Guest Lecture by Michael Pistiner MD, MMSc: Opportunities and
Challenges Presented by Food Allergies
1. Introduction: Dr. Pistiner works with pediatric allergies, among other areas
of health and medicine
a. Unfortunately, there are food allergy related deaths that occur.
Education and appropriate mgmt. of kids with food allergies saves
lives.
b. Most deaths this year were from families with breakdowns in food
allergy management that didn’t realize how severe an allergic reaction
could be, and had they known, they would have implemented more of
the management information they knew.
2. Hoping to bring health to our patients (Slides 3-5)
a. Health: state of complete physical, mental and social well-being, not
just the absence of disease- WHO
b. Preventable mortality in US: we’re only hitting about 10% of
information related to prevention in what physicians focus on in
clinics.
c. Majority of issues will come from different determinants of health
such as behavior, genetic predisposition, etc. Physicians are missing
the majority and bulk of the icebergs: doctors are only hitting the tip.
d. Doctors need to encourage disease prevention and health promotion.
e. Hard to tackle all these issues in addition to physician duties in a
clinical appointment.
3. Managing allergies gets harder because various issues play a huge role,
asking people to change major aspects of their lives, such as completely
changing their homes and habits.
4. Food Allergy Mgmt. (Slides 6-7)
a. Prevention:
i. Avoid: Avoiding coming in contact with the allergen containing
food, and protecting from cross contact exposure, etc.
ii. Teach/ Communicate: Feeling confident enough to
communicate with people appropriately about how to keep
children with allergies safe
b. Emergency Preparedness:
i. Recognize Anaphylaxis: being prepared for allergic reactions:
about 50% of kids 15 months to three years with food allergies
have what’s classified as a severe reaction every three years.
ii. Epinephrine: People need to know how to recognize an allergic
reaction, and how to give epinephrine.
iii. Activate an emergency response: knowing when and how to
activate an emergency response.
5. Community (Slide 8)
a.
Parents need an entire community for effective food allergy
management, including babysitters, relatives, schools, etc.
b. Parents are the primary educators, who transfer information to the
secondary caretakers.
c. There is a massive unmet need for education for parents and
secondary caretakers.
d. Many families don’t have the resources or time to learn and master
allergy management.
6. Who provides the community with food allergy education? (Slides 9-13)
a. Food allergy teaching tools are hard to come by and often at a higher
reading levels than majority of community.
b. Primary caregivers:
i. Information provision from health care providers is also
lacking: not enough time in average clinical visit.
ii. At the time of diagnosis there’s a huge amount of information
needed, as well as follow up and during the development of the
child.
iii. Information needed is always changing
iv. Parents need a way to refresh their own skills and teach
others how to recognize anaphylaxis and to avoid
allergens
v. Inadequate education resources
c. Core informational needs are how to educate secondary caretakers,
how to avoid allergens and how to administer auto-injectors.
7. Health Care providers:
a. Proper training is also lacking
b. 24% of physicians leave their patients to their own defenses, leaving
them to figure out avoidance of allergies.
8. Major Goal: to meet this unmet need
9. AllergyHome (Slide 15)
a. Solution: Provide accurate, succinct easy to access educational
videos/material that can be a resource at all points of the
information chain
10. Benefits of Multimedia Food Allergy Mgmt. education (Slide 16)
a. Accessible teaching tools
b. Increased awareness
c. Standardization of information to all caregivers
d. Provides a teaching aid that families can refer to as a refresher
11. Strengths of Multimedia Education Aids
a. Standardization of education, and you can use different medias: audio
visual, etc for different education levels and learning styles
b. People can look at the information as many times as necessary, at
their convenience
12. Discussion/Questions
a. Are kids using the app?
b.
c.
d.
e.
f.
i. It’s not an app yet: we have video modules for diff audiences.
We have a module created for kids without food allergies to
learn how to take care of their friends, as well as for parents to
learn how to use the audio injector. Our population is different,
and our training material is for specific audiences. We’ve had
similar but slightly different content for school nurses to train
their staff, for parents, for camp counselors, for parents of kids
without allergies, etc.
