Source: UNIVERSITY OF CALIFORNIA, DAVIS submitted to
MULTIFACETED FOOD ALLERGY EDUCATION PROGRAM
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
TERMINATED
Funding Source
Reporting Frequency
Annual
Accession No.
0197267
Grant No.
2003-51110-01728
Project No.
CA-D*-FST-7216-CG
Proposal No.
2003-04253
Multistate No.
(N/A)
Program Code
111.C
Project Start Date
Sep 15, 2003
Project End Date
Sep 14, 2008
Grant Year
2003
Project Director
Bruhn, C. M.
Recipient Organization
UNIVERSITY OF CALIFORNIA, DAVIS
410 MRAK HALL
DAVIS,CA 95616-8671
Performing Department
FOOD SCIENCE AND TECHNOLOGY
Non Technical Summary
Severe food allergies impact the health of nearly 7 million Americans, whom must avoid exposure when selecting food for home and the food service environments. This project will enhance the ability of the consumer, restaurant industry, and physicians in preventing life threatening food allergies.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
5046010106010%
5046010303090%
Goals / Objectives
Patients/Consumers: Specific Aim1. Increase understanding of the attitudes and behavior of adults and adolescents with severe food allergies. Specific Aim 2. Modify or supplement educational materials in collaboration with FAAN and deliver material to meet the needs identified in Aim 1. Evaluate the effectiveness of the educational material. Physicians/Health Care Providers: Specific Aim 3. Identify needs in physicians' abilities to advise adults and adolescents with severe food allergies. Specific Aim 4. Develop and deliver material for physicians on identifying food allergies, advising patients how to select foods in the home and food service environment, and advising patients on emergency preparedness. Evaluate satisfaction with the material. Identify strategy to increase reporting incidence of severe food allergies Restaurant/Food Service Industry: Specific Aim 5. Deliver and evaluate food allergy training for food service workers on handling food for customers with allergies.
Project Methods
CONSUMER EDUCATION: Will recruit 100 adults and adolescents in CA and NY (200 total) with severe allergies, conduct individual face-to-face interviews, and identify attitude/behavior patterns associated with appropriate/inadequate compliance with recommended practices. Give all participants at the Year 1 interview a current handout on food allergy (Fact Sheet: Food Allergy and Intolerances) and referral service listing (Am. Acad. Allergy, Asthma and Immunology Find-a-doc, Food Allergy and Anaphylaxis Network (FAAN)). Information on barriers to recommended behavior, materials will be modified or new material developed in collaboration with FAAN and deliver in Year 2 to the 100 patients previously interviewed extensively and to a new group of 30 patients who at baseline do not carry self-injectable epinephrine. Effectiveness of educational material, and factors correlated with greater adherence, will be assessed by determining the extent of adherence to allergy avoidance and preparedness measures after delivery of educational material at a follow-up interview in Year 3. ENHANCE THE PHYSICIANS' ABILITIES TO ADVISE ADULTS AND ADOLESCENTS WITH SEVERE FOOD ALLERGIES: Review materials currently available to assist patents in managing food allergies. Note areas where additional guidance is needed. Consult with other physicians regarding their perceptions of patient needs. Identify needs in physicians' abilities to advise adults and adolescents with severe food allergies. Accomplish via review of available material, discussions with collaborators in the FDA/CFSAN, and discussions with primary care and emergency medicine providers. Modify existing or design new educational materials for physicians. Material will be presented to the physician groups and the satisfaction of the physicians will be assessed. A newsletter for national distribution may be formulated, depending on needs assessment. Plan to develop mechanisms to enhance surveillance of food allergy associated anaphylaxis and death. DELIVER AND EVALUATE FOOD ALLERGY TRAINING FOR FOOD SERVICE WORKERS: Coop. Ext. Advisors will expand food service classes in safe food handling to include the Natl. Restaurant Assoc. (NRA)/FAAN unit on food allergies. Advisors will explore restaurants' interest in publicly posting their training in food allergies. Restaurants will keep tally sheets of allergy-related requests from customers and how restaurant responded (check-list will be prepared to keep track of this activity). Scope of the menu, and type and size of restaurants receiving allergy training will be recorded for future analysis. To assess effectiveness of the materials, restaurants that received allergy training will be contacted at 4 mo. intervals (frequency needed in order to anticipate significant turnover of restaurant staff and need for refresher education). Through personal interview with the mgr./food safety officer, we will assess their knowledge of food allergy, including issues of cross-contamination, reading labels and their satisfaction with the allergy training. Will review the restaurant allergy tally sheet and inquire as to their comfort in serving a person with allergies.

