Monday, February 7, 2011

Your Family Doctor vs. an Allergist

by Kelley Lindberg

One of the first questions I ask someone who has been newly diagnosed with a food allergy (or who suspects they may have a food allergy) is “Have you seen a board-certified allergist?” There’s a good reason for this question.

A January 2010 article published in Pediatrics magazine, the official journal of the American Academy of Pediatrics, included an article called “Food Allergy Knowledge, Attitudes, and Beliefs of Primary Care Physicians,” by Ruchi S. Gupta, MD, MPH; Elizabeth E. Springston, BA; Jennifer S. Kim, MD; Bridget Smith, PhD; Jacqueline A. Pongracic, MD; Xiaobin Wang, MD, MPH, ScD; and Jane Holl, MD, MPH.

In this article, the authors describe their research into food allergy knowledge and perceptions among pediatricians and family physicians in the United States. They surveyed 407 primary care physicians around the U.S., 99% of which reported that they provide care for food-allergic patients.

The results of the study show that while general-practice physicians and pediatricians are of course invaluable in many ways for many common illnesses or preventative care, their knowledge of a complex, specialized, and rapidly changing field like food allergies is not necessarily what most patients or parents of food-allergic might expect.

According to the article, participants in the study answered only 61% of knowledge-based items correctly. Only 80% of the physicians knew that the flu vaccine is unsafe for egg-allergic patients. While 90% knew the number of food-allergic children is increasing in the United States, only 23% knew that milk-based yogurt and cheese are unsafe for children with IgE-mediated milk allergies.
Even more concerning: “Fewer than 30% of the participants felt comfortable interpreting laboratory tests to diagnose food allergy or felt adequately prepared by the medical training to care for food-allergic children.”
Some other particularly concerning statements from the article:
  • “There was some confusion among participants regarding signs and symptoms suggestive of an underlying food allergy.”
  • “The majority of participants believed that anaphylaxis posed the greatest threat to young children rather than teenagers.”
  • “…only half chose the correct concentration and route of administration for epinephrine in the event of food-induced anaphylaxis.”
The article’s authors suggested that part of the problem may be that “Most pediatric and family medicine training programs do not offer formal training in food allergy, although experience likely varies by program.” As broad and far-ranging as the entire field of medicine is today, that’s not surprising. A general-practice physician tries to be a generalist to do the most good for the most patients – they usually strive to be well-grounded in the basics of healthcare, with a more surface-level knowledge of various specialties. But there are simply not enough hours in the day for anyone to be a specialist in everything.

From this study, it’s important to realize two things:
  1. Patients with food allergy probably should not rely on their family doctor or pediatrician for expert diagnosis, treatment, and ongoing care of their food allergies. Instead, they should seek out the knowledge and experience of an AAAAI board-certified food allergist. (To find one in your area, click here for the American Academy of Allergy Asthma & Immunology Physician Referral Directory.)
  2. Physicians are often aware of their limitations, but even so, they may not be willing to refer their patients to allergy specialists. In some cases, because of their limited knowledge or experience, they may even downplay the seriousness of food allergy symptoms, such as treating severe eczema with creams instead of identifying a possible root cause of food allergy.
The authors conclude by rating the overall knowledge of their sampled physicians as “fair.” The authors go on to recommend: “With the recent increase in childhood food allergy and the threat posed by food-induced anaphylaxis, it is important for generalists to be educated about the diagnosis and treatment of this condition.” They also suggest that general physicians can take advantage of the many resources already available to increase their knowledge, such as “a food allergy practice parameter, outlining risk factors, diagnostic techniques, and treatment plans,” which was developed and published in 2006 by the American Academy of Allergy Asthma & Immunology and the American College of Allergy, Asthma, and Immunology.

Please understand – pediatricians and family doctors are essential and invaluable, and I am NOT trying to undermine them. Instead, I am just pointing out that once they identify a possible food allergy, you will probably be better served by a dedicated allergist, in the same way that if your family doctor suspects (or confirms) cancer, you would probably then go see a cancer specialist.

I absolutely love and depend upon my son’s pediatrician for most of his ailments and normal childhood problems. But I also love and depend upon my son’s allergist for all of his food-allergy issues. We can’t live without either of them.


foodallergymom said...

Thanks for the great reminder. I have yet to find a pediatrician as knowledgeable with allergies as I'd like. It seems to be pretty much hit and miss if they even understand some of the basics.

Julie Myers said...

I think this is a great point, because allergists can be more specific with those that have bad allergies. My son is allergic to quite a few things, but it's difficult to get specific help from our family doctor. It would probably be very helpful to take him in to an allergist to see if that can help him feel better.