This story reports the results of a study of 6,300 oral food challenges, or medically supervised allergy tests, to determine whether patients have outgrown their food allergies.
The story did a good job discussing how oral food challenges work, and included an expert source not directly connected to the research who provided important context. It discussed the risks of oral food challenges, and why they are best done in a carefully monitored setting. The story would have scored stronger if it had better described what kind of research this was, and what made it novel. We also think a discussion of how much oral challenge tests typically cost–with and without insurance–would be useful information for parents.
One minor quibble: The headline made it sound like this was a new test–it’s not. What’s new is the research findings and what they illuminate for doctors.
It’s important to determine the effectiveness of oral food challenges because food allergies affect up to 6 million people, and cost in the aggregate $24 billion annually in medical and food costs and lost labor productivity. At a family level, finding foods their children can eat can be challenging for parents, and errors can have serious, even life-threatening consequences. This story will help people understand how often food allergies are likely to dissipate, as well as how best to find out that information.
The story does not mention the cost of oral food challenges. That’s too bad because the economics of food challenges are part of the overall newsworthiness of the procedure, although it was not a focus of this particular study. Considering that oral food challenges take three to six hours and require multiple staff to provide adequate supervision, families with inadequate or no insurance may not consider looking into the time-consuming procedure. However, families of patients on special diets spend thousands of extra dollars per year on groceries. Prior research suggests that in the end, having a food challenge earlier rather than later could save money for children assessed as low risk.
The story provides the percent of patients who were categorized as having no response, mild allergic response, and anaphylaxis. Because this wasn’t a randomized controlled trial, those numbers summarize the important findings of the study.
As the story explains, patients who experienced either mild or serious allergic reactions to the oral food challenge were treated with antihistamines or epinephrine respectively. For the 86% of patients who passed their food challenges with no adverse reactions, no harm was involved.
This story is based on a study in which data were obtained via a physician survey in five food allergy centers across the United States. The researchers used a statistical procedure called meta-analysis to pool the proportion of reactions and anaphylaxis. The fact that this study used secondary data generated between 2008 and 2013, and that the data came from clinical records rather than controlled trials isn’t a bad thing, but it should have been mentioned in the story, as well as the limitations that stem from this kind of research (all research has limitations).
No disease mongering is present in the story. Severe food allergies can be life threatening, but the story focuses on the daily experience of children who live with them.
The story cites one expert not involved in the research, and we could find no potential conflicts of interest that should have been disclosed. The independent source provided a quote that we wished had been explored more in-depth: “But it’s also possible [some of them] never truly had a food allergy.” This is an important point–how much did the study help actually overturn incorrect diagnoses?
In one sense, the only alternative to having an oral food challenge is not having an oral food challenge, and possibly not discovering that a child has grown out of an allergy. That issue is covered in this story. Another important point is that skin prick tests have been found to produce misleading results in a large proportion of patients. There is a growing conviction among researchers and practitioners that the only way to confirm beyond doubt that an individual has a food allergy is to conduct a food challenge. That alternative was mentioned in the story, but more emphasis would have presented a fuller picture of the significance of the study findings.
The story doesn’t discuss how easy it is to find an allergy clinic that does oral food challenges, but it does refer parents to allergists for further discussion.
The study on which this story was based is described by the researchers as being the largest national survey of allergic reactions of clinical open oral food challenges in a nonresearch setting in the United States. The story doesn’t note this, making it unclear what’s novel about the research.
The story quotes one outside expert, so it appears not to rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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