United States Asthma Hospitalization Rates in the 21st Century Show a Peak Female Predominance in the 5th and 6th Decades of Life

Abstract

S U N D A Y 451 Circumstances of Medically Unadvised Purposeful Exposure to Food Allergens in an Observational Study (Consortium of Food Allergy Research, COFAR) Kim E. Mudd, RNMSN CCRP, Jill Ellingson, Phyllis Mayfield, Lisa P. Talarico, RN, MS, Janet S. Kamilaris, RN, Scott H. Sicherer, MD, FAAAAI; Johns Hopkins University, Baltimore, MD, Department of Pediatrics, National Jewish Health, Denver, CO, University of Arkansas for Medical Sciences, Pediatric Allergy and Immunology Arkansas, Children’s Hospital, Little Rock, AR, Mount Sinai School of Medicine, New York, NY, Division of Pediatric Allergy and ImmunologyUniversity of North Carolina, Chapel Hill, NC, Mt. Sinai School of Medicine, New York, NY. RATIONALE: To determine motivational factors accounting for allergic reactions when young children with known food allergies were fed an allergen against medical advice. METHODS: Families (n5512) participating in an observational study on the natural history of food allergy (CoFAR) were queried about purposeful exposures to foods that resulted in a reaction. The motivational factors resulting in the purposeful exposures were categorized using a structured questionnaire. RESULTS: Forty of the 512 families (8%) described 52 purposeful exposures that were medically unadvised. Multiple motivational circumstances were recorded per reaction so categories total to> 100% as follows : 46% belief that small exposures would not cause symptoms; 42% to see if allergy resolved; 38% child tolerated food in baked or processed form; 29% prior exposure to the food produced no symptoms; 25% belief that small exposures would speed allergy resolution; 24% past reactions were not perceived as severe; 15% thought the food allergy diagnosis was not accurate;14% thought decreased IgE measurement meant food allergy resolved; 8% to test severity of food allergy reaction; 4% read something that influenced their decision; and 2% tried the food while waiting for a scheduled food challenge. Reactions were attributed to purposeful exposures by mothers (33/64%), fathers (11/21%), grandmothers (7/14%) and (1/2%) by a caregiver. CONCLUSIONS: Families expose food allergic children to known food allergens despite receiving avoidance recommendations. These purposeful exposures to food reflect potentially dangerous misconceptions about food allergy among parents and other caretakers and present an opportunity for anticipatory guidance.