Key Study Findings and Management Implications for Infants/Young Children With Proven or Likely Egg or Milk Allergy

ObservationClinical Implication for Anticipatory Guidance/Education
The annualized rate or reactions for all foods was 0.81 (95% CI: 0.76–0.85).The high rate of reactions suggests the need for increased education to avoid reactions.
Most (64.9%) accidental allergic reactions to milk, egg, or peanut were attributed to lack of vigilance (failure to check ingredients, forgetfulness, child taking the food, etc).Emphasize need for supervision, checking ingredients for each meal/snack.
Additional common errors in accidental milk, egg, or peanut allergic reactions include misreading labels (15.8%), cross-contact in meal preparation (15.1%).Educate about label-reading, avoiding allergens in meal preparation/restaurant meals.
Half (50.6%) of all allergic reactions were attributed to food not provided by parents, including relatives and teachers.Education should be given to all caretakers, not just parents.
Purposeful trial of avoided milk, egg, or peanut accounted for 11.2% of allergic reactions to these foods.Family should discuss allergen re-introduction before attempting on their own.
Overall, only 29.9% of reactions with severe symptoms were treated with epinephrine.Emphasize the symptoms that warrant treatment with epinephrine.
Almost all severe reactions (94.8%) were attributed to ingestion rather than other routes of exposure (skin, inhalation).Emphasis should be placed on avoidance of oral exposure (including transfer from hand to mouth in young children).