Disclosures: Gonzalez-Estrada reports no relevant financial disclosures. Goldsobel reports serving as an investigator for Aimmune Therapeutics, AstraZeneca, Chiesi, Novartis, Optinose, Regeneron, Sanofi Pharmaceutics and Teva. Leiberman reports serving as vice chair of the American College of Asthma, Allergy and Immunology’s Food Allergy Committee, as a consultant for DBV Technologies and as a clinical investigator for Kaléo. Wright is medical director of the U.S. clinical affairs immunodiagnostics division at ThermoFisher Scientific.
August 18, 2020
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Allergy-related ED visits rising; four ways PCPs can help reverse trend

Disclosures: Gonzalez-Estrada reports no relevant financial disclosures. Goldsobel reports serving as an investigator for Aimmune Therapeutics, AstraZeneca, Chiesi, Novartis, Optinose, Regeneron, Sanofi Pharmaceutics and Teva. Leiberman reports serving as vice chair of the American College of Asthma, Allergy and Immunology’s Food Allergy Committee, as a consultant for DBV Technologies and as a clinical investigator for Kaléo. Wright is medical director of the U.S. clinical affairs immunodiagnostics division at ThermoFisher Scientific.
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Allergy-related ED visits increased 14% in the United States between 2007 and 2015, researchers wrote in The Journal of Allergy and Clinical Immunology: In Practice.

There were approximately 10 million ED visits for allergy-related conditions during this period, according to Alexei Gonzalez-Estrada, MD, of the division of pulmonary, allergy and sleep medicine at Mayo Clinic, and colleagues. The highest relative risk occurred among patients aged younger than 10 years.

To reduce allergy-related ED visits: 1) Introduce potential allergens early 2) Tell patients to prepare action plans 3) Ask patients to do a symptom check 4) Explain food labels
Reference: Healio Interviews

“These data provide further evidence of increasing allergic conditions in the U.S.,” the researchers wrote.

Healio Primary Care spoke with several allergists who are unaffiliated with the study about strategies that primary care physicians can use to reduce the number of allergy-related ED visits.

Introduce potential allergens early

Alan B. Goldsobel, MD, allergist at Allergy and Asthma Associates of Northern California, said that food allergies are the most common cause of allergy-related ED visits among children aged younger than 10 years. One way that PCPs can reduce these visits is by encouraging parents to introduce infant-safe peanut products by 4 to 6 months of age, which can help prevent the development of a peanut allergy, he said.

This recommendation is only for peanuts, he added.

Alan Goldsobel

“The data for other foods, particularly eggs, is less clear,” Goldsobel said. “High-risk infants — those with moderate-severe eczema and/or egg allergy — should be referred to an allergy clinic for evaluation first to facilitate clear diagnosis and education that can prevent accidental ingestions resulting in ED visits.”

Advise patients to prepare action plans

Lakiea Wright MD, MAT, MPH, board-certified allergist and associate physician at Brigham and Women’s Hospital, said PCPs should complete the Food Allergy Resource Education’s (FARE’s) “excellent” action plan.

“This document lists the signs and symptoms of an allergic reaction,” she said.

Lakeia Wright
Lakiea Wright

Upon the plan’s completion, PCPs should then provide their patients or their parents with a copy of the plan for the patient’s school and another to keep at home, Wright said. “Patients and their parents should then be encouraged to practice their plan, especially when and how to use an epinephrine autoinjector.”

Wright also said that a completed plan cannot be tucked away and forgotten. “I tell patients to keep their plans on their refrigerator and take a photo with their cell phone and save it,” she said.

Ask patients to do a symptom check

Jay Lieberman, MD, vice chair of the American College of Allergy, Asthma and Immunology’s food allergy committee, said .that in non-emergent situations, telemedicine may offer a way for patients to assess their symptoms with their doctor before heading straight to the ED.

If the patient has a strong pulse, is not wheezing, and their breathing and skin tone appear normal, then treatment that does not require an ED visit may be possible, according to the American College of Asthma, Allergy and Immunology (ACAAI) website.

Explain food labels

A Current Opinion in Allergy and Clinical Immunology study indicated that people do not always read food labels, which are often “difficult to interpret.” In addition, a report in Annals of Allergy, Asthma and Immunology suggested that some consumers also find food labels untrustworthy and ambiguous.

According to ACAAI, manufacturers of packaged foods made in the United States are required to indicate if there is any amount of milk, egg, wheat, soy, peanut, tree nut, fish and crustacean shellfish in their products. However, there is no standard definition for precautionary allergy labeling; that is, those that use statements such as “may contain,” “might contain,” “made on shared equipment” and “made in a shared facility,” which adds to the confusion of such labels.

Goldsobel said such labels can cause confusion regarding how much risk these labels imply. Therefore, “most patients with a history of more severe, life-threatening food allergic reactions completely avoid foods with such labels,” he said. Also, when a patient mentions precautionary allergy labeling, Goldsobel said he explains these labels by using shared decision-making to ascertain the patient’s level of risk aversion.

Lieberman, also an associate professor at the University of Tennessee Health Science Center and LeBonheur Children’s Hospital, stated that food products with labels that contain “the allergen of concern in bold letters under the ingredient list are probably not safe to consume.” He also noted that the risk for allergic reaction from foods within precautionary allergy labeling “is very low but not zero.”

Jay Lieberman

Lieberman added that questions regarding allergy-related matters such as labels can also often be answered by consulting “reliable sources” such as the ACAAI, the American Academy of Allergy, Asthma and Immunology, FARE, and the Food Research and Action Center websites.

References: