Food allergy: Putting children at risk

Infants and toddlers with food allergies suffer a high rate of allergic reactions because of lack of vigilance on the part of caregivers, researchers report. Inadequate treatment of severe reactions with epinephrine is also a significant problem.

A prospective, observational study evaluated data on allergic reactions collected over a median follow-up period of 36 months in 512 children aged 3 to 15 months who were known or suspected to be allergic to milk or eggs. Overall, 367 of the children had 1,171 allergic reactions-mostly to milk, egg, or peanuts-at an annualized rate of 0.81 per year. More than half (269 patients) suffered more than 1 reaction.

Half (50.6%) of all reactions involved food given to the child by caretakers other than parents, including relatives and teachers.

Most of the 834 reactions to milk, egg, or peanuts resulted from accidental exposures arising from forgetfulness, reduced supervision, or failure to check product ingredients thoroughly (64.9%); errors in reading product labels (15.8%); cross-contamination (15.1%); food preparation errors (4.1%); and manufacturer labeling errors (0.1%). Despite common concerns about reactions from skin contact or inhalation, the study found that ingestion caused almost all severe reactions.

About 11% of reactions to milk, egg, or peanuts resulted from purposeful exposures, perhaps attempts by parents testing to see whether the allergy had resolved.

Of the 134 severe reactions (11.4% of all reactions), only 29.9% were treated with epinephrine. Reasons included failure to recognize the severity of the reaction, unavailability of epinephrine, and worry about giving the drug. In 65 reactions, a caretaker did not give epinephrine despite feeling that the child needed it.

The researchers emphasize the need to educate parents and caregivers about remaining vigilant, reading labels accurately, preventing cross-contamination, avoiding risky purposeful exposures, and treating reactions appropriately, including providing reassurance that epinephrine is safe to use.

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