Archive for October, 2007

Anaphylaxis – Allergic Reaction Videos – SBS – Insight

Hi

A big thanks to Josie H one of our members for pointing me in the direction of these videos, and big kudos to Australian SBS and Insight for putting these on the web for us all to benefit from.

I suggest that you watch them all…

Part 1 of 3
http://publish.vx.roo.com/sbs/portal/?channel=Insight&clipId=1207_09102007GG4772

Part 2 of 3
http://publish.vx.roo.com/sbs/portal/?channel=Insight&clipId=1207_09102007GG4773

Part 3 of 3
http://publish.vx.roo.com/sbs/portal/?channel=Insight&clipId=1207_09102007GG4774

Nigel Baptist demonstrates the use of the epi-pen
http://publish.vx.roo.com/sbs/portal/?channel=Insight&clipId=1207_09102007sm4761

Post Show Interviews
http://publish.vx.roo.com/sbs/portal/?channel=Insight&clipId=1207_09102007sm4756

Transcript on Anaphylaxis TV Show – Insight SBS Australia

Thank you to Josie H one of our members for correcting me on the show that aired in Australia last week. I have found from the Insight @ SBS website a transcript of the show, and I’ve included it here.

ARCHIVES – October 09, 2007

ALLERGIC REACTION

Why are so many of our children suffering from serious food allergies? Around 1 in 20 Australian kids is allergic to some type of food, with eggs, peanuts and milk commonly causing problems. Experts are particularly worried about peanut and other nut allergies because they’re on the rise and they can be fatal.

JENNY BROCKIE: Insight will talk about food allergies in a moment. But first, Skye Docherty visits one family on constant alert.

THE MITTAGONG STORY:

REPORTER: Skye Docherty

Joshua Quine was only nine months old when his mum, Sandy, discovered he had an allergy to peanuts.

SANDY QUINE: We were actually fortunate in that the first reaction he had was just a rash around his face.

JOSHUA QUINE: It means if I have any peanuts or anything with peanuts in it I, like, get rashy and I have to go to the hospital. Is that the one that’s the lady?

As a young child Josh also had eczema, asthma and allergies to dust mites and pollens. His older brother, Sam, had no allergies at all. Sandy managed to keep Joshua away from peanuts for the next couple of years.

SANDY QUINE: He was three and we were out at a barbecue, which is a real danger time when you’re out with these children, and he put a mouthful of something that had peanut butter in it in his mouth, and I saw him do that. He was only three years old and I got him to spit it back out. And he reacted to that and had shortness of breath so we took him to the hospital.

JOHN QUINE: To actually witness somebody struggling for breath, I think that’s what you need to see to sort of say, “Well, hey, this is life and death.”

At the hospital Josh was placed on oxygen until his airways reopened. A severe allergy can result in anaphylaxis, a process where airways close over, the heart beats quickly and blood pressure drops. In severe cases it can lead to death. The severity of Josh’s reaction has many impacts on the family’s life choices.

SANDY QUINE: We used to live a lot further out of town. One of the reasons that we moved was I feel a lot safer if something does happen that we can get to a hospital quickly or an ambulance can get to us because we’re only about 10 minutes away.

The family live in Mittagong in the Southern Highlands, a couple of hours south of Sydney. Sandy says few restaurants cater for Josh’s needs.

SANDY QUINE: You go anywhere to a restaurant is really, really tricky. Often we buy as a treat because he can’t eat at a restaurant that we’re going to, we’ll buy McDonald’s on the way because we know that it’s safe for him.

Josh is never without his EpiPen which releases a shot of adrenaline to stop an anaphylactic reaction.

JOSHUA QUINE: I take my EpiPen to school and put it in a special place at the back of my classroom.

Josh receives good care at his school. It’s when they take him away from the security of home and school that they worry the most.

REPORTER: Does he go around and play at people’s houses and things like that?

SANDY QUINE: He does. Not at many people’s houses. And anywhere that he goes I always go the first time and explain about the EpiPen and how to use it. I make sure that the parents are comfortable with doing that if something does happen. I usually send his own food.

