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Food Allergies, Youth & Alcohol

Food Allergies, Youth & Alcohol Adolescence and young adulthood is a time of developmental transition with gains in independence and broadening social experiences. Those who have been living with IgE mediated food allergy for years may have a more gradual but familiar shift into greater daily self-management of this disease with necessary avoidance and preparedness steps such as ingredient label reading, cooking/baking, risk assessment, self-carry of epinephrine auto-injectors and contacting food manufacturers with questions on ingredient labels. Those newly diagnosed with food allergy in adolescence or young adulthood may require a longer period of time to adapt to needed lifestyle changes.

Adolescence and young adulthood can be a time of risk taking behavior within growing independence. Inherent personality traits, peer pressure, new surroundings and knowledge level about food allergy and anaphylaxis may influence how a teen or young adult analyzes risk identification, avoidance or mitigation. Additionally, disease severity, co-existing allergies or asthma, and external influences may also affect quality of life perceptions.1

Research has indicated that adolescents and young adults are particularly at risk for fatalities from food-induced anaphylaxis.2 A widening social world coupled with balancing daily food allergy management in novel situations can be very challenging and requires practice. Dining out safely entails additional tasks which may include pre-planning, vetting recipes with restaurant chefs and self-advocacy. While teens may be reluctant to educate peers themselves about food allergy and anaphylaxis risks, having their friends informed by others may provide additional safety measures.3,4

Alcohol is a known eliciting factor that might expedite a reaction and outcomes.5 In addition, drinking alcohol may impair judgement and put an individual at risk for consuming their diagnosed food allergen(s). Any subsequent impaired cognitive abilities may result in an inability to recognize a food allergen or clearly communicate if they are experiencing anaphylaxis. They may also be unable to adequately perform necessary steps of self-injection of epinephrine with prompt calling to 911 for transport to the nearest emergency department.

Teens and young adults may need to be reminded or taught anew that the Food Allergen Labeling Consumer Protection Act (FALCPA) does not cover alcoholic beverages.6 Therefore, this is an unregulated area which may make determination of the ingredients of mixed alcoholic drinks difficult to ascertain. Additionally, they may encounter inconsistencies in how well educated restaurants and bar staff are about food allergy, anaphylaxis and cross-contact issues with food proteins.

It is crucial that direct patient education of teens and young adults with food allergy be ongoing and promotes active communication and engagement. Using a variety of potential patient education tools will assist in choosing the most effective option for a given patient. While some patients may respond well to written materials, others may prefer phone consultations or face to face contact with healthcare professionals.

The clinical team of physicians, registered nurses and dieticians may collaborate to ensure that patient education is reinforced consistently. In addition, clinical team members should consider screening for risk-taking behavior, identifying social and emotional challenges, discussing comfort levels with self-advocacy, adaptive/maladaptive coping strategies and review of fundamental food allergy prevention and anaphylaxis preparedness education.3 Additionally, a review of common social scenarios with interactive dialogue of constructive means of handling the situations may be beneficial.3

References
1. Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy. 2010; 65: 933–945.
2. Bock S, Munoz-Furlong A, Sampson H. Fatalities due to anaphylactic reactions to foods. Journal of Allergy and Clinical Immunology. 2001; 107:191-193.
3. Russell AF, Gosbee LL, Huber MM. Part 2: Pertinent food allergy education in a pediatric ambulatory care setting with a focus on anaphylaxis. Journal of Asthma & Allergy Educators. 2012; 3:162-171.
4. Sampson MA, Munoz-Furlong A, Sicherer S. Risk-taking and coping strategies of adolescents and young adults with food allergy. Journal of Allergy and Clinical Immunology. 2006; 117:1440-1445.
5. Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. Journal of Allergy and Clinical Immunology. 2014; 133:291-307.e5.
6. Food Allergy Labeling and Consumer Protection Act of 2004. Accessed October 27, 2015.

This article has been reviewed by Andrew Moore, MD, FAAAAI

Reviewed: 9/28/20