Progress 09/15/03 to 09/14/08

Outputs
OUTPUTS: In person interviews with allergic persons indicated that their challenges managing their food allergy included insufficient information from physicians and accidental exposure to allergens when eating out. An educational booklet responding to the questions identified in the interviews was developed and evaluated by allergic individuals. This information has been distributed to study participants and to the Food Allergy and Anaphylaxis Network. Further, the booklet is being distributed without charge to physicians through professional meetings. Posters describing research findings have been presented at the Institute of Food Technologists and the International Associating for Food Protection meetings. Two manuscripts describing the combined data from New York and California are under development. One paper will be submitted to a food science journal and the other to a nutrition education journal. A third manuscript describing development of the educational booklet will be submitted to a food science education journal. Interviews with physicians indicated many sought additional information as to how to effectively meet patient needs. An educational program that addressed this need was developed and evaluated. The program will be available for continuing medical education units through UC Davis School of Medicine. A manuscript describing the program and its evaluation was published in a medical journal. PARTICIPANTS: Physicians Suzanne Teuber (UC Davis) and Scott Scherer (Mt Sinai) lead the needs assessment for physicians and developed and evaluated the physician educational material in collaboration with medical fellows Yu and Kumar. Two graduate students in California and one in New York were trained in consumer research methods and completed data collection and analysis. Robert Gravani, Bruhn's collaborator from Cornell, supervised data collection and analysis in New York. The Food Allergy and Anaphylaxis Network provided guidance on allergic person's needs and evaluated the consumer educational booklet. The International Food Information Council also provided guidance and facilitated communication. Representatives from the US Food and Drug Administration the National Restaurant Association, and the American School Nutrition Association evaluated the consumer educational material. TARGET AUDIENCES: Physicians who care for allergic persons were targeted in needs assessment and evaluation of the physician educational program. Persons with life threatening food allergies were the focus of the consumer oriented portions of the project. PROJECT MODIFICATIONS: The food service educational component of this project was not successful. Although food service representatives were pleased to learn about food allergies as part of general food safety training, they declined to keep records of the impact of this training on their restaurant operation. Fever than 10 restaurant managers volunteered to post and complete a simple form that required checking a box to indicate if a food allergic person visited the facility. Those that volunteer admitted that they did not keep tract of all requests for allergen free meals. Because records were incomplete and few were willing to evaluate the food allergy training, we discontinued this portion of the project.

Impacts
Persons with food allergies evaluated the educational packet as useful. The majority, 93%, reported that the booklet was very clear and easy to read. Participants commented that the simple illustrations were ideal for a child with allergies or someone reading at a 6th-8th grade level. Even among this group with longstanding food allergy, over 60% reported that they learned something new from the packet. Physicians in New York evaluated the educational slide set. Pre-post knowledge base scores increased from a mean of 38% correct to 64% correct (p<0.001). Ability to correctly demonstrate the use of epinephrine self injectors increased significantly. Nearly all participants (>95%) indicated that the teaching module increased their comfort with recognition and management of food allergy. Publication in the professional literature, making continuing educational units available without charge, and discussing both the physician educational slide set and the patient material at physician conferences will increase the distribution of the material.

Publications

  • Development of a Food Allergy Education Resource for Primary Care Physicians. 2008. Yu,JE, Kumar,A, Bruhn,CM, Teuber,SS, Sicherer. BMC Medical Education 8:45-52.
  • Coping with Food Allergies. 2008 Olson, BF, Bruhn, CM, Teuber, SS. University of California, Davis.
  • Coping with Food Allergies: Improving Methods of Communication of Food Allergy Information to Patients and the Lay Public. 2008. Olson, BF. Masters of Science Degree in Food Science. University of Califonria, Davis. (Thesis)
  • Phillipo, L. J. 2006. The Impact of Education on the Consumer's Ability to Manage Life-Threatening Food Allergies. Masters of Science Degree in Food Science. University of California, Davis. (Thesis)


Progress 01/01/07 to 12/31/07

Outputs
A total of 67 volunteers are enrolled in this project. The primary focus of this time period has been to review the educational packet designed to address consumer food allergy information needs. A packet was developed based upon a review of the professional literature and in response to consumer's needs. Abstracts describing project procedure and the content of the packet were presented at the Institute of Food Technologists and the International Association for Food Protection annual meeting in June 2007. Persons who had initially volunteered were sent a packet as promised. Packets were mailed in groups of 10, then follow-up telephone conversations were scheduled for those willing to provide feedback. To date 58 individuals have been mailed the packet, 18 have provided comments, none have refused to participate, 21 have not returned the phone call, one person changed phone numbers and can not be reached, 18 have just received the packet and will be contacted to schedule an interview after the holidays. The packet is revised as appropriate after each set of mailings. An educational program for physicians has been developed and evaluated. A manuscript describing the impact of the educational program is in preparation.

Impacts
The number of persons with life threatening food allergies appears to be growing. This project has identified the educational needs for adults with this condition. An educational packet addressing these needs has been prepared and is under evaluation. This information will help persons with this condition better manage their condition. Further, physicians have expressed a need for more information as to how to assist patients with life-threatening food allergies. An educational program that effectively responds to this need has been developed. We plan to make both the patient and physician educational material available without charge.

Publications

  • B.F. Olson, S.S. Teuber, and C.M. Bruhn, Development and evaluation of an educational bulletin for consumers facing life-threatening food allergies. International Association for Food Protection. Florida, Book of Abstracts, 2007.
  • B.F. Olson, S.S. Teuber, and C.M. Bruhn, Constructing a more inclusive informational packet for consumers facing life-threatening food allergies. Institute of Food Technologists. Chicago. Abstract. 2007.
  • L. Phillipo. MS Thesis. Department of Food Science and Technology. University of California, Davis. 2007.


