By Dr. Michael Pistiner
My son was 4 when he had a severe allergic reaction to a chocolate bar with walnuts in it. Around that time, I was completing my second year of training as a pediatric allergist and was already very interested in how to teach families about managing their children’s food allergies. My wife and I found that the first few months after his reaction were surprisingly difficult. We were quickly faced with the challenges that so many families face when dealing with food allergies. I have since been determined to find ways to help families comfortably and effectively manage their children’s food allergies.
Food Allergy Management
Food allergy management is a complicated process. It requires 2 basic sets of building blocks: those of prevention and those of emergency preparedness. These must be applied in all situations and at all times, which can be tricky as it requires all people caring for the child to competently understand and apply these principles consistently.
What complicates this is it is an ever-changing process that is affected by the child’s age, maturity, and temperament. And social and practical challenges abound. Outside influences like the attitudes of extended family and friends, schedules, geographic area and financial circumstances influence it as well and can be very challenging to both children and their parents.
Teaching and getting caregivers comfortable with food allergy management is absolutely essential. The frustrating part is that a typical visit with an allergist does not allow for the degree of training necessary, and the available resources can at times be overwhelming and difficult to be processed.
The Power of the Group
Another issue that can be difficult for families is the feeling of isolation. Because of the need to maintain constant food allergy management, kids with food allergies need to do things a bit differently than children without food allergies. The opportunity to interact and learn with other children with allergies can prove to be invaluable.
For the last several years I’ve had the amazing opportunity to volunteer with Drs. Jenny LeBovidge and Lynda Schneider at Children’s Hospital Boston, working with groups of families managing food allergies. I have seen the value that groups can offer. Parents and children not only have the opportunity to interact with others experiencing very similar issues, but they are also able to learn from others and even experience the pride and mastery of teaching as well.
Shared Medical Appointments
In addition to my role at Harvard Vanguard Medical Associates as a pediatric allergist, I have recently become the medical director of the shared medical appointments program. Shared medical appointments (SMAs) have been in use for decades, and Harvard Vanguard has been a pioneer in cultivating this exciting approach. Now with over 50 successful groups, this approach to care is becoming another way to practice medicine. These visits offer participants additional social and emotional support, increased access to educational information, and in some cases more time with their healthcare team. Not only do these visits offer a great deal, to patients and their families but they also provide benefits for doctors, staff, institutions and insurance carriers. Shared medical appointments may be one of many answers for how we can accommodate the rapid changes in our healthcare system.
Food Allergy SMAs
As of July, we are now offering food allergy SMAs as an option to all children who see a Harvard Vanguard allergist. During these appointments, skin testing and blood testing are performed if needed, food allergy action plans and other paper work are updated, and prescriptions for epinephrine auto-injectors written or updated. In each food allergy SMA, we will review basic food allergy management, but focus it to the issues and concerns of the group. School readiness, eating at restaurants, and using babysitters are just a few topics that are often addressed.
For more information about how you and your child can participate in a food allergy SMA at Harvard Vanguard, please contact our Burlington office at (781) 221-2700.
Michael Pistiner, MD, MMSc recently joined Harvard Vanguard Medical Associates as a pediatric allergist and is an instructor in pediatrics at Children’s Hospital Boston, Harvard Medical School. He is a fellow in the American Academy of Pediatrics where he is a member of the Council of School Health, Section of Allergy & Immunology, and a member of the American Academy of Allergy Asthma & Immunology where he is a member of the Adverse Reaction to Food Committee. He is a food allergy educator and advocate and serves as a voluntary consultant for the Massachusetts Department of Public Health, School Health Services. He also serves on a team assembled to implement a law designed to increase food allergy awareness in Massachusetts eating establishments and is a medical advisor for Kids with Food Allergies Foundation. Dr. Pistiner has received awards from the Food Allergy & Anaphylaxis Network in 2009 and 2010, as well as the American Medical Association Young Physician Section Community Service Award (2010) for his work on the Food Allergy Awareness in Restaurants Act. He is co-creator of AllergyHome.org, an allergy education website, and has recently authored “Everyday Cool With Food Allergies,” a children’s book designed to teach basic food allergy management skills to preschool and early school age children.
(This piece is adapted with Dr. Pistiner’s cooperation from his original blog here.)