And when the family’s on holidays they’re still on high alert.

SANDY QUINE: I always drive through the first town, the closest town to where we’re staying, and find out where the hospital is so that I know where to take him if something happens.

JENNY BROCKIE: Well, welcome, everybody. Thanks very much for joining us tonight. Welcome, Joshua. Good to have you here. You’re going on camp soon, aren’t you?

JOSHUA QUINE: Yep.

JENNY BROCKIE: When’s that?

JOSHUA QUINE: In November.

JENNY BROCKIE: In November, and is that the first time you will have been on camp?

JOSHUA QUINE: Yep.

JENNY BROCKIE: And is Mum going with you?

JOSHUA QUINE: Yep.

JENNY BROCKIE: She is. And how do you feel about that, about Mum going on camp?

JOSHUA QUINE: Well, when she comes I feel a lot safer.

JENNY BROCKIE: Do you? Why is that, Joshua?

JOSHUA QUINE: Well, because when I’m on camp if she’s there she knows best about what’s happening.

JENNY BROCKIE: About what sort of food you should be eating and that kind of thing?

JOSHUA QUINE: Yeah.

JENNY BROCKIE: Sandy, what’s that like? I mean, it must be a huge thing for him to be going away like that. Are you worried about it, about him being on the camp?

SANDY QUINE: Not if I’m there. If I’m there it will be OK.

JENNY BROCKIE: So you will be watching him all the time?

SANDY QUINE: Absolutely.

JENNY BROCKIE: How long do you think that will have to go on for for you?

SANDY QUINE: I plan on going on a lot of camps.

JENNY BROCKIE: Can you envisage a time when you’ll ever be able to let go of that anxiety about this problem?

SANDY QUINE: Not yet, not for a lot of years. Not until he’s quite… later in high school, perhaps, when I’m confident that he can do it himself. But not for a lot of years.

JENNY BROCKIE: What’s it like for you, Joshua, having to be so careful about what you eat?

JOSHUA QUINE: Well, it sort of makes me feel different.

JENNY BROCKIE: Makes you feel different to the other kids?

JOSHUA QUINE: Yep.

JENNY BROCKIE: And do the other kids understand it, do you think?

JOSHUA QUINE: Yeah, they understand it really well.

JENNY BROCKIE: That’s good, that’s very good to hear. Olivia, can you tell me what sort of food you’re not allowed to eat, that you’re not supposed to have?

OLIVIA SNOW: Eggs and fish and rice and peas and milk and..

JENNY BROCKIE: That’s pretty good, that’s a pretty good memory you’ve got. What about things like peanuts and nuts, are you allowed to eat things like that? No. Jane, Olivia has a really extensive list of thing, doesn’t she?

JANE FRICKER: Yes.

JENNY BROCKIE: Can you fill us in a few more? Because there are so many.

JANE FRICKER: I know. I sometimes forget until I’m confronted with them. She also can’t have yeast, wheat, any of the nuts, watermelon, cantaloupe, strawberries, citrus fruits are out, sulfur dioxide and I’m sure I’ve missed some.

JENNY BROCKIE: What happens if she eats any of those things?

JANE FRICKER: Varying reactions. To things like watermelon and all the nuts, then she has an anaphylactic reaction, the normal extreme reaction. To the other ingredients she has varying degrees of allergic reaction ranging from severe eczema to urticaria welts, but not to the point where she would stop breathing. And sometimes the reaction’s delayed, so with cocoa, another one I didn’t mention, she only gets the reaction 24 hours later.

JENNY BROCKIE: How do you cope with that? That’s an extraordinary list of things. How do you get on with living a life?

JANE FRICKER: In some ways it being so extensive makes it easy because..

JENNY BROCKIE: Because it’s really what she can eat as opposed to what she can’t.

JANE FRICKER: Like tonight, the hotel cooked up chicken and some simple vegetables and they were cooked in a canola oil and that was it. And so you just get used to having very simple food choices.