Progress 01/01/06 to 12/31/06

Outputs
Subjects with allergies: Interviews were completed with a total of 65 persons. The majority of subjects reported receiving little information on how to manage their food allergies. Two abstracts were submitted to a medical meeting and one to the Institute of Food Technologists meeting. Physician contacts: Dr. Teuber has completed initial interviews with several physicians. An educational module in slide format was developed by Dr. Sicherer at Mt. Sinai. Food service: Recruiting restaurants for participation continues to be difficulty. The restaurant managers do not want to keep tract of requests for allergen-free meals. This portion of the project will be discontinued by California and pursued only in New York.

Impacts
We anticipate that this project will improve the ability of physicians to assist patients with life-threatening food allergies. Additionally we will design and validate an informational packet for patients that addresses the needs they have articulated.

Publications

  • J. S. W. Kong, L.A.D. Haapanen, L. Phillipo, C.M. Bruhn, S.S. Teuber. 2006. Physician advice and action plans in severe food allergy American Academy of Allergy, Asthma and Immunology 2006, Miami Beach, FL.
  • J. S. W. Kong, L.A.D. Haapanen, L. Phillipo, C.M. Bruhn, S.S. Teuber. 2006. Food Allergy Education for Non-Allergist Physicians: A Needs Assessment Survey. American Academy of Allergy Asthma and Immunology, Miami Beach, FL.
  • L.J. Phillipo, L.D. Haapanen, J.S.W. Kong, S.S. Teuber, and C.M. Bruhn. 2006. The impact of education on the consumer's ability to manage life-threatening food allergies. Institute of Food Technologists. Orlando, FL.


Progress 01/01/05 to 12/31/05

Outputs
This project involves research and/or education for three groups, people with allergies, physicians, and food service operators. Subjects with allergies: Interview are completed with 44 volunteers and additional 20 scheduled in January and February. We will recruit additional subjects through a newspaper advertisement in the Sacramento Bee and Davis Enterprise. Physician contacts: Dr. Teuber has conducted informal interviews with over 40 physicians. Food service: Several restaurants have agreed to training but wish to postpone their commitment until January 2006 to avoid the holiday period.

Impacts
We anticipate that this project will improve the ability of physicians to assist patients with life-threatening food allergies, patients to manage their allergies, and restaurants to safety serve foods to sensitive persons. Additionally we plan to design a means for more accurate reporting of severe food allergies

Publications

  • Physician advice and action plans in severe food allergy. J. S. W. Kong, L.A.D. Haapanen, L. Phillipo, C.M. Bruhn, S.S. Teuber, Division of Rheumatology, Allergy, and Clinical Immunology, Department of Internal Medicine, University of California at Davis. American Academy of Allergy, Asthma and Immunology 2006.
  • The impact of education on the consumer's ability to manage life-threatening food allergies. L.J. Phillipo, L.D. Haapanen, J.S.W. Kong, S.S. Teuber, and C.M. Bruhn, Dept. of Food Science and Technology, University of California, Davis, CA 95616. Institute of Food Technologists. 2006.


Progress 01/01/04 to 12/31/04

Outputs
Approval for all interview procedures was received from The University of California Human Subjects Committee. Funding for the project was received in the spring. This project involves research and/or education for three groups, people with allergies, physicians, and food service operators. Subjects with allergies: Interview sites were identified and letters requesting participation were mailed to 40 subjects. After funding was received, one interview was conducted. The questionnaire was revised to shorten the interview time so the subject would not be overburdened. This revision is under review by the IRB committee. Physician contacts: Dr. Teuber has conducted informal interviews with several physicians and has discussed the project while lecturing in the medical school. The physician interview questions and format are being revised to more smoothly obtain the required information. Further the interview is designed to complement the research being conducted by our collaborators in FDA. Food service: The appropriate educational material has been received and is being reviewed. Restaurant training will be scheduled in 2005.

Impacts
We anticipate that this project will improve the ability of physicians to assist patients with life-threatening food allergies, patients to manage their allergies, and restaurants to safety serve foods to sensitive persons. Additionally we plan to design a means for more accurate reporting of severe food allergies

Publications

  • No publications reported this period


Progress 01/01/03 to 12/31/03

Outputs
PI's Bruhn and Teuber developed draft questions for patients, physicians, and food service personnel. Bruhn and Teuber met with Elieen Parish and her committee at FDA to review procedures and areas of inquiry. The University of California Human Subjects Committee has reviewed all materials and requested clarification in some areas. We are awaiting their final approval before funding can be received and the project initiated.

Impacts
We anticipate that this project will improve the ability of physicians to assist patients with life-threatening food allergies, patients to manage their allergies, and restaurants to safety serve foods to sensitive persons. Additionally we plan to design a means for more accurate reporting of severe food allergies.

Publications

  • No publications reported this period