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.

Asthma can be tricky for a doctor to diagnose, especially in young kids. Symptoms can mimic other diseases and spirometry, the breathing test to diagnose asthma, requires the patient be able to breathe into a tube, which isn’t possible for most small children.

“The hypothesis has been that people with airway disease will have different metabolism compared to those without disease,” says Dr. Darryl Adamko, head of pediatric pulmonary medicine for the Saskatoon Health Region.

That is, the chemicals in their urine will have a unique compound that could be tested for. His team, based at the University of Alberta where he used to work, is using a technology called nuclear magnetic resonance (NMR) and they believe they have pinpointed what the metabolism of an asthmatic looks like in urine.

They are now working with groups in the United Kingdom and Canada to see how well testing urine for this compound predicts asthma. (Adamko is also testing the theory with COPD, bronchiolitis and allergic rhinitis.)

The researchers are still trying to recruit groups large enough for a robust study, but based on the early results, “it does look like it can differentiate asthma versus COPD or asthma versus no asthma,” says Adamko.

The pediatric respirologist hopes this test will do more than just diagnose. “As you get sicker, your metabolism changes,” he says. That means if someone comes into a clinic or hospital with asthma symptoms, a urine test could tell doctors whether the symptoms will get worse. While Adamko is optimistic his team will be successful, he says it’s at least five years before such a test is used in common practice.

First published in Allergic Living magazine.
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Clarke and her colleagues surveyed close to 10,000 Canadians in the Surveying Canadians to Access the Prevalence of Common Food Allergies and Attitudes towards Food Labelling and Risk (SCAAALAR) study. They found that 3.2 per cent were allergic to one or more of peanuts, tree nuts, shellfish, fish and sesame. Of those, “at most, only 38.7 per cent reported receiving epinephrine,” while having a moderate to severe reaction, says Clarke.

It’s not clear whether these individuals had auto-injectors and simply didn’t use them, or if epinephrine wasn’t available to them. Either way, Clarke told Allergic Living that the numbers concerning.

“We certainly know that there is a problem here in the proper management, because one would like to see that almost everybody who is reporting a moderate to severe reaction would receive the epinephrine.”

Clarke says her team has dug into the data a little further to look at what type of people are likely to carry an auto-injector, but results of that analysis are not yet available.

The SCAAALAR study, which is partially funded by the allergy research network AllerGen, also looked at attitudes towards food labeling, particularly precautionary statements on food packages (such as “may contain” advisories), and attitudes of general population toward risk of food allergy in the context of environmental health risks. Results will be available in the coming months.

Highlights from SCAAALAR study

Allergies in the Canadian population

Published in the June 2010  issue of the Journal of Allergy and Clinical Immunology. View here.