syndrome). Food-allergic responses also contribute to chronic inflammatory disorders such as eosinophilic esophagitis and atopic dermatitis. Although food allergy affects people from infancy through adulthood, there are allergic features that differ according to age (ie, presentation, triggers, and natural course) and have important implications for diagnosis, prognosis, and management. New food allergies can develop at any age, and we propose similarities in the etiology of de novo food allergy whether in infancy or adulthood. The approach to managing food allergy changes dramatically over the life course, and physicians and patients must respond accordingly to optimize care. Food allergy therapies are emerging, and the efficacy and safety of these interventions could differ by age group of those treated. In this review, we highlight interesting observations on the etiology and characteristics of food allergy presenting at different ages and discuss clinical management as it relates to life stage.

Psychosocial Aspects of Food Allergy: Resiliency, Challenges and Opportunities

Food allergy is a public health concern and has been found to be increasing in prevalence; however, psychosocial factors differentiate challenges related to management throughout the lifespan. Resilience has been found to improve quality of life in other chronic diseases, but little has been published regarding increasing resilience in food allergy. The psychosocial impacts of food allergy vary by age group and developmental stage. This article reviews developmental milestones within the context of food allergy in infancy, school-age children, adolescents, and adults. Recommendations for promoting resilience in patients with food allergy are provided.

Psychosocial issues and quality of life associated with food allergy

The day-to-day challenges involved in caring for a child with food allergies can be a significant stress within a family. As the child with a food allergy grows up, developmental changes as well as external influences such as bullying and peer pressure can further influence these stressors. When the child with a food allergy is young, the family may be limited on where they can vacation or go out to restaurants, which can cause tension and frustration within the family. Hypervigilance and fear of accidental exposure to the allergen takes an emotional and physical toll on the child with a food allergy and the child's family. Socially, children with a food allergy may have to limit participation in school events, parties, or camps. These limitations can cause feelings of isolation for the child and feelings of guilt for the parents. As the child becomes an adolescent and young adult (AYA), increased autonomy of dining options and a desire to fit in with peers can trigger higher risk-taking behavior, which can be a source of anxiety for the AYA as well as the caregivers. The aim of this review was to describe potential negative psychosocial impacts of having a food allergy for the family. Data were reviewed from a literature search of medical literature data bases between 2010 and 2020 by using the search terms "food allergy," "psychosocial," "anxiety," and" quality of life." As we better recognize the psychosocial issues associated with food allergies, we will have a better ability to develop effective interventions to improve the quality of life for these families.

Managing food allergy and anaphylaxis: A new model for an integrated approach

There is an increasing public concern on food allergy and related anaphylactic reactions that occur mainly at the community level. The perception of the disease is huge among parents who believe that 1 out of 20 children suffers from severe food allergy. The discrepancy between this self-reported prevalence and the real one when a food challenge is performed, points out the gap in the implementation of guidelines for clinical practice. Health professionals as well show scarce adherence to the guidelines both at the Emergency Departments and at the primary care level. Anaphylactic reaction are not recognized, adrenaline is under-used and self-injectable devices are not prescribed. Although education and training are limited to local, spontaneous initiatives from patient's organization and few allergists, the data so far available demonstrate that improvement in knowledge and attitudes can be achieved further to a structured program. There is the need to establish good evidence -based practices for educational intervention that should be adopted in the context of public health policies for food allergy. This would imply a change in legislation in many countries to prevent prosecution for liability of lay people administering adrenaline when properly trained. In parallel an integrated clinical care pathway should be developed by multidisciplinary and multi-professional teams in the context of national Centres of Excellence -CoE. These CoE could drive the progression to digital health create, creating networks of CoE for best practices of care and for clinical trials.