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Suboptimal care of peanut allergic children in Germany concerning professional dietary advice and the supply of self-injectable epinephrine

Background

Patients with peanut allergy are advised to strictly avoid peanuts in their diet and to carry an emergency kit including self-injectable epinephrine at all times.

The aim of the study was to determine to which extent peanut allergic children in Germany are provided with self-injectable epinephrine and if they had received professional dietary advice.

Methods

63 peanut allergic children (median: age 6 years; peanut-specific IgE 73,5kU/l) who participated in an oral immunotherapy (OIT)-study were enrolled. Data concerning age of diagnosis, provision with self-injectable epinephrine, professional advice and performance of a peanut-free diet as well as the characterization of accidental allergic reactions to peanut (grade of severity I-V) were collected at their baseline visit of the OIT-study.

Results

At baseline visit, 17/63 children (27%) had not been provided with self-injectable epinephrine although the diagnosis of their peanut allergy was already made 4 years (median) ago. Five of these 17 children had at least one severe allergic reaction after accidental peanut consumption (grade IV) in their history. 27/63 children (43%) had not received self-injectable epinephrine at initial diagnosis but later in their life. In 13 of these 27 cases self-injectable epinephrine was prescribed only after at least one severe allergic reaction to peanut (grade IV). 19/63 children (30%) had received self-injectable epinephrine directly at initial diagnosis. A strict avoidance of peanut was performed by 51/63 families (82%). 12/63 families (18%) did not avoid products labelled with “may contain traces of peanuts”. Only 13/63 families (21%) had received dietary advice from a dietician.

Conclusion

Currently, peanut allergic children are not sufficiently provided with self-injectable epinephrine and do not receive enough professional dietary advice in Germany. Accidental allergic reactions are common. Therefore we recommend prescribing an emergency kit including self-injectable epinephrine directly at initial diagnosis. Furthermore families should receive an emergency training and a professional dietary advice.

Disclosure of interest

None declared.

Author information

Correspondence to V Trendelenburg.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Public Health
  • Epinephrine
  • Allergic Reaction
  • Initial Diagnosis
  • Baseline Visit