KIDS’ HEALTH

Be­tween 6 and 8 per cent of chil­dren are thought to have food al­ler­gies – why is this statis­tic only go­ing on the rise?

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In July 2016, Natasha Ed­nan-Lap­er­ouse col­lapsed on a flight from Lon­don to Nice, suf­fer­ing a fa­tal al­ler­gic re­ac­tion to a baguette. At an in­quest, the court heard how Natasha, who was 15 and had mul­ti­ple se­vere food al­ler­gies, had care­fully checked the in­gre­di­ents on the packet. Sesame seeds – which were in the bread dough, the fam­ily later found out – were not listed. ‘It was their fault,’ her fa­ther Nadim said in a state­ment. ‘I was stunned that a big food com­pany ... could mis­la­bel a sand­wich and this could cause my daugh­ter to die.’

This hor­ri­fy­ing case high­lights how care­ful peo­ple with al­ler­gies need to be, as do the food com­pa­nies – not least be­cause al­ler­gies have been grow­ing in preva­lence in the past few decades.

‘Food al­lergy is on the rise and has been for some time,’ says Holly Shaw, nurse ad­viser for Al­lergy UK, a char­ity that sup­ports peo­ple with al­ler­gies. Chil­dren are more likely to be af­fected – be­tween 6 and 8 per cent of chil­dren are thought to have food al­ler­gies, com­pared with less than 3 per cent of adults – but num­bers are grow­ing in west­ern­ised coun­tries, as well as places such as China.

‘Cer­tainly, as a char­ity, we’ve seen an in­crease in the num­ber of calls we re­ceive, from adults and par­ents of chil­dren with sus­pected or con­firmed al­lergy,’ says Shaw. Cer­tain types of al­lergy are more com­mon in child­hood, such as cow’s milk or egg al­lergy but, she says: ‘It is pos­si­ble at any point in life to de­velop an al­lergy to some­thing pre­vi­ously tol­er­ated.’

Stephen Till, pro­fes­sor of al­lergy at King’s College Lon­don and a con­sul­tant al­ler­gist at Guy’s and St Thomas’ hos­pi­tal trust, says that an al­ler­gic re­ac­tion oc­curs when your im­mune sys­tem in­ap­pro­pri­ately recog­nises some­thing for­eign as a bug, and mounts an at­tack against it. ‘You make an­ti­bod­ies which stick to your im­mune cells,’ he says, ‘and when you get re-ex­posed at a later time to the al­ler­gen, those an­ti­bod­ies are al­ready there and they trig­ger the im­mune cells to re­act.’

Al­ler­gies can have a huge im­pact on qual­ity of life, and can, in rare cases such as that of Natasha Ed­nan-Lap­er­ouse, be fa­tal. There is no cure for a food al­lergy, al­though there has been re­cent promis­ing work in­volv­ing the use of pro­bi­otics and drug treat­ments. The first trial ded­i­cated to treat­ing adults with peanut al­lergy is just start­ing at Guy’s hos­pi­tal.

‘There is a lot of work go­ing on in preven­tion to bet­ter un­der­stand the wean­ing process, and there’s a lot of buzz around de­sen­si­ti­sa­tion,’ says Adam Fox, con­sul­tant pae­di­atric al­ler­gist at Guy’s and St Thomas’ hos­pi­tals. De­sen­si­ti­sa­tion is con­ducted by ex­pos­ing the pa­tient to mi­nus­cule, con­trolled amounts of the al­ler­gen. It’s an on­go­ing treat­ment though, rather than a cure. ‘When they stop hav­ing it reg­u­larly, they’re al­ler­gic again, it doesn’t change the un­der­ly­ing process.’

What we do know is that we are more al­ler­gic than ever. ‘If you think in terms of decades, are we see­ing more food al­lergy now than we were 20 or 30 years ago? I think we can con­fi­dently say yes,’ says Fox. ‘If you look at the re­search from the 1990s and early 2000s there is pretty good data that the amount of peanut al­lergy tre­bled in a very short pe­riod.’

