Food Restrictions in Allergists Waiting Room?
Q: My 5-year-old daughter is allergic to wheat, egg and peanut. At my allergist's office, others are allowed to eat in the waiting room, without restrictions. My concern is that the food could get on the chairs or in the carpet and she could have a life-threatening reaction as a result. What are the risks to her, and how can I best address my concerns with her allergist?
A: Two issues exist here: 1) medical and 2) perceptual. Medically there is minimal risk to food allergic patients from casual exposure to foods as would happen if someone were eating in the waiting room. Contact with food-covered chairs and airborne food allergen does not cause a life-threatening reaction. Such exposure is part of daily life, so there is no completely avoiding it. A food has to be ingested to cause such a severe reaction. To that end, we would discourage food sharing.
The general perception is that casual food exposure does pose a risk. For that reason, many offices do ban eating in the waiting room. After all, we don't permit cats to wander the halls, nor do we grow ragweed in the planters, so why permit food? The answer is that food is not an aeroallergen/airborne, so these are not causing the same level of risk. Allergic patients do expect an allergy office to be a safe haven from allergies, regardless of whether it is medically necessary.
A bigger concern is the anxiety created regarding the hazards of exposure to certain foods. This anxiety can lead to psychological trauma to the child, and to problems when parents insist that schools ban certain foods, children sit at food-free tables and so on. The best way to know the risk level to your child is to have a "proximity challenge" done at the time of diagnosis. This can reduce anxiety and allow you to see the exact dangers posed by exposure to food - both to the food by air, and also by applying a small amount on the skin. Such testing is best done in an allergist's office. For those who feel uncomfortable with such testing, the allergist can also offer to have your child taken directly to an examination room on arrival so they don't have to sit in a waiting room where food is being consumed.
Bottom line: it is easy to ban all eating. It is much harder to address the underlying anxiety that leads to the concern. The best outcome for all is to deal with that directly, by doing appropriate testing in an allergist's office.