Here’s food for thought
WE HAVE ONE OF THE HIGHEST RATES OF ALLERGIES IN THE WORLD; WE MAY SOON KNOW WHY, WRITES NAOMI WHITE
While we’re no closer to seeing a decline in the number of kids being diagnosed with asthma and food allergies, new research is providing hope we may soon have a better understanding of their triggers — and how to better prevent allergies developing. Today one in nine, or around 2.5 million Australians are estimated to have asthma, up from one in 10 a decade ago. One report has found up to 10 per cent of infants have a proven allergy.
WHILE we’re no closer to seeing a decline in the number of kids being diagnosed with asthma and food allergies, new research is providing hope we may soon have a better understanding of their triggers – and how to better prevent allergies developing.
Today one in nine, or around 2.5 million, Australians are estimated to have asthma, up from one in 10 a decade ago.
And in children the figure has been estimated as high as one in five.
Food allergies are also over-represented in children, with an Australasian Society of Clinical Immunology and Allergy report finding up to 10 per cent of infants have a proven allergy.
And allergic diseases are considered to be one of the fastest growing chronic diseases in Australia, with a prediction by ASCIA that by 2050 the number of patients could increase by 70 per cent.
But new research is providing better insights into their possible causes, with hopes we’ll be better able to prevent and treat them within years.
Paediatric allergist Dr Richard Loh from the National Allergy Strategy says the high numbers in Australia, now also being seen in developing countries like India and China, are concerning.
But we’re gaining a better understanding of the impacts of multiple contributing factors.
This includes advice once given by allergists not to introduce eggs, a food that can cause allergies, before the age of two and peanuts before the age of three, which while given with the best of intentions, Dr Loh says probably contributed to the increase in allergy sufferers.
What’s now known is that introducing these foods before 12 months can reduce the risk of allergies.
It’s a message the NAS, in partnership with ASCIA, will soon begin promoting among child health services and parents.
And an established school of thought is what’s known as the hygiene hypothesis – the idea that our obsession with cleanliness is thought to contribute by not allowing children to build their immunity up naturally.
Vitamin D deficiencies are also being looked to as a possible factor, as are theories on changes in infants’ gut bacteria, with probiotics a growing research area.
“There’s a lot of research on the gut organisms showing they’re a bit different now and we’re probably too clean. The bacteria in babies’ guts is not the same as it was 30 years ago and that change is affecting how the immune system responds to foods and dust mites and pollen,” Dr Loh says.
Acknowledging the changing advice can be frustrating for parents.
He urges avoiding “Dr Google” and finding reputable sources of information, adding the NAS is working to update pharmacists, nurses and GPs to avoid parents being given conflicting advice.
Allergy and Anaphylaxis Australia CEO Maria Said has seen an increase since she joined the charity in 1993, saying there’s “been a real surge” in both the numbers of children affected and the number of hospitalisations for anaphylaxis. Although she says it was prevalent in the 1990s, patients often self-managed by avoiding foods and she has concerns some adults who have never seen a specialist may be without emergency medication.
But while awareness has also increased so too have waiting times for specialists, which for food challenges can
be up to two years in some areas.
“It’s a triage system, if someone has had an anaphylaxis they’ll hopefully see a specialist sooner,” she says.
“But then people on the waiting list for mild or moderate reactions who might next time have an anaphylaxis shock are without emergency medication. We want people to be properly diagnosed because the prescription of an epi-pen is life changing, it’s quite a challenge, the specialists are doing the best they can but at the end of the day consumers are left needing support and direction.” Asthma Australia CEO Michele Goldman says it’s a similar story for the airways disease, saying while knowledge has increased, there are still many unanswered questions. What’s known is there’s a genetic component – a child has a 25 per cent chance of developing asthma if one parent has it and 50 per cent if both do.
Children exposed to tobacco smoke are also at higher risk.
Those with food allergies and hay fever are also more prone to asthma, and where one isn’t properly managed, it can flare up the other.
Ms Goldman says while great progress has been made in managing asthma in young children by parents, school and childcare teachers, adolescents are a group of concern as they often slip into complacency once they’re instructed to self-manage their asthma.
“It’s the first time they’re becoming more independent and unless they’ve had some scary flare ups, generally we find complacency around asthma,” Ms Goldman says.
“They may think it’s not that serious or think they’re invincible, that it won’t happen to me.
“If they’re fit and healthy and full of life it’s very challenging to try and get them to talk about and acknowledge their disease, especially one that can be invisible.”
The organisation, working with the University of Sydney designed an app in consultation with young adults with the aim to address this.
Kiss myAsthma allows patients to track symptoms, set goals and access a personalised asthma plan, with hopes that offering a platform they’re comfortable with will engage them more.
While in the decade leading up to 2016 the rate of hospitalisations among children aged 0-14 decreased and the overall rate of mortality remained steady between 2011-2015, it remains a leading reason children visit emergency departments.
But promising research to develop a vaccine, shown to be effective in mice, is being explored to see if it’s possible to replicate it in humans.
And experts are also optimistic about studies of pregnant women showing that if their asthma is properly managed the likelihood of their child developing it can be almost halved.
Paediatric respiratory specialist and consultant at Sydney Children’s Hospital Dr Louisa Owens says if properly managed, asthma sufferers should be able to lead full lives and the disease doesn’t have to be debilitating.
But where it’s not is where she sees kids end up in our hospitals.
“The children we worry about are those who need a lot of Ventolin,” Dr Owens says.
“They might be going to school and seem to be coping fine, but if they need it more than a couple of times a week, it’s a sign it’s not properly controlled.
“You should never rely on Ventolin to get through the day.”
IF THEY’RE FIT AND HEALTHY AND FULL OF LIFE IT’S VERY CHALLENGING TO TRY AND GET THEM TO TALK ABOUT AND ACKNOWLEDGE THEIR DISEASE, ESPECIALLY ONE THAT CAN BE INVISIBLE MICHELE GOLDMAN, ASTHMA AUSTRALIA CEO