There has also been an in­crease in the num­ber of peo­ple with se­vere re­ac­tions show­ing up in hos­pi­tal emer­gency de­part­ments. In 2015-16, 4,482 peo­ple in Eng­land were ad­mit­ted to A&E for ana­phy­lac­tic shock (al­though not all of these will have been down to food al­lergy). This num­ber has been climb­ing each year and it’s the same across Europe, the US and Aus­tralia, says Fox.

Why is there this rise in al­ler­gies? The truth is, no­body knows. Fox doesn’t be­lieve it is down to bet­ter di­ag­no­sis. And it won’t be down to one sin­gle thing. There have been sug­ges­tions that it could be caused by rea­sons rang­ing from a lack of vi­ta­min D to gut health and pol­lu­tion. Wean­ing prac­tices could also in­flu­ence food al­lergy, he says. ‘If you in­tro­duce some­thing much ear­lier into the diet, then you’re less likely to be­come al­ler­gic to it,’ he says.

Should par­ents wean their ba­bies ear­lier, and in­tro­duce foods such as peanuts? Fox says it’s a ‘mine­field’, but he ad­vises stick­ing to the Depart­ment of Health and World Health Or­ga­ni­za­tion’s line that pro­motes ex­clu­sive breast­feed­ing for six months be­fore in­tro­duc­ing other foods, ‘and to not de­lay the in­tro­duc­tion of al­ler­genic foods such as peanut and egg be­yond that, as this may in­crease the risk of al­lergy, par­tic­u­larly in kids with eczema’. (Fox says there is a di­rect re­la­tion­ship be­tween a baby hav­ing eczema and chances of them hav­ing a food al­lergy.)

The adults Till sees are those whose al­ler­gies started in child­hood (peo­ple are more likely to grow out of milk or egg al­ler­gies, than peanut al­ler­gies, for in­stance) or those with al­lergy that started in ado­les­cence or adult­hood. Again, it is not clear why you can tol­er­ate some­thing all your life and then de­velop an al­lergy to it. It could be to do with our chang­ing di­ets in re­cent decades.

‘The com­mon­est new on­set se­vere food al­lergy I see is to shell­fish, and par­tic­u­larly prawns,’ says Till. ‘It’s my own ob­ser­va­tion that the types of food we eat has changed quite a lot in re­cent decades as a re­sult of changes in the food in­dus­try and sup­ply chain.’ He says we are now eat­ing foods such as tiger prawns that we prob­a­bly didn’t eat so of­ten in the past.

He has started to see peo­ple with an al­lergy to lupin flour, which comes from a legume in the same fam­ily as peanuts, which is more com­monly used in con­ti­nen­tal Europe but has been in­creas­ingly used in the UK. Sesame – thought to have been the cause of Natasha Ed­nan-Lap­er­ouse’s re­ac­tion – is an­other grow­ing al­ler­gen, thanks to its in­clu­sion in prod­ucts that are now main­stream, such as hum­mus. One prob­lem with sesame, says Till, is: ‘It of­ten doesn’t show up very well in our tests, so it can be dif­fi­cult to gauge just how al­ler­gic some­one is to it.’

Fox says it’s im­por­tant to stress that deaths from food al­lergy are still rare. ‘Food al­lergy is not the lead­ing cause of death of peo­ple with food al­ler­gies - it’s still a very re­mote risk,’ says Fox. ‘But of course you don’t want to be that one who is in­cred­i­bly un­lucky, so it causes great anx­i­ety. The real chal­lenge of man­ag­ing kids with food al­lergy is it’s re­ally hard to pre­dict which of the chil­dren are go­ing to have the bad re­ac­tions, so ev­ery­body has to be­have as if they might be that one.’

‘Are we see­ing more food al­lergy now than we were 20 or 30 years ago? I think we can con­fi­dently say yes’

Sesame is an­other growingal­ler­gen,thanks to its in­clu­sion in prod­ucts that are now main­stream, such as hum­mus

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