Knowledge and practice of physicians and nutritionists regarding the prevention of food allergy

A Survey of Canadian Dietitians on Identification of Infants at High Risk of Food Allergy and Frequency of Allergenic Food Consumption

Purpose: To assess knowledge of Canadian dietitians on the topics of food allergy and food allergy prevention guidelines, including introduction of allergenic solids to infants at risk of food allergy.Methods: An online survey was distributed via email listservs targeting Canadian dietitians.Results: In total, 144 of 261 dietitians completed the survey (60.5%). Respondents recommend introduction of peanut (89.5%) and allergenic solids (91.2%) within the recommended age of 4-6 months for infants at high risk of food allergy, but only 26.2% recommend offering peanut three times per week once it has been introduced. In identifying what constitutes an infant at high risk of developing peanut allergy, dietitians expressed lower comfort levels and lower number of correct responses.Conclusions: Dietitians demonstrated they are up to date regarding the timing of introduction of allergenic solids, but not the frequency of consumption once introduced, for infants at high risk of food allergy. They also expressed low comfort level identifying risk factors for peanut allergy. There are opportunities for further education of dietitians, as well as potential to further utilize dietitian services for the benefit of patients with food allergy or who are at risk for food allergy.

Parents' and Health Care Professionals' Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study

BACKGROUND

Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade-away from allergen avoidance toward a tolerance induction approach-challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information-seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking.

OBJECTIVE

The aim of the study is to explore and understand parents' and health care professionals' perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families' experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored.

METHODS

This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals' predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents' experiences, interactions, and social processes in families in daily life.

RESULTS

Recruitment and data collection started in February 2022 and is still ongoing.

CONCLUSIONS

The qualitative study will provide insight into parents' information-seeking behavior and needs regarding the prevention of food allergy in children, parents' use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user's perspective and inform the development of the NAMIBIO apps.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41436.

Evaluation of the complementary feeding practices, dietary intake, and nutritional status of infants on a cow's milk protein elimination diet

OBJECTIVE

To evaluate the complementary feeding practices, food intake, and nutritional status of infants on a cow's milk protein elimination diet.

METHODS

A cross-sectional and observational study was conducted to compare infants aged 4-18 months who were on a cow's milk protein elimination diet with a control group of healthy infants without any dietary restrictions. General information on the child's health, demographic data, and food consumption were collected.

RESULTS

The study included 96 infants in the elimination diet group and 99 in the control group. In the elimination diet group, the median age (in months) of introduction of solid foods (5.0 × 4.0; p < 0.001) and water (5.5 × 4.0; p < 0.05) was later, consumption of soft drinks and industrialized cookies was less frequent (p < 0.05), and a lower index of complementary feeding inadequacies (2.75 × 3.50; p < 0.001) was observed. The elimination diet group presented lower individual values of Z scores for weight/age, weight/height, and body mass index/age, although they were fed with higher amounts of energy (117.4 × 81.3 kcal/kg of weight; p < 0.001) and macro-and micronutrients, except for vitamin A. In the elimination diet group, breast milk and its substitutes contributed to more than 67% of energy intake. Although calcium consumption was a deficit in 31.5% of the infants, none received supplementation.

CONCLUSION

Infants on an elimination diet presented more adequate complementary feeding practices and higher nutritional intake, despite lower body weight values.

Alimentação complementar e estado nutricional de lactentes em dieta de exclusão das proteínas do leite de vaca

