The Practical Management of Cow's Milk Allergy - Minority groups & food insecurity

[outro music] So Kiran, thank you for joining us today.

We're just gonna jump straight in.

So in your article, you explored the research in this area.

So in practice, what would you say are the challenges to managing cow's milk protein allergy in minority groups?

It really depends on the individual in front of you and not the fixed identity that's assigned to them by society.

And a quote that really resonated with me, which was one, um, I came across in a paper about South Asian parents managing food allergy, but really applies to any group, is that when we look at people from different ethnic minority groups, they're not a homogenous group, and factors such as social class, dietary practices, religion, and migration history are really important.

And whether parents speak English, whether they're first, second, third generation migrants or have sufficient health literacy are also some of the important things to understand, which I wrote about in my article.

And for dieticians, it's actually really important to remember it's more than just knowing about the dietary customs that belong to each ethnic minority group.

If we start to think about some of the structural barriers of the consultation, um, language barrier can be a challenge.

So if you think about cow's milk protein allergy and the management of it, it's a lot of complex information that you have to convey.

So you know, you're talking about protein reactivity, hydrolysis, how to use a progressive milk ladder, and that's a lot of information to communicate in a s- short space of time with an interpreter.

And in my own experience, having worked in a few different NHS trusts, I've had to do that in really short consultation times because services are stretched, and we don't have the luxury of longer appointments, and unfortunately it does affect the quality of the consultation.

Um, and then when I've had the privilege of longer consultations, there is an opportunity to ask the parent to repeat what they've understood and explore those concerns and barriers with the interpreter.

And my experience is echoed in an NIHR-funded study of 30 healthcare professionals in the UK who are managing food allergy in British South Asian parents.

This was the fair study, and they described feeling constrained by consultation time, reporting from as little as five to 20 minutes.

So if you think about the role of the interpreter, they are repeating everything you say, everything the patient says, and it really should necessitate a double consultation time.

And if we're not advocating for that in our services, it's no surprise patients from ethnic minority groups are worse off, as I described in my article.

In reality, um, how many people have access to an interpreter or know how to get access to an interpreter?

Yeah.

That's quite difficult to come across in the literature.

And even if we did have the numbers, I think it wouldn't reflect a true need because there is a bit of a stigma around asking for help and support with English.

Um, in the fair study that I mentioned, they did touch on interpreter quality, and the clinicians reported that interpreters were omitting key information and not fully translating.

Now, one of the clinicians, um, who partially understood the patient's language could hear that the translation was incomplete, and that's really worrying because it's a matter of safety, especially in patients with cow's milk allergy or any food allergy.

So do you...

Sorry, just to interrupt there.