Health care professionals’ beliefs and practices regarding food allergy testing for children with eczema

Problem

Atopic eczema/dermatitis (“eczema”) affects ~20% of children and symptoms can be difficult to manage. Parents often request food allergy tests or exclude foods from their child’s diets to manage symptoms. The value of routine food allergy testing of children with eczema is uncertain. Current guidance advises only to suspect food allergy if the child has IgE mediated symptoms or the eczema is difficult to treat. Children may be managed by health care professionals (HCPs) across specialties but data on HCPs’ beliefs and practices regarding food allergy testing in children with eczema is limited. We sought to investigate HCPs’ beliefs and practices regarding blood specific IgE or skin prick food allergy tests for children with eczema.

Approach

A short survey was compiled with fixed, multiple-choice style questions and one optional free text question at the end, which invited respondents to explain their responses. HCPs in the UK who diagnose and treat children with eczema were invited, via professional networks and social media, to participate anonymously via a GDPR compliant survey host (www.onlinesurveys.ac.uk). The survey was open for four weeks.

Findings

129 eligible HCPs responded to the survey from four specialties: 50% (65/129) General Practice (GP), 17% (22/129) Allergy, 9% (12/129) Dermatology and 23% (30/129) Paediatrics. Beliefs about when to request food allergy tests varied by scenario and speciality, with HCPs in Allergy and Paediatrics more likely to request tests than HCPs in GP or Dermatology. For a child with no clinical history of an allergic reaction, more GPs (56/65, 86%) would never undertake food allergy tests, compared to dermatologists (7/12, 58%), paediatricians (16/30, 53%) and allergists (5/22, 23%). For a child with eczema and an immediate reaction to food, more HCPs in Allergy (20/22, 91%) and Paediatrics (22/30, 73%) always requested, compared to GP (16/65, 25%) and Dermatology (3/12, 25%). For a child with very severe eczema but no history of clinical reaction to food, more HCPs in Allergy (8/22, 36%) and Paediatrics (9/30, 30%) would request an allergy test, compared to GP (6/65, 9%) or Dermatology (0/12, 0%). However, there was more agreement with respect to testing children with clear skin (82% of allergists to 100% GPs “never” testing) and parent requests influencing testing decisions.

Consequences

The disparities are likely to cause increased costs to the NHS, with potential long-term consequences for children in terms of nutrition, loss of tolerance and/or risk of IgE-mediated reactions. Future research should focus on strengthening evidence on the role of food allergy tests and dietary exclusions in children with eczema and exploring how evidence-based guidance can be effectively disseminated amongst HCPs.