The Need for a Food Allergies Field in Electronic Health Records

Jan Greer-Carney, MS, MBA, RD, LD

This week I saw a disoriented patient, let’s call him Jack, who told me he was “allergic to lactose.” He usually followed a vegan diet. Jack was a notably poor historian, but was able to tell me that lactose “caused his throat to close.” I probed him about whether he was allergic to milk. He insisted he was only allergic to lactose.

Jack was a patient a few months earlier, so I had the benefit of his past medical record. I found that his admitting provider had placed him on a “regular vegan diet” and recorded “no known allergies.” Jack was eating poorly prior to admission and had lost more than 10% of his usual weight since his last admission. He continued to have poor intake in the hospital. I needed to find a lactose-free supplement for Jack. I decided on our fruit-flavored liquid supplement, which I confirmed was lactose free.

Jack had taken only a few sips of the supplement when he began to experience his “throat closing.” He immediately was treated for his allergic reaction. The product contained a whey isolate. Jack, in fact, had a milk protein allergy.

I decided to see if I could find any evidence of a milk allergy documented in Jack’s medical records. Sure enough, in Jack’s record from his primary care provider’s office, milk was listed as an allergy, with his symptoms identified. Unfortunately, food allergies are not set up to follow the patient. If this information was a required field in the electronic health record (EHR), it would have followed Jack to the hospital!

I went back to see Jack to tell him to always make sure he listed milk as an allergy with a serious reaction when he is seeking medical attention. Jack then told me he thought milk and lactose were the same thing. He had heard a lot about lactose intolerance on the television. He said he does not drink milk because he is a vegan, so he does not encounter it in his daily life.

Jack is not unlike many of our patients. He unintentionally provided inaccurate and incomplete information. However, if food allergies were a part of his EHR, Jack’s allergy and reaction would have followed Jack with a prominent display in his EHR. This would have prevented this reaction. A required field for food allergies will help patients like Jack avoid unnecessary food allergy reactions!