Where would you see an app fitting in, and in a way that it is beneficial
for everyone involved?
i. The time to educate would be maximized if there were an app
or tool that the family could use. It could also be reinforced to
be used outside the office, when they go home. I would
envision information on how to read a label, how to give an
auto-injector, and that core can be used to teach the babysitter,
or anyone important in the care of the child.
Why is the perceived severity of these allergic reactions so low for
parents?
i. The majority of allergic reactions that happen are mild. The
majority of severe reactions don’t end in fatality. Behavior
plays a big role.
Where would the app fit into a checkup?
i. The info families are going to need is broad and vast. It takes
more than an hour to explain. You’re teaching them what you
would teach them if you had unlimited time. By explaining the
app to them you’re patterning them to use it to teach others.
You get to show people how to use what you’re using on them.
Would people be skeptical or cynical about the app or would they
embrace it?
i. Particular types who would react certain ways. Any app
replacing a health care provider would be met with skepticism.
I think it’s about communicating. Perhaps whoever presented
the app, typically we don’t have the chance to target material
like this, this is something people would normally get a
handout for, but we have to use this to train people, and ask
them to let us know what they think. Perhaps it’s just the way
you sell it.
How can taking a history be done outside of the appointment, either at
home or in the waiting room, to use appointment time for reviewing it
and for patient care?
i. I think if folks at home filled out a history sheet, if they fill out
some questions the doctor might want to know. The doctor will
have planted the questions they want to know with the family.
That’s a way a history inventory app can help doctors, to help
them and give them more time to ask more directed and
important history questions.
g. Parents today are involved technologically with each other: do you
think there could be an app to allow parents to share the health
information ahead of time?
i. Certain information like allergies and weight etc how and
when to use an auto injector, I believe there are some apps that
exist now by the auto-injector company, and I don’t know if
there is currently an allergy action plan app available. But
educating the caretakers involved is really important.
h. What is most important to get face time with in an appointment?
i. Diagnosing and testing for a specific allergy takes up most of
the face time with a physician; the education component is
sometimes completely lacking. What is missing is getting
behind the behavioral and social issues.
i. Social dynamics of discovering you have a food allergy. Clearly your
time with patient and resources are limited, but what behavioral
aspects could the app cover?
i. Increasing the awareness of people in the surrounding
community, thereby making it less awkward when you’re
dropping your kid off with secondary caretakers. It seems that
basic understanding, for instance the kid video we’ve done, we
hope that kids will know having an allergy is not a reason to
bully somebody. Hopefully by having easy access to
information it can take away some of the confusion
surrounding children’s food allergies
j. Price accessibility?
i. I would assume that $1 would be reasonable for this app. In a
perfect world I’m all about free resources for the family.
My Favorite App
1. Endomondo Sports Tracker
a. Used for running, cycling, etc. Includes GPS system that logs into a
website where you can keep track of all that you do.
b. There are “challenges” created by the app that allow people to sign up
and challenge themselves.
c. Social network feature where friends can engage with each other
2. DNA Info.com
a. Possibly idea for act: integrating different (free) exercise/outdoor
activities taking place in different neighborhoods is a great idea
3. Catch the Bus
a. Health aspect: improves daily mental and physical well-being,
protecting from inclement weather and the stress of missing buses
and having to navigate transportation on the fly.
b. Ideas: a feature that suggests how you could do more
walking/physical activity during your commute
i. Offering health facts while you’re waiting for you bus
ii. Highlighting upcoming bike paths, or linking bus routes to
those paths/ nearby hubways
4. My FitnessPal
a. Allows person to track what they eat and their exercise
b. Ideas: it would be handy to be able to just scan a barcode instead of
typing in lots of text
5. Nike Training Club
a. Simple pre-programmed circuits that can be done anywhere
b. Reward system motivates
c. Syncing to music library a plus
d. Ideas: random reinforcement works well