By Kirsten Evans, MD, FAAP
In the fall, I attended the national meeting Chapter Champions for Asthma and Food Allergy in Chicago. The conference was attended by representatives from each state chapter. The majority were allergists from tertiary care centers, but there were a handful of general pediatricians. The focus of this year’s meeting was food allergies, with the intention of educating the attendees who would then develop plans to implement statewide education in their own locales.
The speakers discussed several areas of interest. The conference opened with a long discussion of the definition of food allergy, an IgE mediated event resulting in skin, respiratory, and gastrointestinal manifestations. This was sharply contrasted to food intolerances, such as lactose intolerance, and adverse food events, such as celiac disease. The speakers discussed the need to educate both providers and parents on the differences, and to advocate for cautious and convincing diagnosis of food allergy. Along those lines, they discouraged primary care providers from obtaining any kind of “food panels” or serum blood testing as diagnostic of allergies, as these are difficult to interpret and lead to an abundance of over diagnosis of food allergies, unnecessarily causing diet restrictions and anxiety to patients and their parents. Only specific testing for a particular suspected food should be undertaken, and this by an allergist.
Another area of discussion was communication among health care providers, parents, and child care providers and teachers regarding those patients with true food allergies. The AAAAI has developed an action plan, similar to the asthma action plan, for treatment of a severely allergic child who experiences exposure to the allergen.
This plan should be given to everyone involved in the child’s care, and everyone involved should be taught how to administer needed medication. As a corollary, speakers advocated for the inclusion of epinephrine at schools, not for a particular child, but for any child who might experience anaphylaxis, as a significant number of children affected are experiencing their first reaction. This raised numerous questions about cost, safety, and administering person, which would need to be worked out locally. Mylan, the company which makes EpiPen, offers free EpiPens to schools which enroll with the company, but some districts have experienced difficulties actually obtaining the pens. The website with information and instructions is http://www.epipen4schools.com.
The last area of discussion concerned the LEAP study, which gave small amounts of peanut oil daily to a small number of at risk children, and found that this protected them from the allergy. While cautioning folks against trying this in their own practices, the study, along with others, led to changing the recommendation of exclusive breast feeding or formula feeding until six months to the introduction of foods at the earlier three to four months of age.
We all left ready to implement these ideas, but we were immediately derailed by the recall of AviQ and the subsequent doubling and in some cases tripling of the cost of EpiPen. The group is now united in finding ways to reduce the cost, encourage the manufacturer to reconsider their one year expiration date (which has no validity), and to get insurers to continue to pay for this as a first line and not secondary or even tertiary medicine, as many of them now list EpiPen. The AAP has listed the epinephrine access issue as its number ten priority this year, and the state champions are working diligently to address and improve this current situation. Stay tuned for further developments.