GPs report worried patients giving infants peanuts or eggs in hospital car parks

Forty Australian GPs have reported they know of parents taking this course of action out of fear of anaphylactic shock, according to an online poll run by Dr Wendy Burton, Chair of the RACGP Specific Interests Antenatal/Postnatal Care network.
 
Dr Burton said that while the practice is understandable given widespread parental concerns regarding allergies and anaphylaxis, it lacks clinical evidence since severe reactions are highly uncommon, particularly in the case of first exposures.
 
‘The worldwide data shows no reported deaths in infants under 12 months from peanut anaphylaxis. So what it is, is the fear factor,’ she told newsGP.
 
‘We see reports or hear of people who had severe reactions and died. But it’s really rare.
 
‘When it comes to care of children, we’re not always evidence-based – emotion and fear is a powerful driver. People feel if they do it somewhere that has oxygen and adrenaline, they’re safe.’
 
Dr Burton said the practice indicates the need for a more effective communication campaign over how best to manage allergen risks. 
 
‘These are pretty potent fears, so a hundred messages from medical professionals will get wiped away by one Facebook post or Twitter comment about a disaster,’ she said. ‘Those are the stories that stick in the mind.’
 
Dr Burton conducted the poll in the wake of updated primary care guidelines and advice from the Australasian Society of Clinical Immunology and Allergy (ASCIA), which suggest that peanut and egg should be introduced within the first year of life in small amounts before increasing the quantity. 
 
The guidelines acknowledge the ‘cultural fear’ of peanut introduction, but stress that this needs to be balanced with a practical approach.
 
‘It is somewhat reassuring that there have been no reports of fatalities to peanut under 12 months of age anywhere in the world, even in countries that have practised early introduction of peanut (eg Israel) for many years,’ the guidelines state.
 
Dr Burton said it can feel as if the job is done when new guidelines are released. 
 
‘[G]uidelines don’t have cut-through in the modern social-media-soaked world. We’ve got to get better at getting the message out in ways that engage and inform parents, to help them understand the science – or lack of science – behind practices,’ she said.
 
One reason for parental confusion is the fact guidelines have shifted away from earlier recommendations to avoid introducing foods with high allergen potential.
 
‘Science says that was a big mistake – it didn’t work,’ Dr Burton said. ‘So now, rather than avoidance, we need to look at sensitisation and frequent early exposure to reduce what is a significant allergy burden.’
 
However, Dr Burton said that if parents notice any reaction after a first exposure, it would then be prudent to see a professional trained in allergy diagnosis and management to administer tests.
 
Rates of food allergies in Australia are the highest in the world, with egg allergies affecting 8.9% of infants under one year old and peanut affecting 3%, according to the ASCIA guidelines. Food allergies have been increasing worldwide. Egg, cow’s milk, wheat, soy, peanut, tree nuts, fish and shellfish are the most common food allergens in Australia.
 
The guidelines also state that infants should not be given soy or hypoallergenic formula, and should not be given probiotics.

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