What Your Doctor Doesn’t Know About Allergies Can Hurt You

By Dr. Paul Ehrlich

While I was traveling around this past week lecturing, I skipped the 2014 meeting of the American College of Allergy, Asthma and Immunology (ACAAI). Now I have my regrets, not because I missed anything new, but because I missed something old. To wit, a survey of 409 internists and pediatricians on how to treat allergies. All of them had to answer six questions, but pediatricians were asked three additional questions.

The lead author, Kara Wada, MD, was quoted in Science Daily: “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. And 85 percent of internal medicine physicians thought the flu vaccine shouldn’t be given to egg-allergic patients. It’s now known that it’s safe for those with egg allergies to get the flu shot.” (Our contributor, Dr. David Stukus, is also an author.)

Other items I found interesting:
• Only 27 percent of the pediatricians correctly identified the most common causes of food allergy in children below 4 years of age as both eggs and milk. 34 percent identified strawberries and 13 percent thought it was artificial food coloring.
• 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. Since shellfish contain iodine, many physicians have linked a contrast reaction to a shellfish allergy. However, shellfish allergy has nothing to do with the reaction, and iodine can’t be an allergen as it is found in the human body. (This is a pet peeve of mine, which we have written about before.)
• The majority of pediatricians thought that skin prick testing for food or inhaled allergens isn’t accurate or reliable until 3 years of age. While skin prick testing is rarely conducted on infants younger than 6 months old, there is otherwise no age limit. (Ignorance on testing? Don’t get me started.)

These factoids combine to paint an even bleaker picture of knowledge of allergies in general practice than I thought, and my opinion was pretty low to begin with. We respect the challenge that general practice physicians bear in keeping up with our specialty. As we wrote in our book: “Consider that in the two major conferences and the two leading professional journals dedicated to allergy there are some 2,000 articles published or presented every year that are peer-reviewed, meaning they have been read by scientists for importance and accuracy. That is just the tip of the iceberg when you take into account all the research that is going on, with sponsorship by pharmaceutical companies, foundations, and universities. That’s a lot for a busy GP. And when you add the reading in ophthalmology, neurology, gastroenterology, pulmonology, infectious disease, and cardiology, you can appreciate the burden of remaining current.”

But some of this data seems to come from thin air. Strawberries? Artificial food coloring? This reflects a fundamental misunderstanding of how the immune system works.

I spend a fair amount of time educating pediatric residents at NYU Medical School on allergies. I take approximately 20 of them (and the occasional internist) in rotations at my office. I do grand rounds and lectures. When this study is published, I’m going to blow it up to the size of a flag and march through the hospital. As Larry and I have been lamenting for years, the number of allergy fellowships has been dwindling, along with the number of allergists. Thank you, Dr. Wada, et al, for shedding light on a dismal and dangerous problem.

Photograph by http://inflammablog6.blogspot.com/