Calling All Nurses: 5 Ways to Take Better Care of Your Food Allergic Patients

Sue Kelly, BSN, RN

by Susan Kelly, BSN, RN

I’m writing this as both a registered nurse who works for an allergist, and also as a food allergy and EoE mom for over a decade.

Nurses are caregivers, teachers, advocates, scientists, artists, healers and problem solvers. The ironic part is, so are food allergy moms!

Nurses, my Food Allergy Mamas need your help!

What’s the big deal, anyway? 

The statistics are impressive: 15 million Americans have food allergies. 6 million of those are children. 1 in 13 children are diagnosed with a food allergy in our country. An allergic reaction to food can quickly become life threatening.”

When my daughter received this diagnosis, I was stunned. Not only did I have to re-learn how to safely feed my toddler, I also had to learn how to keep her safe. I never expected this to happen to my child! I was angry. Why?

Like many of you amazing & highly skilled nurses, I never learned anything about food allergy management in my education or training. I thought there was a lot of hype, and not many facts.

I was wrong!

Many health care professionals, including nurses, do not understand how to care for patients with food allergies or food allergic related conditions. This includes basic care needs like feeding, administering medications, and even using skin and hair care products on such patients.

I have worked on medical floors, procedural areas, intensive care units and the emergency room setting. Patient trays, turkey sandwiches, peanut butter and graham crackers would come and go, and I never heard the words: Food Allergy. I’m afraid to admit it… what if I did?

Would I have rolled my eyes, thinking to myself, “This is not a hotel!” as my daughter and I were told when she was hospitalized with the flu, and I tried to explain her allergic digestive gastrointestinal disorder called, eosinophilic esophagitis?  I really hope not, but I can see how a busy nurse might think such patients are being high maintenance.

“I cannot eat dairy because of my EoE!” What’s EoE? Another food-allergic related condition that often requires a medically restricted diet.

To help keep my nurse colleagues from going down this “eye rolling” path,

Here are 5 ways to Take Better Care of Your Food Allergic Patients:

1. Believe them.

Please do not lecture or tell them they over reacted, or should have given antihistamine first. This is a myth. If they arrive in the ER and have given epinephrine, they are truly shaken by this whole ordeal. Tell them they did a good job. They made the difficult decision to administer this life saving drug, call 911 and land in your care, knowing they did their best to stop an anaphylactic reaction from potentially becoming fatal. Our life saving mantra is: “Epi First, Epi Fast” if suspecting anaphylaxis! Next, please monitor these patients. This is why we call 911 and go to the Emergency Room after administering epinephrine in the first place. It’s not because epinephrine is dangerous. Allergic reactions can return! A second and more serious reaction called a biphasic reaction can happen up to 72 hours after the first!  This is an important fact to know for discharge teaching.

2. Please to not eat in patient care areas.

There’s nothing more unsettling than coming into the hospital or doctor’s office and seeing a jar of mixed nuts or treats at the desk. We are not joking around when it comes to something called cross-contact. We know nurses eat on the go, as breaks are few and far between. But please, wash up after eating your snacks. Like microbes, food proteins love to hang around on surfaces until thoroughly wiped away with a commercial cleaner. Please wash your hands before examining us or touching our things. Thank you!

3. Do not give your food-allergic patient ANYTHING to eat or drink without asking first.

Allergens love to hide in the most unsuspecting foods, like ice pops! Yes, even some ice pops contain common allergens such as milk or may be made on shared equipment with other allergens like peanuts. We are not rude or picky eaters. We have to read every label for possible allergens and may even have to contact companies to find out if their products are safe for us. This is a standard part of food allergy management. We do appreciate any help we can get on this, especially with the hospital’s dietary department and kitchen. Allergic Living Magazine did an excellent piece on this topic called, “Is Your Hospital’s Food Safe?” in their Fall 2017 issue. It’s an eye opening read about patients’ experiences while being hospitalized with food allergies and how hospitals are now realizing this is a patient safety issue. 

4. Ask the Pharmacist if medications contain allergens.

Allergens hide in the strangest places! They are found in medications, injectables, inhalers, eye drops, ointments, etc. These are technically called excipients. Please double check with the pharmacy, asking if any of your food-allergic patient’s medications contain their allergens. Please remind all those who are prescribing medications about your patient’s food allergies.

5.  Ask your patient if they have an Allergy & Anaphylaxis Emergency Plan & a board-certified allergist.

An Allergy & Anaphylaxis Emergency Plan is similar to what nurses commonly call a standing order. It is a document signed by the patient’s allergist. An Allergy & Anaphylaxis Emergency Plan tells the patient exactly what to do if they accidentally eat or bite into something containing their allergen, or are experiencing signs of anaphylaxis. While discussing this topic, this is also an excellent time to review with your patient how to administer their epinephrine auto-injector.

If your patient doesn’t have a board-certified allergist managing their care, or if this is a new diagnosis, it’s time for a referral! Food allergy management is a specialty area of medicine. A board-certified allergist is the expert on this topic and needs to then co-manage with the pediatrician or primary care provider. Having an allergist can really help improve patient care and quality of life through ongoing education and support.

I hope these 5 tips help you provide the best care possible to your food allergic patients!

As we like to say in this food allergy life, “We’re not crazy. We’re Vigilant. Keep swimming!”

If you come across a patient who could use some extra support, please send them to FAACT, The Food Allergy & Anaphylaxis Connection Team and the FAACT-recognized Facebook support group I co-lead called, Friends Helping Friends Food Allergy Support Group.