JENNY BROCKIE: And going to friends’ houses, coping with that sort of thing?

JANE FRICKER: Take everything with you.

JENNY BROCKIE: You take it all with you?

JANE FRICKER: I mean, very good friends and family know and you know what they have in their cupboards and you know what you can access, but I just take everything, it’s just easier.

JENNY BROCKIE: And what’s it like for you, Olivia? When you see other people eating things that you can’t eat, how do you feel about that? Is that hard when you’re with your friends sometimes?

OLIVIA SNOW: Yes.

JENNY BROCKIE: Yeah. Ryan, you’re Olivia’s brother, you’re 10. Do you have any allergies as well?

RYAN SNOW: Only to peanuts and wheat.

JENNY BROCKIE: And have you ever had those things? Have you had a reaction to those things?

RYAN SNOW: Well, I don’t really have a reaction to wheat but I’ve had a reaction… I need an EpiPen for the peanuts, and I come out in welts as well.

JENNY BROCKIE: So you’ve had to be injected with the EpiPen that we saw in that story some time?

RYAN SNOW: Yeah.

JENNY BROCKIE: Dallas Tye, you have two kids as well who are the same age as these children. Now, I wonder if you could just explain to us what they’re allergic to and how sensitive your oldest child is to peanuts?

DALLAS TYE: My eldest daughter, Celine, we found out she was anaphylactic by her leaning over some reheated satay. She was a bit over 12 months old.

JENNY BROCKIE: Leaning over it?

DALLAS TYE: Leaning over it and inhaling the steam from the reheated satay and straightaway her lips started to swell up and she was in distress. And they were about to take her off to hospital and my wife’s girlfriend had the peace of mind to think that she may be having an allergic reaction. We had no experience with that sort of thing before. And they called an ambulance instead. And yes, it was an anaphylactic reaction and she ended up in hospital with, well, lots of tubes plugged into her and..

JENNY BROCKIE: So it was a life-threatening situation?

DALLAS TYE: Oh, absolutely, yeah, absolutely. And it was, yeah, a pretty sad and scary little sight to see a tiny little child like that.

JENNY BROCKIE: Martha Baptist, thank you very much for joining us. I know it’s really tough for you to be here tonight. Your son Alex died three years ago when he was at kindergarten. He had a severe peanut allergy. Can you take us through what happened?

MARTHA BAPTIST: That’s right. Basically we took Alex to kinder and about an hour later I received a call that he’d collapsed and when I arrived at kinder there were three ambulances there trying to resuscitate him but he had already passed away.

JENNY BROCKIE: How long had you known that he had this allergy?

MARTHA BAPTIST: We found out at about 13 months that Alex had the peanut allergy. I fed him a peanut butter… peanut butter on toast and he started to react almost immediately with…began as a rash around his mouth and then he began to swell, his face and his neck.

JENNY BROCKIE: Now, his kindergarten, like many kindergartens now, was nut-free, wasn’t it, it was a nut-free environment, so how did this happen?

MARTHA BAPTIST: We felt we’d taken a lot of precautions with taking Alex to kinder in that the children only ate fruit, which was shared between them. On the day that Alex passed away, through the coronial inquest it was found that the duty parent had bought in a peanut butter sandwich. We don’t really have a lot more detail than that.

JENNY BROCKIE: Because the Coroner was never able to establish whether he’d actually come into contact with it or how or whether he in fact had or not, wasn’t that the case?

MARTHA BAPTIST: That’s right, that’s right, yes.

JENNY BROCKIE: Martha, do you think people understand how serious this is when they hear about kids having these kind of reactions? Do you think they understand how intensely serious it is, how life-threatening it is?

MARTHA BAPTIST: At the time when we still had Alex, no, we were sort of treated as paranoid parents. I think it is changing. Though, some people still, I think, will never fully understand just how serious a small amount of an allergen can be. But, I mean, we did have parents rolling their eyes at us at the kinder, at Alex’s kinder.

