Morawetz Deborah Y, Hiscock Harriet, Allen Katrina J, Davies Sarah, Danchin Margie H
Centre for Community Child Health, The Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2014 Jun;50(6):432-7. doi: 10.1111/jpc.12498. Epub 2014 Feb 26.
The prevalence of Immunoglobulin E (IgE)-mediated food allergy in the developed world is increasing, overwhelming tertiary allergy services. Alternative models of care are required. General paediatricians could provide this care but may require further training to do so. We aimed to determine Australian general paediatricians': (i) knowledge and management of IgE-mediated food allergy; (ii) access to and use of diagnostic services; and (iii) interest in further training.
Members of the Australian Paediatric Research Network completed an online survey in 2011/12. A case study elicited paediatrician's knowledge of diagnostic history taking, testing and key management principles. Study-designed questions assessed paediatricians' current practice, access to allergy services and interest in further training.
One hundred sixty-eight (43%) of 390 paediatricians responded; 93 paediatricians reported managing food allergy. Diagnostic and management practices varied widely. Paediatricians had high levels of agreement (>90%) for only three of 13 questions pertaining to diagnosis and management. Only 56 (61%) correctly identified that a diagnosis of IgE-mediated food allergy requires a history consistent with a clinical reaction and a positive specific serum IgE antibody or skin prick test result. Reported waiting times for tertiary allergy services ranged from 5.4 (private) to 10.6 months (public). Most (91%) paediatricians expressed interest in further training.
General paediatricians would benefit from further training if they are to practice allergy care as their diagnosis and management is often inconsistent with international guidelines. Training could be delivered online to maximise reach and uptake. If effective, such a model could relieve some of the burden experienced by Australian tertiary allergy services.
在发达国家，免疫球蛋白E（IgE）介导的食物过敏患病率正在上升，使三级过敏服务不堪重负。需要替代护理模式。普通儿科医生可以提供这种护理，但可能需要进一步培训才能做到。我们旨在确定澳大利亚普通儿科医生：（i）对IgE介导的食物过敏的知识和管理；（ii）诊断服务的获取和使用；以及（iii）对进一步培训的兴趣。
澳大利亚儿科研究网络的成员在2011/12年完成了一项在线调查。一个案例研究引出了儿科医生对诊断病史采集、检测和关键管理原则的了解。研究设计的问题评估了儿科医生的当前实践、过敏服务的获取情况以及对进一步培训的兴趣。
390名儿科医生中有168名（43%）做出了回应；93名儿科医生报告管理食物过敏。诊断和管理实践差异很大。在与诊断和管理相关的13个问题中，儿科医生只有3个问题的认可度较高（>90%）。只有56名（61%）正确识别出IgE介导的食物过敏诊断需要与临床反应一致的病史以及阳性的特异性血清IgE抗体或皮肤点刺试验结果。报告的三级过敏服务等待时间从5.4个月（私立）到10.6个月（公立）不等。大多数（91%）儿科医生表示有兴趣接受进一步培训。
如果普通儿科医生要从事过敏护理工作，他们将从进一步培训中受益，因为他们的诊断和管理往往与国际指南不一致。培训可以在线提供，以最大限度地扩大覆盖范围和接受度。如果有效，这种模式可以减轻澳大利亚三级过敏服务所承受的一些负担。
