7 Strategies to Communicate Anaphylaxis Risk in Pediatric Allergy Consultation

A new study provided insight into how clinicians can communicate anaphylaxis risk during pediatric allergy consultations.1

“Our ground-breaking analysis of video-recorded consultations between parents, children, and a pediatric allergy specialist reveals a set of sophisticated communicative practices used to discuss anaphylaxis risk and make decisions about adrenaline auto-injector prescriptions,” wrote study investigator Laura Jenkins, PhD, from the department of criminology, sociology and social Policy at Loughborough University in the United Kingdom, and colleagues.1 “We have explicated how the doctor’s diagnostic reasoning is unpacked for the patient, embedding risk-relevant factors and judgements. By doing so, a more nuanced and comprehensive picture of risk is presented to caregivers.”

The US Centers for Disease Control & Prevention (CDC) has reported a 50% increase in food allergies since the 1990s, affecting roughly 33 million Americans.2 In the UK, the estimated incidence of probable food allergy doubled between 2008 and 2018, with the British Society for Allergy & Clinical Immunology reporting that about 1 in 40 infants develop a peanut allergy.3,4

With few allergy specialty clinics in the UK, risk discussions often occur in visits with general practitioners in primary care or pediatricians in secondary care.1 These clinicians may lack the confidence or training to discuss adrenaline auto-injector use.

In this study, investigators sought to identify strategies for communicating risk and guiding decisions on prescribing adrenaline auto-injectors during pediatric allergy consultations.1 The team examined 23 video-recorded UK consultations involving children aged 2 – 10 years.

Investigators identified 7 communication practices to convey risk:

1. Risk categorization
2. Describing risk-relevant factors
3. Mitigating or intensifying risk factors
4. Non-vocal elements
5. Uncertainty formulations
6. Invoking caregiver anxiety
7. Assessing caregiver understanding

Risk Categorization

Clinicians should describe a patient’s risk by severity level: low, moderate, or high.

Describing Risk-Related Factors

During a consultation, a clinician should describe the risk by laying out concerns but also providing reassurances. Here, a clinician can communicate high-risk factors.

Mitigating or Intensifying Risk Factors

This may be using language such as “really,” “very,” “a bit more,” or “high.” This should be lexical descriptions that modify the risk severity.

Non-vocal Elements

Using hand gestures or following gaze patterns to emphasize or mitigate specific risk judgments. For instance, a clinician may use a hand circle motion while saying “putting all of those together,” gesturing steps, moving the hand, shuttling both hands repeatedly right and left, and gazing at the medical history.

Uncertainty Formulations

This strategy downgrades the strength of the assessment. This can be achieved by linguistic uncertainty markers, such as saying something incorrectly like, “I think that probly still puts her onto a kin’ve sort of low moderate in terms of severity fer now” or “somewhere between low and possibly moderate.”

Clinicians could also use this strategy by downplaying the medical evidence, saying something along the lines of, “The research in this area is not particularly high quality.” Clinicians can also describe medical history as uncertain, saying, “I would say that we have a question mark.”

Invoking Caregiver Anxiety

The next strategy is invoking caregivers with the fear of having or not having an EpiPen. This could be achieved by saying: “She’s not somebody… I would be particularly pushing for things like adrenaline, EpiPens, that kind of thing. Unless… it got to a point where your anxiety levels were so high that life was just…unbearable.”

Assessing Caregiver Understanding

The last approach is to monitor and check the patients’ understanding of the risk and provide explanations when appropriate. Clinicians should maintain a frequent gaze toward the caregiver, could check caregiver competency by asking them to confirm their level of education in science, could explicitly ask caregivers if they understand, and could describe an EpiPen: “[EpiPens] are a self-loaded...single dose adrenaline injection.”

“We noted parallels with a practice observed in primary care, wherein clinicians describe what they are seeing, feeling, or hearing as a related form of diagnostic reasoning,” investigators wrote. "Within pediatric allergy, the goal of this practice is not always to gatekeep treatment (as seen in primary care). Rather, rendering visible the diagnostic reasoning can furnish caregivers with knowledge around allergy risk factors and research quality, significantly, putting them on the same epistemic playing field and enabling participation in decision-making.”

References

1. Jenkins L, Potter J, Hepburn A, Macdougall C. Communicating anaphylaxis risk in pediatric allergy consultations: A conversation analytic study. Patient Educ Couns. Published online August 6, 2025. doi:10.1016/j.pec.2025.109284

2. Derman, C. Microbes, Medicine, Modern Life May Drive Food Allergy Rise, Experts Say. HCPLive. May 29, 2025. https://www.hcplive.com/view/microbes-medicine-modern-life-may-drive-food-allergy-rise-experts-say. Accessed August 25, 2025.

3. Turner PJ, Baseggio Conrado A, Kallis C, et al. Time trends in the epidemiology of food allergy in England: an observational analysis of Clinical Practice Research Datalink data. Lancet Public Health. 2024;9(9):e664-e673. doi:10.1016/S2468-2667(24)00163-4

4. Statistics and Figures: Allergy Prevalence: Useful Facts and Figures. Allergy UK. https://www.allergyuk.org/about-allergy/statistics-and-figures/. Accessed August 25, 2025.