A number of parents are intentionally exposing food-allergic children to their allergens, sometimes in the misguided belief that either a small amount won’t hurt a child or to “test” whether an allergy had been outgrown.
Those behind this discovery were caught off guard: “We were shocked. We were just floored,” said Kim Mudd of Johns Hopkins University, lead author of the study. “It was quite clear that some of these purposeful exposures were against medical advice.”
Researchers from five leading allergy clinics were trying to get to the motivation behind why 8 percent of 512 families with food-allergic kids had reported in an earlier study that their young children had been purposely exposed to a food allergen. The results from a new questionnaire survey with this group were presented at the 2013 AAAAI annual meeting. Among the 40 families in question (who often gave more than one reason for a food exposure):
• 46 percent reported believing that small exposures to an allergen would not cause symptoms;
• 42 percent experimented with the allergenic food to see if the child’s allergy had resolved;
• 38 percent saw that a child was now tolerating either baked milk or egg and decided to try it in an unbaked form;
• 29 percent said they’d given a food because the child hadn’t had symptoms on a previous exposure;
• 25 percent believed that small exposures would speed the resolution of the allergy;
• 24 percent gave a food because their child’s past reaction hadn’t been severe;
• 15 percent knowingly gave the food because they didn’t believe the diagnosis of food allergy;
• 14 percent thought an allergy test showing decreased IgE antibodies meant the allergy had resolved;
• 8 percent gave the food to “test” the severity of their child’s reaction;
• 4 percent were influenced by something they’d read;
• and 2 percent tried the food at home while waiting for an oral food challenge with the allergist.
The study, funded by the Consortium of Food Allergy Research (CoFAR), notes that feeding an allergen to a child is against medical advice; kids with allergies are supposed to avoid their allergen at all times. The researchers concluded that “these purposeful exposures to food reflect potentially dangerous misconceptions about food allergy among parents and other caretakers.”
Next: Who was exposing the children to allergens
Click here  to see Allergic Living‘s full coverage of the 2013 AAAAI allergists conference.
As for who was exposing the child to a food, most often it was the child’s mother (64 percent of the time), followed by the father (21 percent). Seven percent of the time, a grandmother tried out the food, and in one case it was a caregiver.
While all the reasons for exposure are of concern, the quarter of this group who believed that “small exposures would speed allergy resolution,” suggest an alarming attempt at home-based oral immunotherapy (OIT). This is dangerous, and allergists always emphasize that this type of therapy must only be begun in a clinical setting, under the supervision of qualified medical professionals.
Lead author Mudd expressed another concern: the families involved in the study are getting some of the best allergy care and education available. They are being told their food-allergic children must completely avoid their triggers at all times. How then could these purposeful exposures be occurring?
“There’s something to be learned here – if you have families who are getting what we think is the best care available, but they are still willing to do this, then clearly there’s something that we’re not doing, that we need to be doing,” said Mudd.
The Fall 2012 edition of Allergic Living magazine informed readers of the original study, published in Pediatrics in July 2012. In it, the researchers were simply trying to learn more about preschool-aged children and their food allergies. They were surprised to learn of a high rate of reaction – 72 percent during a three-year period – among infants. They were taken aback to learn that 11 percent of those reported reactions were caused by the infants being “knowingly” fed their allergen (peanut, milk or egg). This second study was undertaken to learn about why the children were being exposed to an allergen. It concludes that, given these intended exposures among parents, it’s important for physicians to offer guidance on the importance of the avoidance diet when dealing with a food allergy.
If you have any questions about your own allergic child’s diet, please contact your allergist or dietitian for assistance. Remember that it is never safe to experiment at home with “testing” a food on an allergic child.