Resumo Objetivo: Avaliar a dieta e o estado nutricional de lactentes em dieta de exclusão das proteínas do leite de vaca. Métodos: Estudo observacional, transversal, que comparou: lactentes em dieta de exclusão das proteínas do leite de vaca (n=60) atendidos em unidade de dispensação de fórmulas hipoalergênicas e lactentes sem restrições alimentares (n=60), de mesma idade e sexo (grupo controle). A idade variou de seis a 24 meses. A dieta foi avaliada com o emprego do inquérito alimentar e foram mensurados o peso e a estatura. Resultados: A ingestão de macronutrientes foi adequada em ambos os grupos. No grupo em dieta de exclusão das proteínas do leite de vaca, as proporções de lactentes com ingestão insuficiente foram menores em relação aos controles, para ferro (13,3 e 31,7%; p=0,029), zinco (5,0 e 18,3%; p=0,047) e vitamina D (25,0 e 71,7%; p<0,001). A fórmula hipoalergênica contribuiu com maior oferta de nutrientes do que os alimentos lácteos para o grupo controle. Entre 12 e 24 meses, o número de lactentes em dieta de exclusão que nunca consumiram carne bovina, peixe, cereais e ovo foi maior do que no grupo controle (p<0,05). Os escores Z de comprimento-idade nos lactentes em dieta de exclusão das proteínas do leite de vaca (-0,4±1,6) foram menores (p=0,039) do que no grupo controle (+0,2±1,3). Conclusões: A dieta de lactentes em exclusão do leite de vaca foi adequada apesar do atraso na introdução de alguns alimentos. Lactentes em dieta de exclusão apresentaram menor crescimento linear não acompanhado de déficit ponderal.

Complementary feeding and nutritional status of infants on cow’s milk proteins elimination diet

Objective:

To evaluate the diet and nutritional status of infants on an elimination diet of cow’s milk proteins.

Methods:

Observational and cross-sectional study that compared: Infants on a cow’s milk protein elimination diet (n=60) assisted at a hypoallergenic formula distribution unit and a control group of same age and gender without dietary restrictions (n=60). Age ranged from 6 to 24 months. The diet was evaluated using the 24-hour food survey and weight and height were measured.

Results:

The macronutrient intake of both groups reached nutritional recommendations. The proportions of infants in the group of elimination of cow’s milk proteins with insufficient intake were lower, compared to controls, for iron (13.3 and 31.7%; p=0.029), zinc (5.0 and 18.3%; p=0.047), and vitamin D (25.0 and 71.7%; p<0.001). The hypoallergenic formula contributed to a greater supply of nutrients than dairy foods for the control group. Between 12 and 24 months, the number of infants on a restriction diet who never consumed meat, fish, cereals, and eggs was higher than in the control group (p<0.05). The length-age Z scores in infants on a cow’s milk protein elimination diet (-0.4±1.6) were lower (p=0.039) than in the control group (+0.2±1.3).

Conclusions:

The diet of infants with exclusion of cow’s milk protein was adequate despite the delay in the introduction of some complementary foods. Infants on an elimination cow’s milk protein diet showed lower linear growth without weight deficit.

Brazilian pediatricians' adherence to food allergy guidelines-A cross-sectional study

Food allergy is an emerging clinical condition in pediatrics, so recommendations on its management have been widely published. Studying pediatricians' adherence to these clinical practice guidelines (CPG) and understanding the reasons for their non-compliance can help to promote better management of this condition. A cross-sectional study was conducted by a survey among Brazilian pediatricians, randomly selected during the 38th Brazilian Congress of Pediatrics, which took place in October, 2017. A validated questionnaire with 16 questions addressing knowledge and practice on food allergy, as well as self-reported adherence to international guidelines was applied. Of the total of 415 pediatricians from all regions of the country who were surveyed, only 69 (16.7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables: 'evaluating more than 10 children with suspected cow's milk allergy (CMA) per month'; 'having read the Brazilian consensus'; or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of those surveyed (20.3-42.3% variation) stated that they knew that their response was in line with the guidelines. This finding was statistically significant (p<0.05) in 7 of these 8 questions. The self-reported adherence of Brazilian pediatricians to international food allergy guidelines was low. Pediatricians who evaluated a higher number of children with suspected CMA or who were aware of the recommendations, had a higher rate of adherence. The results of the survey found that lack of resource was the major reported barrier to guideline adherence but lack of awareness must be a relevant non perceived barrier. This study shows the pediatricians´ self-reported adherence to food allergy guidelines in a widely overview for the first time in Brazil. More studies are necessary to investigate adherence to guidelines by pediatricians in other countries and to develop strategies to improve adherence.

