Food allergy management in daily life: accidental allergic reactions, cofactors and adherence to dietary advice

Food allergy is caused by an IgE-mediated immune response to allergenic proteins in a food. It manifests by symptoms of the skin, mucous membranes, gastrointestinal tract, respiratory tract and/or cardiovascular system. The severity of the symptoms varies per patient and per food from only mild itching in the mouth, to sometimes life-threatening and fatal reactions, by for example, blocking of the airways or a drop in blood pressure and shock. The key interventions after diagnosing a food allergy are prescribing an elimination diet and emergency medication to treat accidental allergic reactions. Despite specific dietary advice and the support given, accidental reactions to food still occur in the daily life of food allergic individuals. The aim of this thesis was to gain more insight into: 1) the frequency, severity and impact on costs and quality of life of accidental allergic reactions to food, 2) which factors play a role in the occurrence of these reactions, and 3) the degree to which dietary advice is followed after ruling out or confirming a food allergy and which factors play a role in the degree of adherence to dietary advice. This thesis showed that accidental allergic reactions occur frequently in the daily lives of adults with food allergy, often causing severe symptoms. These reactions have a significant impact on direct and indirect costs. The occurrence of accidental allergic reactions is affected by many factors, related to the patient, health care and food. Important patient-related factors are age, social barriers to the disclosure of their allergy (e.g. in restaurants) and non-adherence to the elimination diet. Not every factor applies for every individual patient. With regard to health care-related factors, the degree to which clinical practice is tailored to the individual patients is important. A major food-related factor is absence of harmonized regulation regarding precautionary allergen labelling (e.g. ‘’may contain peanuts’’). Furthermore, non-adherence to dietary advice frequently appears both after ruling out and confirming a food allergy. It is highly recommended to tailor health care even more to the individual patient, for example with regard to education and support of behavioral and psychosocial aspects. Furthermore, it is of great importance that steps are taken to improve policies and guidelines for precautionary allergen labelling