Allergic Kids Intentionally Exposed to Allergens

[LinksEtc]

"Allergic Kids Intentionally Exposed to Allergens"
http://www.medscape.com/viewarticle/780470

Roughly 11% of allergic reactions in children with known food allergies are the result of caregivers intentionally exposing the child to the allergen

[CMdeux]

Whoahhhhhhhh....



<speechless> 

<blink>

[starlight]

My mother was definitely afraid my father's side of the family would do this, and with good reason. Grandmother once gave me an easter basket with a bunch of loose hershey kisses. Mom wouldn't let me eat any of them. We found a single almond one in the mix...they just didn't believe that a food could kill someone (unless you choke on it). That was back in the late 80's/early 90's, so there wasn't any online research or articles posted everywhere, they just had to take my parents' word for it.

[Gray]

I'd like to say that this surprises me, but unfortunately, it doesn't.  My dh (the one with the PhD, btw) came very close years ago to doing this to our dd.  I prevented this, dragged him to another allergist for a second opinion who thankfully convinced him to avoid.  Let's just say that recent events have not helped convince him of the seriousness of the issue.  Maybe I should be in vent & delete.

[twinturbo]

PhDs aren't immune to bias. Whether or not they are willing to acknowledge and disclose them--different story. Peer reviewed journals, best practices issued by NIH NIAID and CDC are excellent in citing credible sources that would defend nicely against bias. If you haven't done so yet you may want to consider reading the exact breakdown of how anaphylaxis occurs written in the blog of a board certified pediatric allergist who is also a parent to multiple children with multiple LTFA. Know that well and then you may inquire firmly yet civilly if he is aware of the mechnics if IgE mediated allergic reactions and anaphylaxis. Present sources as being inside this specific medical discipline under autoimmune.

To ensure a proactive dialogue is in place make it about the data, the material, not between the two of you. Treat it as though you're sharing a source and allow a credible source to challenge it in like. His PhD training might force him to challenge his own bias. Howver this is a personal matter so sometimes ego and emotion can present formidible barriers.

Depending on how detached you can remain some possible time buyers might be cite your source, how did you arrive at that conclusion, please share that source with me I'd like time to review it together in detail, can I ask what that is evidenced by, let's discuss controls first so we know our data would be less contaminated, ad infinitum.

This happens with MDs, too. I have friends who go way off map for their own kids allergies because they're derms, pediatric ER, research specialists. Believe it or not it's much easier to deal with a skeptic whose patterns have been established through academic rigor, you just follow that path. It's the Neo-luddite junk science junkies with circular logic that are nigh unreachable.

[Gray]

*** poof ***

Post was about the different opinions of various doctors.

[twinturbo]

The way I would frame it is that the biases are strong. I'm not sure who you meant by "he" being Egyptian and I'm not sure how or if that contrasts with what you, your husband's or your doctors' background because I never assume that Anglo is default unless otherwise specified.

My husband and I are East Asian as of course is our family and circles of friends. Both my husband and father in law are doctors in non-medical disciplines though my husband's work is on humans. In addition to academia I do hail largely from a enclave community comprised of 1st - 2nd generation Americans more heavily weighted on relatively recent immigration than not.

What bias ancestral culture plays in the sense that 'back home' this isn't a real problem isn't as cut and dry as most people may generally attribute. Even casual observance of the driving forces behind allergy research (clinical trials, lead authors, treatment investigations) shows that our academic and medical forces working strongly for us is a truly international roster.

I believe where much of that disconnect gets lost is in the education and advocacy at the patient level as to kids who are affected. Much like emergency managment for natural disaster there are always hard to reach segments of communities that are harder to reach due to language and cultural barriers.

My experience with family and medical professionals breaks with the convention that the more a background deviates from an unwritten standard of American then it is less likely that person will "get it". Our pediatrician in Asia called the allergies in our child while our non-Asian pediatrician in USA thought no nuts allergies in our family meant that our child could not be allergic to nuts. My more Americanized family is clueless about LTFA in comparison with my husband's family who are all mostly still in Asia or much more recently working in the US who give us endless moral support.

The type of bias that I've read attributed to culture and language is, I think, becoming accepted as an expected absolute to the detriment of overall message reaching the harder to reach communities. With my own two eyes and ears I've observed the same indifferences exhibited by more people with no such purported cultural or language barrier.

[twinturbo]

Separate post to continue my previous post on communicating with a scientist holding on to illogical or irrelevant biases. The strategy isn't about changing the person in question. It's about changing your communication style so that it makes the person work against their own biases or at least alter a behavior because they are pausing to question the bias.