Knowledge and practice of pediatricians and nutritionists regarding treatment of cow’s milk protein allergy in infants

ABSTRACT Objective This study evaluated the knowledge and practices of pediatricians and nutritionists about cow’s milk protein allergy in infants, with an emphasis on issues related to the exclusion diet and nutritional status. Methods A cross-sectional, descriptive study was performed with a convenience sample of 204 pediatricians and 202 nutritionists randomly invited in scientific events in the city of São Paulo, from November 2014 to March 2016. Results Between 1.5% and 21.0% of respondents indicated inadequate products for the treatment of cow’s milk protein allergy, including goat’s milk, beverages or juices based on soy extract, lactose-free milk formula and partially hydrolyzed formula. The daily calcium recommendation for children between zero and 36 months of age was correctly indicated by 27.0% of pediatricians and 46.0% of nutritionists (p=0.001). Additionally, 96.1% of pediatricians and 82.7% of dietitians (p<0.001) provided guidance on about labels of industrialized products. Conclusion Pediatricians and nutritionists present gaps in knowledge about cow’s milk protein allergy treatment in infants and educational strategies that increase the knowledge of the professionals are important for the management of cow’s milk protein allergy.

Parental confusion may result when primary health care professionals show heterogeneity in their knowledge, attitudes, and perceptions regarding infant nutrition, food allergy, and atopic dermatitis

INTRODUCTION AND OBJECTIVES

Whether the guidelines on infant nutrition, food allergy and atopic dermatitis confer real health benefits in practice at the population level has not been deeply studied. We aimed here to characterize the knowledge, attitudes, and perceptions regarding these issues among primary health care professionals. In addition, we surveyed available parent-reported information sources and the incidence of food-related symptoms, dietary restrictions, food allergy, and atopic dermatitis among one-year-old children in the general population.

MATERIALS AND METHODS

An online questionnaire was designed for public health nurses and general practitioners. In addition, parents of one-year-old children were recruited to a separate survey at the time of their regular check-up visit.

RESULTS

Altogether, 80 professionals took part. The median overall knowledge score was 77% and significantly higher among the general practitioners than among the nurses (p=0.004). However, only 35% of all the professionals recognized either severe airway or cardiovascular symptoms as potential food allergy-related symptoms. Moisturizers and emollients were thought to be adequate treatment for atopic dermatitis by 56%. Among 248 one-year-old children, the incidence of food allergy was 4% and atopic dermatitis 13%. During this period, parents intentionally avoided giving at least one food to 23% of the children, yet more than 80% of these restrictions can be regarded as unnecessary.

CONCLUSION

The knowledge, attitudes and beliefs regarding infant feeding, food allergy, and atopic dermatitis varied significantly among the primary care professionals. This will likely result in heterogeneous guidance practices and confusion among the families at the population level.

"If we are waiting for the numbers alone, we will miss the point": a qualitative study of the perceived rise of food allergy and associated risk factors in the Greater Accra Region, Ghana

Background

Globally, food allergy [FA] is considered a growing health epidemic. While much of what is known comes from developed countries, there is growing interest in the epidemiology of FA in developing regions such as sub-Saharan Africa. Indeed, researchers are beginning to document the incidence and prevalence of FA and sensitization. The results outlined in this paper stem from an exploratory qualitative study examining the emergence of the health risk of FA in Ghana, a country undergoing epidemiologic changes.

Methods

Between June and August, 2015, we conducted thirty-seven (37) semi-structured in-depth interviews. This comprised seventeen (17) healthcare workers across 12 public and private hospitals and twenty (20) individuals with FA and families with allergic children. All interviews were recorded and transcribed verbatim. Transcripts were analyzed to develop thematic areas that characterize perceptions and experiences around FA.

Results

Three key broad themes arise from this study. First, FA is an emerging health risk, whose incidence is perceived to be increasing. Second, participants expressed mixed perceptions about the public health burden of FA. Third, participants identified individual and societal factors that may be influencing FA risks and susceptibility.

Conclusion

Our research suggests FA is a growing but unrecognized public health concern. There is the need for health policies and researchers to consider the full extent of ongoing epidemiologic changes for the health of populations in developing regions.

