Kate Johnson

November 20, 2014

ATLANTA — General physicians who are not board-certified in allergy and immunology have gaps in their knowledge about allergy that could have serious consequences for their patients, according to the results of a new survey.

"Our study identified several knowledge gaps regarding common allergic conditions, and correct responses were low for all respondents," said researcher Kara Wada, MD, from Ohio State University in Columbus.

She said the degree of misinformation did not differ significantly between residents and internists, or by level of experience; however, pediatricians were significantly better informed than internal medicine physicians, particularly in the recognition and treatment of anaphylaxis.

The findings, presented here at the American College of Allergy, Asthma & Immunology 2014, suggest that information campaigns, traditionally designed to bust allergy misconceptions in the general public, might also need to focus on the medical community.

The researchers used their own clinical experience and the Choosing Wisely template from the American Board of Internal Medicine Foundation to develop the anonymous electronic survey that was distributed at two tertiary care academic medical centers.

There were different versions of the survey for residents in internal medicine, attendings in internal medicine, residents in pediatrics, and attendings in pediatrics.

The findings were based on answers from 409 physicians (a 24% response rate).

For attendings in pediatrics, 35% had been practicing for more than 10 years and 25% had been practicing for 5 to 10 years. For pediatric residents, 35% were in their third year, 26% were in their second year, and 25% were in their first year.

For attendings in internal medicine, 49% had been practicing for more than 10 years and 21% had been practicing for 5 to 10 years. For internal medicine residents, the majority — 51% — were in their first year.

Getting It Wrong

Pediatric residents and attendings answered a mean of only two of the nine questions correctly, Dr. Wada reported.

For example, when respondents were asked which of a list of allergies must be asked about before an imaging study with radiocontrast media is ordered, only 14% answered correctly. Most respondents (79%) chose iodine, 39% chose shellfish, and 20% chose artificial dyes; the correct answer was none of the above.

The pediatricians were more likely than the internal medicine physicians to answer correctly (20% vs 5%; P < .0001).

"Internal medicine respondents, at nearly 88% and 50%, respectively, still believe it's important to ask about iodine and shellfish allergy," said Dr. Wada.

The survey also showed that myths about vaccine contraindications for egg-allergic patients persist, despite recent publicity campaigns regarding the new recommendations for flu vaccine.

In addition, only 8% of survey respondents knew that skin prick testing for food or environmental allergens becomes accurate and reliable when children reach 8 months of age.

"Almost half of all respondents believed that skin testing could not be performed with accuracy until 2 years of age. This highlights an important area for our specialty to focus on, as many younger patients with both food and environmental allergies may not receive a timely diagnosis with this misconception," said Dr. Wada.

These findings are not a surprise to Richard Loh, MD, immediate past-president of the Australasian Society of Clinical Immunology and Allergy (ASCIA), who made headlines recently when he said that children were being denied vaccinations because of allergy misconceptions.

"We are aware that there are also gaps in resources and knowledge about allergic diseases in Australia and New Zealand," Dr. Loh told Medscape Medical News.

To address these issues, the ASCIA and Allergy and Anaphylaxis Australia, a patient support organization, are in the process of developing a national allergy strategy for Australia, he reported.

The main goals of the Australian strategy will be to develop and maintain minimum standards to improve the health and quality of life of people with allergic diseases, promote timely access to appropriate healthcare, improve access to information and education for patients and caregivers, and promote research.

Dr. Wada and Dr. Loh have disclosed no relevant financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2014: Abstract 50. Presented November 10, 2014.

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