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Understanding unintentional and intentional food allergic reactions

Published online: August 22, 2020

Avoidance of allergenic food is challenging and limits the social sphere of children and adults living with food allergy (FA). Research on the lived experience of food-related allergic reactions, including frequency rate and reason for exposure, is largely based on small clinical samples that do not provide insight into the experience of the broader population of food allergic individuals. It is well known that most allergic reactions are unintentional and often stem from cross-contamination; however, limited evidence suggests that deliberate risk-taking in the form of an intentional exposure is also a phenomenon that occurs among children and adults with food allergies. Greater insight into the frequency and context of food-related allergic reactions in both children and adults is needed.  

In the most recent issue of The Journal of Allergy and Clinical Immunology: In Practice, lead author Dr. Jamie Fierstein PhD and colleagues analyzed patient-reported survey data for 4,075 participants in the Food Allergy Research & Education (FARE) patient registry as of September 2019. Registry participants included individuals with their own diagnosed food allergy and parents or caregivers of a child with food allergy. All participants completed electronic surveys. Data for the current study were drawn from surveys of the participant’s food allergy history and the most recent food-related allergic reaction. The study team analyzed the annual frequency of reactions and the context of the most recent reaction, including the patient’s classification of the exposure as intentional (i.e., non-accidental/deliberate), unintentional (i.e., accidental), or unsure.

The study found that nearly two-thirds of adults and nearly half of children with food allergy experienced one or more food-related allergic reactions per year. Additionally, while the majority of reactions were unintentional, 1 in 10 patients reported an intentional food allergen exposure. Among children with intentional exposures, the most common reason was that the child had never had a serious reaction (50.0%), and among adults, it was the decision to take the risk anyway (47.8%). Cross-contamination was the most commonly cited reason for unintentional exposure (children: 24.1%; adults: 32.2%). The study also found that reactions were most often rated as severe (27.0%) to very severe (12.8%), yet only 23.1% of reactions were treated with an epinephrine auto injector.  

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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