Physician practice in food allergy prevention in the Middle East and North Africa

BACKGROUND

A number of scientific organisations have developed guidelines for the primary prevention of allergic disease through nutritional interventions. However, even if the best evidence-based guidelines are available, these guidelines do not necessarily lead to adherence and improved health outcomes.

METHOD

To determine how closely the practice of physicians in select Middle Eastern and North African countries compares with the current recommendations on the primary prevention of allergy a survey study was performed using a structured questionnaire and convenience sampling.

RESULTS

A total of 1481 physicians responded, of which 66.1% were pediatricians. A total of 76.6% of responding physicians routinely identify infants who are at risk for developing allergy. In infants at risk for developing allergy, 89.1% recommend exclusive breastfeeding for at least 4 months. In contrast to current recommendations, 51.6% routinely recommend avoidance of any allergenic food in the lactating mother. In infants at risk of developing allergy who are completely formula fed, standard infant formula was recommended by 22.5% of responders. Of the responding physicians, 50.6% would recommend delaying the introduction of complementary food in infants at risk of allergy compared to those not at risk, whereas 62.5% would recommend postponing the introduction of potentially allergenic foods. Only 6.6% stated they follow all current recommendations on food allergy prevention.

CONCLUSION

The results of this survey suggest that a substantial part of responding physicians from select Middle Eastern and North African (MENA) countries do not follow current recommendations on primary prevention of allergic disease through nutritional interventions.

Awareness of food allergies: a survey of pediatricians in Kuwait

Background

Early diagnosis of food allergies (FA) is important for a favorable prognosis. This study aimed to determine the level of awareness of FA among pediatricians in Kuwait.

Method

A 43-item self-administered questionnaire was designed and distributed to pediatricians working at 4 government hospitals in Kuwait.

Results

A total of 140 pediatricians completed the questionnaire, with a participation rate of 51.1% (81 males and 59 females). The mean age of participants was 40.81 years, and the mean number of years working in pediatrics was 13.94 years. The mean overall knowledge score was 22.2. The pediatricians’ overall knowledge scores were found to be significantly associated with their age (older pediatricians had higher overall scores) and years of experience as a pediatrician but were independent from hospital site, gender, or rank. A multiple linear regression revealed pediatrician age and gender were the only variables that were significantly associated with the overall knowledge score. Only 16.4% of the participants answered at least 2/3 of the survey questions correctly. The questions that were correctly answered by ≤ 2/3 of the participants constituted 80% of clinical presentation questions, 66.6% of diagnostics questions, 77.7% of treatment questions, and 42.8% of prevention questions. Interestingly, among 68 pediatricians (48.5%) who determined that they felt comfortable evaluating and treating patients with FA, only 12 (17.6%) passed the questionnaire.

Conclusions

This survey demonstrates that there is a noteworthy deficiency of pediatricians’ awareness about FA. The implementation of strategies to improve pediatricians’ awareness is critical to diagnose food allergy patients early and improve their health and outcomes.

Food allergy competencies of dietitians in the United Kingdom, Australia and United States of America

BACKGROUND

A knowledgeable and competent dietitian is an integral part of the food allergy multidisciplinary team, contributing to effective diagnosis and management of food allergic disorders. Little is currently known about the food allergy training needs and preferences of dietitians. The purpose of this paper is to measure and compare self-reported food allergy competencies of dietitians based in the UK, Australia and USA.

METHODS

A survey of USA-based paediatric dietitians was developed to measure self-reported proficiency and educational needs in the area of food allergy. The survey was modified slightly and circulated online to paediatric and adult dietitians in the UK and Australia. Descriptive statistics and Pearson correlations are presented.

RESULTS

A total of 797 dietitians completed the questionnaire. Competency in "developing food challenge protocols" and "managing feeding problems" were rated the poorest overall across all three settings. A higher level of competency was significantly positively associated with length of practice as a dietitian, percentage of caseload composed of patients with food allergy and training in food allergy. The most popular topics for further training were food additives, pharmacological reactions and oral allergy syndrome.

CONCLUSIONS

There is a need amongst dietitians to increase their knowledge in different aspects of food allergy diagnosis and management, specifically the areas of developing food challenge protocols and management of feeding problems. This study provides valuable information for designing targeted food allergy education for dietitians.