ArticleFrontiers in allergy2026
Food ladder use among ASCIA-affiliated clinicians in Australia and New Zealand: an exploratory descriptive survey.
Article in Frontiers in allergy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Food ladders are clinician-guided graded dietary advancement tools used in selected patients with food allergy, but real-world implementation in Australia and New Zealand is not well described. Objective: To characterise respondent-reported food ladder use and implementation patterns among ASCIA-affiliated clinicians in Australia and New Zealand. Method: We conducted a cross-sectional online survey of ASCIA-affiliated healthcare professionals from 1 to 30 June 2024. Invitations were distributed via the ASCIA email distribution list. Analyses were descriptive, with percentages calculated using valid-response denominators. Results: Seventy clinicians participated: Australia 45/70 (64.3%) and New Zealand 25/70 (35.7%). Disciplines included allergy/immunology specialists (29/70, 41.4%), general paediatricians (13/70, 18.6%), nurses/nurse practitioners (10/70, 14.3%), dietitians (10/70, 14.3%), trainee doctors (7/70, 10.0%), and one general practitioner (1/70, 1.4%). Most primarily saw paediatric patients (53/70, 75.7%). Food ladder use was commonly reported among respondents (66/70, 94.3%). Among ladder users, most reported use in both IgE- and non-IgE-mediated contexts (47/66, 71.2%); milk (65/66, 98.5%) and egg (64/66, 97.0%) ladders predominated. Standardised ladders, recipes, and home introduction protocols were reported by 43/66 (65.2%), 43/66 (65.2%), and 45/66 (68.2%) respondents, respectively. Prior anaphylaxis to the proposed ladder food (51/66, 77.3%) and poorly controlled asthma (38/66, 57.6%) were the most frequently cited contraindications. In scenario responses, clinicians were least likely to recommend a ladder when there was prior anaphylaxis to the relevant food: milk 9/70 (12.9%) and egg 13/70 (18.6%). Conclusion: Among respondents, food ladder use was commonly reported, particularly for milk and egg allergy, with variability in implementation supports and in responses to higher-risk scenarios. These exploratory, self-reported findings are descriptive and hypothesis-generating. Together, they encourage further prospective evaluation and consensus-based standardisation.
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