“My advice: Don’t be intimidated – say what you want and what you don’t want!”

Josefine Grünhagen, dietetic assistant at Allergie-Centrum-Charité

A winter’s day in December at 2 p.m. The lift in the skin clinic at Berlin Charité opens with a quiet ping. I’ve arrived at the fifth floor and am now sitting in the office of Josefine Grünhagen. She is a dietetic assistant who counsels patients on allergy-related nutritional issues. Her mobile phone rings constantly in the pocket of her white coat as we talk. A doctor wants to know whether to go ahead with a provocation test. At the end of our conversation, one thing is especially clear: The job of dietetic assistant carries a lot of responsibility.

E: Josefine, what is an average workday like for you? 

J.G.: Few days are alike in the clinic, but certain things do happen on a regular basis. For example, I have many appointments during which I counsel patients. I also conduct oral provocation tests every week.

E: What exactly is an oral provocation test?

J.G.: If a patient comes to our clinic and has had allergy symptoms after eating, and the trigger has not yet been identified through other examinations, we need to consider which foods should be tested as the potential cause. Then the patient comes to the ward for the provocation test. I mix up a low-allergen porridge that does not trigger any reactions. I add cocoa and beta-carotene to change the colour of the mixture. I change the taste with a syrup, such as peppermint syrup. This hides the allergen – what we call blinding in medical terms. So a porridge with celery and one without both look and taste exactly the same. Neither the patient nor the doctor can or should know whether the placebo porridge or the allergenic porridge is being served.

E: So you are the only one who knows which porridge the patient has been given?

J.G.: That’s right. I stay behind the scenes during the provocation tests and avoid contact with the patient so that I don’t influence anybody. The others must not be able to figure out which porridge has been served from my questions or facial expression. The doctor, who doesn’t know what is in the porridge, gives the patient whatever I have prepared. The fear of an allergic reaction can trigger strong physical reactions that are similar to an allergic reaction. If that happens, it becomes difficult for the doctor to decide whether or not to go on with the provocation test. If we have to stop the test, it means we won’t be able to determine what is triggering the reaction from the patient’s immune system.

E: Does everyone with a food allergy have to undergo a provocation test?

J.G.: No. Provocation testing is only necessary if the patient is not sure which foods are tolerated and if this cannot be reliably determined through the consultation with the doctor, the blood test or other examinations.

E: What does a dietetic assistant do?

J.G.: Provocation testing is only done within my specialty, which is allergology. A dietetic assistant working in a clinic has to be familiar with various diseases and understand medical diagnoses. We provide a nutrition diagnosis for food-related diseases and develop therapy plans. We also go through all the details with the patient, since doctors do not always have the time or the opportunity to do so. For example, it is rarely noted in a patient’s file whether he cooks only for himself or for his entire family. This kind of information is important for a dietetic assistant. Some dietetic assistants are independent and run their own practices rather than working in a clinic.

E: Why did you choose this profession?

J.G.: I always wanted to work with patients in the medical field. But I couldn’t become a doctor or nurse because I can’t bring myself to draw blood or administer injections, even now. I wanted a practical job, so I decided to train as a dietetic assistant.

E: You are specialised in allergies. What does that mean?

J.G.: All dietetic assistants are fully qualified after three years of vocational training. But highly specialised areas are not covered in depth during this training. This is why I acquired additional certification in nutritional therapy for food allergies from the professional association of dietetic assistants.

E: Have there been any highlights during your career?

J.G.: All the time. Whenever I can help a patient in a difficult situation – for me that is the best thing.

E: Do nutritionists and dietetic assistants actually do the same thing?

J.G.: No. A dietetic assistant has to complete a recognised three-year training program. A nutritionist normally has to take a course lasting several weeks. Dietetic assistants possess a lot of medical knowledge. They help patients suffering from a specific disease and in need of professional advice. A nutritionist helps people who want to stay healthy and build more muscle at the gym, for example.

E: How can I find a dietetic assistant in my area?

J.G.: The easiest way is to ask your health insurance provider about a dietetic assistant near you. You can also find nutrition professionals in your area on the websites of professional associations such as the German Dietitian Association (VDD), Berufsverband Oecotrophologie (professional association for nutritional science in Germany) or Verband für Ernährung und Diätetik (association for nutrition and dietetics in Germany).

E: Are the costs covered by health insurance?

J.G.: Health insurance generally covers around 80% of the costs. The costs are only covered if the nutritional therapy has been prescribed by a doctor.

E: Why is it important to get professional advice if you have an allergy?

J.G.: In my experience, most people with food allergies eliminate more than is necessary. Patients often look on the Internet and find lists of ingredients that should be avoided if they have a particular allergy. A dietetic assistant helps determine more precisely which foods they can or cannot have.

E: Do you have any special tips for people with food allergies?

J.G.: Seek professional help. And don’t back down! Since it has become a kind of lifestyle to avoid certain foods, people with food allergies have a particularly hard time when they go to restaurants because they are not taken seriously. My advice: Don’t be intimidated. Be assertive, say what you want and what you don’t want!

We thank Josefine for this interview. She spoke with Dr Cosima Scholz from ECARF.