Anthropological and sociological perspectives on food allergy

Pursuing a "normal" life of food: Families' experiences of pediatric food allergy clinical trials

Although food allergies have been on the rise over the past twenty years, there are currently just two products approved by the United States Food and Drug Administration (US FDA) for this condition, and one treats peanut allergy only. For families seeking medical intervention for their children's food allergies, many turn to clinical trials, which have proliferated in the last decade. Indeed, the entry of the pharmaceutical industry and the availability of clinical trials are rapidly reshaping the food allergy landscape. As a result, many families now perceive clinical trials as a way to "do something" other than merely avoiding the foods to which their children are allergic. Based on ethnographic research, including 124 semi-structured interviews with families and other key stakeholders, this article describes parents' and children's experiences in these clinical trials. It describes how the families that pursue clinical trials for their children's food allergies are typically affluent, and the "normal" life they hope to achieve for their children reflects idealized and privileged notions of normalcy. Analyzing my findings through the lens of stratified biomedicalization, I argue that affluent parents willingly accept a form of biomedicalization of their children that involves exceptional, and sometimes traumatic, clinical trial experiences as they pursue the elusive normal life and future they envision for them.

Integrating Patients Into Programmes to Address the Allergy Knowledge Practice Gap

There is a wide gap between the first publication of new treatments with efficacy and their successful application in clinical practice. In many respects, the management of allergic diseases is a good exemplar of the knowledge/practice gap. It was assumed that systematic reviews and publication of guidelines would ensure timely delivery of effective care, but this has not proved to be the case. While there are many reasons to explain shortcomings in healthcare delivery, the lack of patient and carer involvement in the planning of research, evidence review, guideline development and guideline implementation is most compelling. To achieve adherence to evidence-based guidelines consistently across all levels of the health service requires the implementation of integrated care with clear pathways through which patients can navigate. Quality improvement methodology could be employed to plan and implement integrated care pathways (ICPs). There is evidence that ICPs achieve improved outcomes for acute hospital-based interventions, but less work has focussed on long-term conditions where more diverse agencies are involved. At all stages, stakeholder representation from the full range of healthcare professionals, patients, their families, social services, education, local government and employers must be involved. In this article we review the step-wise and iterative process by which knowledge is implemented into practice to improve patient experience and outcomes We argue how this process can benefit from the involvement of patients and their carers as equal partners, and we discuss how different initiatives have involved patients with allergic diseases. There currently is a gap in evidence that links patient involvement to improved outcomes. We recommend the use of the Core Outcome Sets (COS) and Patient Reported Experience Measures (PREMS) which have been developed for allergic diseases to monitor the effects of implementation research and the impact of patient and carer involvement on outcomes.