A recent study published in The Journal of Allergy and Clinical Immunology: In Practice suggests that administering an epinephrine autoinjector (EAI) during oral food challenges (OFCs) can be a positive and confidence-building experience for families of young children with food allergies.
Michael Pistiner, MD, MMSc, director of food allergy advocacy, education, and prevention at Mass General for Children, Harvard Medical School, highlighted the importance of managing food allergies early in infancy, supported by recent guidelines promoting early allergen introduction.
OFCs are pivotal in distinguishing between patients with clinically relevant food allergies and those who may tolerate allergenic foods despite positive test results. However, these challenges carry inherent risks of severe reactions, including anaphylaxis.
“Our study aimed to explore two key aspects,” Pistiner explained. “Firstly, we wanted to capture caregivers’ experiences during OFCs with their infants and toddlers. Secondly, we sought to evaluate caregivers’ ability and confidence in administering an EAI to their young children in the event of a reaction, with the support of education and training.”
The mixed-methods sub-study collected prospective data on OFCs conducted from September 2020 to August 2022. Participants included infants and toddlers whose caregivers were trained in EAI administration prior to the challenge. In instances where a reaction occurred during an OFC, caregivers administered the EAI under staff supervision. Pre-interview surveys assessed caregivers’ attitudes, beliefs, and confidence levels related to food allergy management and anaphylactic treatment, while qualitative interviews conducted post-EAI usage explored caregivers’ emotions and experiences.
Of the 343 participants in the study, nine infants and toddlers experienced reactions requiring EAI administration by their caregivers. Insights gleaned from interviews identified three primary themes: caregivers perceived the experience as positive and beneficial despite initial anxiety; they reported increased confidence in managing future reactions and administering EAIs; and they expressed a desire for additional information on post-OFC procedures.
“Despite witnessing allergic reactions in their children, caregivers viewed the overall experience positively,” Pistiner noted. He emphasized that sharing such findings could reassure other parents facing similar challenges, potentially addressing concerns and barriers associated with OFCs and EAI use in young children.
Pistiner suggested that healthcare providers conducting OFCs consider involving trained family members in EAI administration under supervision, turning a potentially alarming event into an educational opportunity. He also underscored the need for quality improvement initiatives and further research to support families post-OFC, including ongoing education and outpatient management.
In conclusion, the study underscores the potential for OFCs and EAI administration to empower caregivers and improve their readiness to manage food allergies effectively in young children, advocating for continued support and education within clinical settings.
