Dealing with food allergies, chronic pain

Food allergies can represent a complicated area of diagnosis and treatment for internists. Research has shown a disconnect between patients' perception of allergy and its actual presence: In one study, 13% of adults reported a food allergy but only 3% had it confirmed with a food challenge. Conversely, some patients who do have a severe allergy may become less vigilant about avoiding their trigger foods as they grow older, leading to potentially serious health consequences. And internists whose patients report new food-related symptoms may find themselves trying to determine whether they're dealing with a true allergy, an intolerance, or something completely different. Charlotte Huff looks at recent guidelines on the subject from the National Institute of Allergy and Infectious Diseases and talks to experts about how internists can manage food allergies in their practices, including when and whether referral to an allergist is appropriate.

This issue also includes three stories on different aspects of medication use. First, Janet Colwell's story on treatment for chronic pain, a common and frustrating issue for internists, offers advice on how to start therapy, measure progress, and modify treatment when necessary. Second, learn more about handling patients' potential addiction to pain medication, including how best to monitor patients, how to recognize signs of addiction, and what to do if you feel a patient may have an addiction problem. Finally, read an article about two physicians whose algorithm can help physicians withdraw elderly people from unneeded medications by considering such factors as the evidence base supporting each drug, the potential benefit, and patients' life expectancies.

Our latest installment of Mindful Medicine, written by Jerome Groopman, FACP, and Pamela Hartzband, FACP, examines an interesting case of attribution error resulting from a positive stereotype. As Drs. Groopman and Hartzband explain, it's more likely for physicians to make assumptions about patients when they fit a negative stereotype, whereas in this case multiple experienced clinicians missed the cause of a patient's problem because he was doing everything “right.”

If you have a case to suggest for future Mindful Medicine columns, or comments on any other topic, please e-mail us. As always, we enjoy hearing from you.

Sincerely,

Jennifer Kearney-Strouse