Are parents equipped to manage their kid’s allergies?

Despite the increasing prevalence of childhood allergies, most parents are unprepared to manage them, a two-part study has shown.

“[Our study showed that] parents do not have sufficient knowledge about environmental allergens and effective strategies for coping with acute allergic reactions,” said the researchers. “[They] were least familiar with the proper course of action in managing severe allergic reactions, particularly outside the home setting and during holidays, and only a third of parents correctly answered the question concerning the management of anaphylaxis.”

Parents of 1,350 pre-schoolers attending 12 kindergartens in southeastern Poland partook in the first study phase. At screening, 197 children (41 percent boys) were diagnosed with allergies. These kids and their parents participated in part two of the study to evaluate parental knowledge on allergens and allergy symptoms and treatment. [Children 2022;9:1693]

Food allergies (FAs) were diagnosed the earliest (mean age at diagnosis 2.3 months), followed by inhaled allergies (mean age at diagnosis 8.6 months). Contact dermatitis was diagnosed the latest (mean age at diagnosis 1.2 and 1.4 years [girls and boys, respectively]).

Two-thirds of parents were able to correctly identify sources of potentially allergenic cow’s milk proteins. These were mostly younger parents (<35 years) with university education and familiarity with allergies in the family (p<0.05).

However, only a third correctly identified breakfast foods, sweets, and ready-made milk-based desserts as potential sources of nuts. Older parents (>35 years) with primary and secondary education were least knowledgeable in this regard (p<0.05).

Also, only 15 percent of parents, mostly those with university education (p<0.05), correctly identified potentially allergenic foods containing soy protein. Most were unaware that soy is a food emulsifier or a component of dietary supplements, drugs, and pharmacologic products.

 

Managing food allergies

Children with FAs must avoid foods with even trace amounts of allergenic components or cross-reactive allergens, as accidental exposure can elicit severe allergic reactions. [J Pediatr Nurs 2014;29:679-687] “[They should enjoy a life similar] to their healthy peers … [Their parents] should consult a dietician to learn about safe meal preparation and food substitutes to prevent nutrient deficiencies,” said the researchers.

A personalized elimination diet is thus imperative for children with FAs, and parents should be able to identify and eliminate triggers to plan safe, allergy-free diets. [J Pediatr Gastroenterol Nutr 2012;55:221-229]

 

Barriers to elimination diet adherence

However, adherence to an elimination diet could be taxing, especially when eating out or traveling. [J Allergy 2016;2016:1497375] Other barriers are the lack of support from other family members and of school compliance, and the costs of implementing and sustaining it.

A third of the moms of children with FAs reported that dietary restrictions were not observed by fathers (p=0.0018) and grandparents/cousins (p=0.003). Many respondents had conflicts or were met with hostility from relatives or other parents in attempts to manage their children’s FA.

Five kindergartens were hesitant to remove trigger foods from the child’s diet (p=0.0051). In three kindergartens, safe substitutes were not provided nor permitted to be brought in school (p=0.02). Twenty percent of children missed school, were picked up earlier, or came in late so they could eat a safe meal at home first. “Education, awareness raising, and training for kindergarten personnel appear to be essential to minimize parental anxiety and decrease absenteeism,” the researchers noted.

 

Takeaways

Almost all respondents were one in saying that food labels should reflect clear information about allergenic ingredients.

Children with FAs following an elimination diet run a greater risk of nutritional deficiencies and impaired growth than their healthy counterparts or those with other allergies. [Pediatr Allergy Immunol 2020;31:827-834] Their diet should therefore be monitored to check if the eliminated foods continue to elicit allergic reactions and see if these can be re-introduced.

“Parents of children [with FAs] and sensitivity to cross-reactive food allergens should be obliged to visit a dietician. The support offered by social-media groups is important, but it cannot replace a consultation with a specialist,” the researchers said.