JENNY BROCKIE: This was because of you saying how careful everybody had to be and that kind of thing?

MARTHA BAPTIST: That’s right, that’s right. I’d check the fruit basket each time I went into the kinder and one day there was a packet of biscuits with nut traces that would have been put out for all the children to share. So I removed it and I was talking to the parent about it, saying that Alex can’t have these and I’d have the sort of the rolling of the eyes and yeah, which is a shame. Fortunately it’s not too many parents that are like that.

JENNY BROCKIE: Rob Loblay, you’re an allergy specialist and an immunologist who’s specifically looking at this problem. How many children are at that kind of risk in Australia at the moment? Do we know?

DR ROBERT LOBLAY, CHAIRMAN, ANAPHYLAXIS WORKING PARTY: In the preschool age group it’s roughly 6%, and 2% roughly would be allergic to peanut.

JENNY BROCKIE: That’s quite a considerable number of children.

DR ROBERT LOBLAY: It is, yes.

JENNY BROCKIE: And is it mainly children or adults as well?

DR ROBERT LOBLAY: Most food allergies occur in early childhood. And with other allergies such as egg, milk, wheat, soy, kids grow out of them by the time they get to school age or high school, almost always. But peanuts, other nuts and seafood often continue on into teens and adult life and can be a lifelong problem.

JENNY BROCKIE: Sandro, you’re 25 and you’ve had a milk, egg and nut allergy since you were a child. What happened the last time you came into contact with one of those foods?

SANDRO TEGHNINI: I was 21, out at a cocktail bar and I was having a drink with some of my friends and sort of ordered a drink that didn’t have nuts, milk, eggs, nothing in it, and was sort of drinking away and one of my friends looked over and said, “Are you OK?” I said, “Yeah.” My eyes had gone red, my skin was rashing up and within two minutes I was on the ground. I had my EpiPen on me but I was in such a state I actually couldn’t put the EpiPen into my leg and my friend actually had to put it into my leg.

JENNY BROCKIE: Inject you?

SANDRO TEGHNINI: Yeah.

JENNY BROCKIE: With the shot. With the adrenaline so that you came out of it?

SANDRO TEGHNINI: Yeah.

JENNY BROCKIE: Rob, just explain physically what happens with anaphylaxis. I think we have some photos here of young children with anaphylactic reactions. Just explain to us what happens to the body.

DR ROBERT LOBLAY: Well, an allergic reaction is an immune reaction. Basically a child like this would have been exposed at some earlier time to the allergen and the immune system would have produced a particular kind of antibody called IgE antibodies. These antibodies normally protect us from parasites but in predisposed people, genetically predisposed, they can be produced against a range of otherwise harmless things including food. So what’s happening here is that contact, subsequent contact with the food enables those antibodies to trigger off cells in the tissues called mask cells, which contain histamine, and it’s the histamine that causes the symptoms that you can see, the swelling, the redness, the itching and the welts.

JENNY BROCKIE: And how long does it last?

DR ROBERT LOBLAY: Well, it depends on how big the exposure has been and how sensitive the person is. A mild reaction might only last for a few minutes, but the more severe reactions can go on for an hour or two or even days in some cases.

JENNY BROCKIE: And they can actually stop you from being able to breathe, yes?

DR ROBERT LOBLAY: They can, yes. Swelling of the tissues in the throat and the lungs can prevent breathing.

JENNY BROCKIE: Velencia Soutter, you’re a paediatrician, you specialise in allergies too. Why peanuts? Why are we hearing so much about peanuts at the moment? Do they create a particularly strong reaction or are they just the same as other foods, we’re just hearing more of them, more of these cases?

DR VELENCIA SOUTTER, PAEDIATRICIAN, ROYAL PRINCE ALFRED: No, we’re certainly seeing more peanut allergy than we used to. I mean, I’ve been doing allergy work for, I guess, 25 years or so now, and the first 10 of those years there was very little in the way of peanut allergy, and in the last 15 years there’s just been an ever increasing workload related to peanut and nut allergies. No-one really knows why there’s more peanut allergy than there used to be but you can only have an allergy if you’ve had a prior exposure to that food. So allergies, you know.. You’re not born with an allergy in most instances.

