Patients With Food Allergies Benefit From Compassionate Care

Ingrid Hein

June 03, 2019

LISBON, Portugal — People with allergies to food typically have complex feelings about the risks they face, so it is important that physicians build trust as they educate about healthy, safe diets.

"Our patients need empathy. You have to understand their psychological profile, accept their feelings about their food allergy, and give guidance based on that," said Emilia Vassilopoulou, MD, from the International Hellenic University in Nea Moudania, Greece.

"In many cases, we are too theoretical in our approach with our patients so we don't reach them," she told Medscape Medical News.

No matter how much education you have, "you still have to build a relationship and engage with your patient," Vassilopoulou told allergists and dieticians here at the European Academy of Allergy and Clinical Immunology 2019 Congress.

"We need to know what makes them feel anxious and we need them to feel that we understand their stress," she explained. If we want patients to follow our guidance, "we have to be more flexible."

Structured and Standardized, But With a Sympathetic Ear

While we are listening to patients with a sympathetic ear, consultation sessions must be structured and standardized, "otherwise we start to miss information," said Vassilopoulou.

The biggest challenge with most food-allergic patients is that they make choices out of fear and misinformation, and end up avoiding foods they are not allergic to, she noted. But it is important that they have a balanced diet and eat a wide variety of foods.

A trusting relationship with a healthcare provider can help patients build confidence when they want to introduce foods.

"Take a holistic approach," she advised. "Take into account the social and economic situation the family is in. Evaluate their education and mental capacity." It is important to speak to people at a level they can understand.

Allergists and dieticians also need to understand the daily lives of patients and their attitudes about allergy and food preparation.

Quelling False Beliefs

To guide patients, it helps to know how they communicate with friends and family about food allergies and how their loved ones react to the allergy. Some people develop a mental block when they adopt a certain belief that they have a hard time letting go of.

Consultations that take place in person or over the phone are advisable. In text or email, "you can't tell if the person understands. She may take it the wrong way and then have even more problems," said Vassilopoulou.

Cross-reactivity in food allergies is often misunderstood, said An de Busser, a dietician at Allergy Dietisten in Antwerp, Belgium.

"I often see people say that when they eat an apple or carrots, they have oral allergy symptoms, like watery eyes or itching," she reported. "They don't realize it's a cross-reaction with birch pollen."

When a person has a reaction after eating a salad and then excludes every ingredient in that salad from his or her diet, the result can be "a very unbalanced diet," de Busser pointed out. And when people have been avoiding foods for years, it is very difficult to get them to change that pattern.

It is important to educate patients early and do what needs to be done to get them to introduce new foods. "Sometimes we send them to the hospital to try foods there," she reported.

Online sources offer a lot of inaccurate guidance for the food-allergic patient.

"One of my biggest challenges is the internet," said Rik Rösken, MD, from Zaans medical Center in Zaandam, the Netherlands, after the presentation. "Some people come with a specific bias based on things they read online."

"It's important to not go flat out into conflict with these patients, telling them they should not read that. If you do, you can lose them and miss the opportunity to actually help them to manage their symptoms," he told Medscape Medical News.

In addition, patients who are convinced that they have an illness rather than a food allergy "can be very difficult to help," he said.

Be patient and consistent. "When we point these patients in the right direction, without confrontation, we can really make a difference," he explained.

Determining Risk

It is important to be aware that boys and girls typically handle allergies very differently.

In general, "adolescent boys do not want to say to their friends that they have a food allergy, so they are at constant risk," Vassilopoulou explained. In contrast, "girls want to talk about it."

This could be because girls want be unique and feel more protected if everyone knows. "Boys just want to be part of the team, so they try to hide their problem," she suggested.

When we understand how our patients communicate with others about their allergies, "we can influence them in ways they can accept. We can open the doors to change their dietary habits."

You cannot help a patient "overcome fear by adding pressure," Vassilopoulou said.

For example, when the mother of a 6-month-old child with multiple food allergies says she is afraid to introduce wheat when she is advised to add more foods to the baby's diet, suggest alternative sources of starch, like rice, corn, soy, or quinoa, and maybe even provide specific recipes.

"Is this easy?" It is not, said Vassilopoulou. But we need to make patients "feel confident."

And patients should be warned to recheck ingredient labels from time to time because product recipes can change, she added.

Vassilopoulou, de Busser, and Rösken have disclosed no relevant financial relationships.

European Academy of Allergy and Clinical Immunology (EAACI) 2019 Congress: Presented June 3, 2019.

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