Knowledge, practice, and views on precautionary allergen labeling for the management of patients with IgE-mediated food allergy—a survey of Australasian and UK health care professionals

Abstract

The use of precautionary allergen labeling (PAL) is voluntary and in general unregulated in the vast majority of countries including Australia and the United Kingdom (UK). There is a growing consensus that PAL, in its current forms, is unhelpful to allergic consumers, their families, and health care professionals (HCPs). Issues highlighted include the absence of standardized nomenclature, lack of regulatory oversight, poor consumer understanding and trust, and inconsistent advice from HCPs about which foods are safe for allergic consumers to eat. Despite several studies investigating consumer attitudes to PAL, no study has specifically sought to understand how HCPs currently incorporate PAL into patient management, and whether current approaches (such as the VITAL initiative) are of value. We sought to examine current knowledge and its impact on clinical practice with regard to PAL from a range of HCPs actively engaged in the management of food-allergic patients. A 28-item online survey (Table E1, available in this article’s Online Repository at www.jaci-inpractice.org) was circulated to members of the Australasian Society for Clinical Immunology and Allergy (ASCIA), British Society for Allergy and Clinical Immunology (BSACI), and Allergy Academy (UK) between September and November 2014. Three questions from a previous survey conducted on allergic consumers in Australia were incorporated to allow comparison between consumers and their HCPs. Participants were asked to respond only if they were actively engaged in the clinical management of adults and/or children with IgE-mediated food allergy. We compared responses between the groups using Pearson c tests. Local Human Research Ethics Committees did not require ethical approval for the survey. There were 161 respondents, 84 (52%) from the UK, and 77 (48%) from Australia/New Zealand. The majority cared for exclusively food-allergic children (109, 68%) with the remainder caring for both adults and children (31, 19%) or adults only (21, 13%). Specialist allergists made up half of the respondents (80) with dieticians (30), allergy nurses (21), and general physicians (23) all contributing. There was no significant difference in HCP practice type (adult and/or child) across regions; however, there were more UK-based general physicians than in Australasia (P < .05). Responses are summarized in Figure E1 (available in this article’s Online Repository at www.jaci-inpractice.org).