title: Management of food allergy: a survey of Australian paediatricians.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Community Child Health, The Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Deborah Y
authors.initials: DY
authors.lastname: Morawetz
authors.forename: Harriet
authors.initials: H
authors.lastname: Hiscock
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Allen
authors.forename: Sarah
authors.initials: S
authors.lastname: Davies
authors.forename: Margie H
authors.initials: MH
authors.lastname: Danchin
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D004032:Diet; D019468:Disease Management; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D020407:Internet; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D011787:Quality of Health Care; D012882:Skin Tests; D011795:Surveys and Questionnaires
chemical_list: D007073:Immunoglobulin E
keywords: food allergy; paediatrician; survey