Advisory warning labels: what do dietitians advise parents of food-allergic children?

Results 61 dietitians participated in the survey, 26% specialised in allergy management, 57% in paediatrics. 70% had been qualified for 5+ years. 38% mandated complete avoidance of foods labelled “may contain... nuts” (but with no nut listed in the ingredients) in nut-allergic individuals. 36% recommended avoidance of only specific foods (such as confectionery) while 12% advised that avoidance of foods with AWLs was not required so long as the child was free of intercurrent infection and/or other factors e.g. absence of recent exercise. Factors which resulted in more stringent avoidance being recommended included: asthma (56% recommending complete avoidance, p<0.05); prior history of anaphylaxis (79%, p<0.01); prior mild reaction to a tiny amount (71%, p<0.05). Provision of an adrenaline auto-injector device did not affect the advice given (p>0.05). Where a nut-allergic child without a history of anaphylaxis was able to tolerate peanut, fewer dietitians recommended complete avoidance (20% vs 38%, p<0.05). Advice did not vary significantly where the allergen in question was egg rather than a nut. Tolerance of baked egg (e.g. in a cake) did not affect the advice given. However, where there was a history of anaphylaxis to raw egg but tolerance to egg in baked foods, more dietitians advised avoidance of foods with an AWL to egg (43% vs 26%, p<0.05).