Peo­ple think they’ll only get a sore tummy … but some can die

The Daily Telegraph (Sydney) - Best Weekend - - FRONT PAGE -

hile 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 over­rep­re­sented 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. Sarah Foster with her sons PJ, Max and Bil­lyy who ha ve all ex­pe­ri­encedp food al­ler­gies.

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 self­man­aged 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. But then peo­ple on the wait­ing list for mild or mod­er­ate re­ac­tions who might next time have an ana­phy­laxis are with­out emer­gency med­i­ca­tion,” she says.

“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 wait­ing and 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. For Sarah Foster, food al­ler­gies in her three sons Max, 12, Billy, 11, and PJ, eight, took her by sur­prise, with no fam­ily his­tory. It has been im­por­tant for the boys to learn to man­age the al­ler­gies. She says: “Max broke out in a rash when I first in­tro­duced eggs which kept get­ting worse. I took him to an al­ler­gist who di­ag­nosed an egg al­lergy. I got Billy tested be­fore I started solids and it showed he had a tree nut al­lergy.

And PJ broke out in hives when he was given cow’s milk and was di­ag­nosed with al­ler­gies to egg, dairy and nuts. He’s out­grown all but the

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. nuts and Max out­grew the egg al­lergy.

PJ has had two ana­phy­lac­tic re­ac­tions. One last year on a plane, we don’t know what to, there were no de­clared al­ler­gens in what he ate. An­other a year be­fore was to eggs.

We al­ways carry four Epi-pens and have them at home and at school and the kids are trained to use them.

In the be­gin­ning a spe­cial­ist didn’t is­sue an Epi-pen for Max, back in 2009, which was re­ally dif­fi­cult. My child had just been di­ag­nosed with a life-threat­en­ing al­lergy but we didn’t have any­thing to man­age it. But my GP said ab­so­lutely he needed one. That’s changed over time, they’re now pre­scribed more and in­struc­tions are to give the Epi-pen and give it early.

In the 11 years I’ve had a child with a life-threat­en­ing al­lergy the in­for­ma­tion and sup­port that’s come out in that time is amaz­ing.

It’s re­ally im­por­tant the kids learn to live in the real world and to man­age these on their own. We have them ask if there are nuts in foods and to check the in­gre­di­ents them­selves, we help them but they need to learn to do it them­selves. I think it’s re­ally im­por­tant the com­mu­nity is aware how se­ri­ous it is. Peo­ple think they’ll only get a sore tummy or feel un­well, but un­for­tu­nately peo­ple can die.”

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