[CMdeux]

Yes-- I think that mostly "cultural" bias is just an excuse.  It's not really an explanation, so much-- no more than any other rationalization of indefensible behavior is, I mean. 

So the fact that there ARE men from patriarchal cultures that do NOT regard women as inferior objects... well, that sort of negates the excuse-making about domestic violence being "cultural" in some way.  KWIM?


But I do get what Gray is saying here, too-- the nature of the allergen can play a role.  If you come from Dairy country, having a milk allergic child is that much harder to accept.  There is an emotional, irrational desire for there to be some loophole that makes it "not true."  I can see how this leads to "testing" the allergy.

I think that the actions discussed in the article reflect the kinds of THOUGHTS that are a natural part and parcel of the ongoing lifestyle demands of LTFA.  That is, you go a while with a certain level of avoidance, and if you're successful, you start edging away from restrictions-- it's human nature to wonder if they are really still necessary.  KWIM?

[Gray]

I can't really say how much of a role dh's Egyptian background contributes to his attitude, but he has referenced it himself quite a few times regarding FA ("In Egypt, if somebody has an allergy, they ...") ("We don't do all this ...") etc.  I do think a lot of it is connected with his personality and his general views on medical care which all rose to the surface after our kids were diagnosed with medical problems.

sigh

Whatever the combination of reasons, he just doesn't "believe" in this food allergy.

sigh.

[twinturbo]

 

I know, I Joel Stein'd myself without a whit of grace into nut allergies. It seemed framed in the public as a problem overwrought American yuppies had with their kids because that's all that had made it through my filters, all that had been publicized. All this with knowing crustacean allergies ran in our families plus DH's issue with ibuprofen. Honestly? I thought it was impossible for my kids to become allergic to nuts because they weren't Caucasian.

Anyhow, I think it's an overdue subject to be brought to light and addressed proactively in allergic medicine and advocacy. Language and culture.

ETA: Oh, and while I'm on a roll to admitting idiotic ideas when I started reacting to soy I just kept eating soy sauce because there was no way I was giving up soy sauce. I'd probably have to be to the point of some super scary reactions before I stop eating soy sauce. I draw that line at my kids though because they don't have the ability to make that decision for themselves.

[twinturbo]

Yes-- I think that mostly "cultural" bias is just an excuse.  It's not really an explanation, so much-- no more than any other rationalization of indefensible behavior is, I mean. 

So the fact that there ARE men from patriarchal cultures that do NOT regard women as inferior objects... well, that sort of negates the excuse-making about domestic violence being "cultural" in some way.  KWIM?


But I do get what Gray is saying here, too-- the nature of the allergen can play a role.  If you come from Dairy country, having a milk allergic child is that much harder to accept.  There is an emotional, irrational desire for there to be some loophole that makes it "not true."  I can see how this leads to "testing" the allergy.

I think that the actions discussed in the article reflect the kinds of THOUGHTS that are a natural part and parcel of the ongoing lifestyle demands of LTFA.  That is, you go a while with a certain level of avoidance, and if you're successful, you start edging away from restrictions-- it's human nature to wonder if they are really still necessary.  KWIM?

Likewise I actually see Gray's DH's POV as well as hers. In the case where diagnostics are inaccurate, or even conflicting, parents deserve a mulligan before having their decisions pinned on larger categorical traits. We were lucky in that we had a clear diagnosis from a pediatric food allergist who took the time to make sure we knew it was unpredictable, life threatening, that we had an emergency action plan and didn't let us leave the office until the nurse was satisfied we could use an EpiPen. 30 days later we had to do just that so again, clear signs.

When you don't get answers then it's natural to speculate. Would the outcome change if my approach was different? The reaction didn't seem so bad so what if we pursued it more aggressively than safely? All of this enters in the risk-benefit calculus based on categorical and personal factors that we can perform with rational thought. Risk as feeling happens at the gut level but is still an equally important tool for risk management because it's what kept us away from things that would eat us, crush us, burn us, poison us, harm us somehow in a particular moment that can't afford the time needed for a risk-benefit calculus.

Between a couple of one is only performing risk-benefit calculus and the other risk-benefit + risk as feeling, or the factors for the risk-benefit calculus aren't in balance, then assertions are made on categorical levels. Example: A woman using risk as feeling to evaluate the result of an oral challenge using in addition to risk-benefit calculus required to even authorize a challenge is hysterical because she's a woman.

[Gray]

Thanks for your opinions.

I do hope allergists can convince more patients the importance of following medical advice.  That 11% # is quite concerning.