MANAGEMENT OF FOOD ALLERGIES IN CHILDREN IN SOUTH AFRICA - DETERMINING ASPECTS OF THE KNOWLEDGE AND PRACTICES OF DIETITIANS AND MEDICAL PRACTITIONERS

作者：Stear G I J^*; Potter P C; Labadarios D; Motala C

来源：Current Allergy and Clinical Immunology, 2011, 24(3): 145-155.

Rationale. Adverse reactions to food are frequently suspected in daily clinical practice yet evidence on knowledge of health-care workers regarding correct diagnosis and management remains limited. Few studies have assessed knowledge and management approaches of food allergies by medical practitioners and none exists for dietitians. There is also limited information as to whether current approaches conform to evidence-based recommendations, particularly with regard to dietary intervention and allergy prevention strategies. This survey attempted to determine aspects of food-allergy-related knowledge and practices of medical practitioners and dietitians.
Methodology. An analytical cross-sectional study design was adopted. Participants, randomly selected from the three provinces with the largest populations in South Africa (N = 660), were categorised as general practitioners (GP), dietitians (DT) or medical specialists (SP). They completed a validated (face and content validity) quantitative questionnaire which explored aspects of food allergy diagnosis and management.
Results. Limited knowledge existed among the professional groups studied regarding appropriate diagnosis, dietary intervention and allergy prevention strategies. Inappropriate alternative diagnostic methods, such as immunoglobulin G (IgG) and antigen leukocyte cellular antibody testing (ALCAT), were being used in practice. Of the medical practitioners performing food challenges, 95% had resuscitation training but only 70% of them had appropriate resuscitation equipment available. Health-care practitioners reported use of concomitant complementary therapy and DT were not consulted for nutritional management of patients. Lengthy food avoidance practices were advocated in infants, regardless of the presence of atopy, and in pregnant and lactating women. For allergy treatment, recommended feeds were not in line with evidence-based guidelines with over a third of all respondents choosing breastfeeding with extensive maternal food avoidance and the use of numerous inappropriate infant formulas. The average (standard deviations (SD)) age recommended for introduction of solid foods was 5 (1.3) months. No guidance for implementing elimination diets was given to patients by more than half of medical practitioners and a third of DT. Only 15% of respondents did child growth assessment and monitoring. Of all respondents, 98% believed they needed more education and training in food allergy management, more than 50% had no knowledge of specialist allergy units and 99% recognised a need for South African-specific 'best-practice' guidelines.
Conclusion. The study highlighted a need for better education and training in food allergy management, at undergraduate and postgraduate level, with particular focus on diagnosis, dietary management and prevention strategies. Nutritional and prevention strategies were not evidence-based. Findings could contribute to creating a platform for achieving minimum competency levels in allergy care and provide motivation for establishing South African-based guidelines, allergy support networks and better public awareness.

• 出版日期2011-8