Jaime Ross

Internet and food allergy: What patients are seeking and what they do with the information

Food allergies affect up to 8% of children and 2% to 3% of adults in the United States. They significantly impact daily activities because avoidance of exposure to food allergens and preparedness for acute reactions are essential. Patients and their families must educate themselves with the many aspects of managing food allergies, such as preparation of allergy-safe meals, navigating various social situations (eg, school, camp, restaurants, and travel), and treatment of allergic reactions, including anaphylaxis. In addition, recent studies examining potential therapeutic interventions for food allergies are generating a lot of interest in the community. How patients educate themselves on the management of food allergies remains an area of investigation. Internet use continues to increase and is becoming an integral part of life for many patients. Although most patients obtain medical information from health care providers, the Internet is a highly accessible, alternative resource for medical information. A 2010 report by the Pew Research Center indicated that 51% of adults living with chronic disease had used the Internet as a source of medical assistance and advice. More than half of these people consulted user-generated health information, such as blogs and online health discussions. In 2011, National Research Corporation’s Ticker survey of more than 22,000 Americans found that 1 in 5 use social media sites to find health information. One in 4 Americans reported that social media’s influence would “very likely” or “likely” impact their future health care decisions, and 32% had “very high” or “high” trust in social media. Only half discuss the information found with a health care provider, and physicians underestimate the proportion of their patients who use the Internet for health information. Currently, there are no published studies examining how and where patients and their families are seeking information online specifically regarding food allergies. Therefore, the aim of this study was to examine the usage of online resources in this population. An anonymous online questionnaire using Qualtrics, a secure online platform that allows users to create and distribute surveys and compile survey results, was distributed to the Mount Sinai Jaffe Food Allergy Institute email list. The email list primarily includes parents of children with food allergy and adults with food allergy, most of whom receive care at the Mount Sinai allergy practice. A minority are food-allergic individuals or parents of food-allergic individuals outside of the practice who have expressed interest in receiving updates regarding the activities of the Jaffe Food Allergy Institute. The 11-item questionnaire was developed by the research team (see this article’s Online Repository at www.jaci-inpractice.org). Data were collected from August 2015 to December 2015. Not all respondents answered all the questions; therefore, results were calculated on the basis of response rates to each question. This study qualified as exempt human subjects research. A total of 530 responders (response rate, 15.5%) participated. Of 371 responses, 91% reported using online resources or social media to obtain information on food allergy. Responders looked to the Internet for a variety of food allergyerelated information. Most (82%) were searching for advice on food allergy management, including allergy-safe recipes, management in schools, and travel advice. Sixty-three percent sought results of food allergy research studies, whereas 43% were searching for clinical trials addressing food allergy. A minority sought referrals to physicians or medical centers (9%) or information related to food allergy diagnosis (8%). Of 372 responders, 75% found the Internet sources through Web searches, 38% from family and friends, and 30% from their health care providers. A wide range of sites are used by respondents, with the most common sites accessed being the Food Allergy Research and Education Web site and Facebook support groups (Table I). Responders indicated the most helpful resources to be the Food Allergy Research and Education Web site (46%), Facebook groups (15%), and online support groups (7%). Responders (n 1⁄4 378) accessed these resources daily or weekly (38%), monthly (25%), or a few times a year (37%). Of 377 responders who were asked whether they followed the advice found through the Internet, 85% reported yes. When asked whether the online advice matched their physician’s advice, 355 responded and 25% of these reported a mismatch between the advice found online and their physician’s advice. If discrepant information was found, 71% followed their health care professional’s advice, whereas 21% went with the online advice, and 8% reported following neither. The results of this study suggest that many subscribers to the Jaffe Food Allergy Institute email list are using the Internet for food allergy information. The ease of access and readily available information at all times makes the Internet an attractive source of information. Most responders felt that the resources provided helpful information. There were several limitations to this study. This was not a standardized, validated questionnaire. It was distributed only to subscribers of the Jaffe Food Allergy Institute research email list and the response rate was low (15.5%); thus, results may not be generalizable and instead reflect the experiences of a subset of individuals who are more apt to use the Internet and are interested in acquiring information relating to food allergies. Furthermore, selection bias is a factor because only

Epinephrine Use in Positive Oral Food Challenges Performed as a Screening Test for Food Allergy Therapy Trials

BACKGROUND Previous studies report epinephrine use for positive oral food challenges (OFCs) to be 9-11% when generally performed to determine outgrowth of food allergies. Epinephrine use for positive OFCs performed as screening criteria for enrollment in therapeutic trials for food allergy has not been reported. OBJECTIVE The objective of this study was to assess the characteristics and treatment for positive OFCs performed for screening subjects for food therapeutic trials. METHODS Retrospective review of positive screening OFCs from 2 treatment trials, food allergy herbal formula-2 (n = 45) and milk oral immunotherapy (n = 29), conducted at the Icahn School of Medicine at Mount Sinai was performed. RESULTS The most common initial symptom elicited was oral pruritus, reported for 81% (n = 60) of subjects. Overall, subjective gastrointestinal symptoms (oral pruritus, throat pruritus, nausea, abdominal pain) were most common (97.3% subjects), followed by cutaneous symptoms (48.7%). Of the 74 positive double-blind, placebo-controlled food challenge, 29 (39.2%) were treated with epinephrine; 2 of these subjects received 2 doses of epinephrine (6.9% of the reactions treated with epinephrine or 2.7% of all reactions). Biphasic reactions were infrequent, which occurred in 3 subjects (4%). CONCLUSIONS Screening OFCs to confirm food allergies can be performed safely, but there was a higher rate of epinephrine use compared with OFCs used for assessing food allergy outgrowth. Therefore, personnel skilled and experienced in the recognition of early signs and symptoms of anaphylaxis who can promptly initiate treatment are required.