A survey of more than 400 pediatricians and internists revealed a surprising lack of knowledge about current allergy treatment guidelines.
Official guidelines around the globe have long touted epinephrine as the key treatment for anaphylaxis, but new research finds that half of all internists have yet to get the message.
In a news release that accompanied the presentation of the study, Kara Wada, MD, an allergist who was the study’s lead author, said “We asked what the best first treatment was for a patient experiencing vomiting and hives after eating a known food allergen. Only 50 percent of internal medicine physicians knew it was epinephrine.”
Wada and her co-authors announced this rather alarming news at the Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology. Unfortunately, it wasn’t the only alarming news they had to share.
Wada’s team surveyed 409 internists and pediatricians about best practices for treating allergies. All participants answered 6 general questions, and pediatricians answered 3 more that focused specifically on pediatric allergies.
The pediatricians fared particularly poorly.
Only 27% of them correctly identified the most common causes of food allergy in children under 4 as both eggs and milk. Another 34% of them guessed strawberries, and 13% of them thought the answer was artificial food coloring.
The majority of pediatricians, moreover, thought that skin prick testing for food or inhaled allergens isn’t accurate or reliable until children turn 3. In reality, however, there is no age limit on skin prick testing, though it is rarely conducted on infants younger than 6 months old.
Internists made their share of mistakes, too.
Fully “85 percent of internal medicine physicians thought the flu vaccine shouldn’t be given to egg-allergic patients,” Wada said, noting that“It’s now known that it’s safe for those with egg allergies to get the flu shot.”
Both groups thought it was necessary to ask about allergies to iodine, shellfish and artificial dyes before ordering a CT scan and other imaging procedures that use iodinated contrast for better imaging.
The thinking here is thatshellfish contain iodine, so a shellfish allergy may predict a contrast reaction. However, the study authors noted, shellfish allergy has nothing to do with the reaction, and iodine can’t be an allergen, as it is found in the human body.
The findings of the new study support a number of earlier studies that have found many doctors to be dangerously ill informed about the diagnosis and treatment of allergies.
The habitual failure of emergency departments to treat anaphylaxis with epinephrine, for example, is well documented. A recent study from Mayo Clinic researchers found that emergency rooms that used specific order sets still failed to use epinephrine half the time — and that represented a dramatic improvement over the status quo. Studies typically find that patients who come to the hospital with anaphylaxis get epinephrine between 12% and 30% of the time.
General pediatricians also tend to fare poorly when researchers evaluate their knowledge of allergies, despite the increasing prevalence of childhood allergies and increasing coverage of the topic.
“If you suspect you or your child has an allergy, it’s important to see a board-certified allergist,” said David Stukus, MD, a senior author of the new study. “Allergists are first board-certified in pediatrics and/or internal medicine, and then have an additional two years of training in the specialty of allergy/immunology. It’s that training that makes them the best qualified to treat allergic conditions of all kinds.”