AAAAI & JACI: In Practice Publish First Known Study on Food Allergies and Nannies

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Nannies have “good grasp” of basic food allergies but some misconceptions are dangerous

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Food allergies affect approximately 15 million people in the United States, including 1 in 13 children, but are all child caregivers knowledgeable and well prepared for a food allergy event?

A study recently published in the Journal of Allergy and Clinical Immunology: In Practice (JACI: In Practice) fills in the gaps of knowledge in the nanny population with regard to food allergy in children.

“Ultimately, this study should inspire increased dialogue among nannies, families and physicians so the best care possible is provided for children, especially those at risk for severe food allergic reactions,” author Justin C. Greiwe, MD, explains in the paper.

While numerous studies have been published that measure food allergy knowledge in restaurant personnel, daycare centers and school nurses, this is the first known study with regards to nannies. This is especially important because the in-home environment can be unstructured and exempt from the medical-legal requirements placed on sanctioned restaurants, day care centers and schools. While nannies are often responsible for preparing most meals for children in their care, they may not receive any formal food allergy training.

For this study, Greiwe and his team of researchers sent an anonymous questionnaire to six nanny organizations and received 153 individual responses. “Although the nannies who took the survey had a good grasp of basic food allergy concepts and answered the majority of questions correctly, the percentages of nannies who answered incorrectly were high enough to merit concern, given the potential for inducing or incorrectly treating an allergic reaction. The combination of confidence with incomplete or incorrect knowledge could be dangerous because nannies may have a false sense of security when preparing a meal.”

Some of the data was very optimistic: 99% recognized food allergy as a potentially fatal event; 96% recognized that delaying the administration of epinephrine increases the risk of a fatal reaction; 66% desired additional information about recognizing food allergies; 71% agreed that food allergy training should be required for all nannies; almost all of the nannies thought that parents were reasonable with regard to their request to follow allergy precautions.

However, some very dangerous concerns and misconceptions persisted: 36% were uncomfortable with recognizing a food allergy emergency; 46% were uncomfortable administering epinephrine; 6% thought that a sensitized child could safely eat a small amount of allergenic food; 14% believed that dilution with water might reduce an allergic reaction.

“We found a small but significant number of nannies who adhered to potentially dangerous misconceptions about the prevention and treatment of food allergy, including the idea that removing allergens from finished meals is acceptable and that provided water can help suppress an allergic reaction,” another author, Brian Schroer, MD, said in the paper.

More information on anaphylaxis and food allergies is available at the AAAAI website. The full study can be accessed through the JACI: In Practice, DOI:

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 6,800 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.


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Melissa Graham
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