JENNY BROCKIE: Walk us through the most common foods. We’ve got them up here. These are the most common foods that cause an allergic reaction?

DR VELENCIA SOUTTER: In almost every society around the world egg is the most common food allergy and then the order in various countries changes, a lot depends on exposure. So, for instance, here in Sydney, we have egg as number one, peanuts number two, milk’s number three, tree nuts number four, sesame’s five, seafood six. But that will vary in a country where not much peanut is eaten, you might have milk as number two. In a place like Israel, for instance, you’ll have sesame as a really common food allergy. So it’s really geographical.

JENNY BROCKIE: Rob, tell us exactly what an allergy is just quickly. Because it’s different to a food intolerance, isn’t it? And people do get that a bit confused.

DR ROBERT LOBLAY: Yes, that’s right. An allergy’s an immune reaction. As I said before, the antibodies are produced when the person is exposed, when they get re-exposed later the food proteins latch on to the antibodies like a lock and key and they switch on the histamine. Food intolerances are entirely different, nothing to do with the immune system. They seem to be triggered off by chemical components of the food, sometimes natural components or additives or a combination. And they work probably through stimulating the nerve endings in the tissues rather than the immune system. And the importance of that is that the standard tests for allergies don’t pick up the intolerances.

JENNY BROCKIE: Right, so you can have a food intolerance but the skin prick tests and everything else will not show that?

DR ROBERT LOBLAY: Exactly.

JENNY BROCKIE: Well, in a minute we’re going to look at what might be behind this rise in food allergies and why we’re seeing such a big increase in food allergies amongst children. And, Mimi Tang, I’d like to involve you in our discussion now. You head up the Allergy and Immunology Unit at the Royal Children’s Hospital in Melbourne. What sort of increases are you seeing in allergies at your hospital at the moment?

PROFESSOR MIMI TANG, ROYAL CHILDREN’S HOSPITAL: We looked at our rates for admission for the condition anaphylaxis over the last five years, and we have seen that admission rates just for that condition have trebled in five years. That’s about the same, if not a little bit higher, than the UK statistics that were published last year. And certainly is also in line with the findings in a study published by Ray Mullins, another allergist who practices in Canberra. He reported on the Australian hospital admission rates, and there has been roughly a fivefold, or just under a fivefold, increase in admission rates for children under the age of four having anaphylaxis.

JENNY BROCKIE: A fivefold increase, that’s huge.

PROFESSOR MIMI TANG: Yeah, in his study the national statistics say fivefold over the last 12 years. We’ve had a trebling over the last five years.

JENNY BROCKIE: And why do you think that’s happening, Mimi?

PROFESSOR MIMI TANG: Yeah, it’s a difficult question to answer. I’ll tell you what we do know. We know that genes are very important and we also know that the environment’s important. Genes are important in terms of if you have a parent with a history of allergy problems, then the risk of a child who’s born to that parent having allergy problems increases significantly. So, for example, if there are no parents with allergy, the child’s risk is about 20% for having one of the allergy disorders. If one parent has an allergy disorder, that risk in the child goes up to about 40%, and if both parents have an allergy disorder, the risk goes up even further, to up to 60% or 70%. But more recently it’s become very clear that the environment is important as well. That’s been highlighted because we’ve had such a rapid rise in the rate of allergy problems. It’s clearly happened much too quickly to be due to the genes changing so we know that the environment has to be responsible for the bulk of this rise.

JENNY BROCKIE: And when you talk about the environment, what do you mean?

PROFESSOR MIMI TANG: Well, it seems that it’s living a Westernised lifestyle that’s particularly linked to an increased risk for allergy problems. We know quite clearly through an international survey done several times now that rates of allergy problems, asthma, eczema, hay fever, food allergy are much higher in Westernised countries than they are in developing and less developed countries. Now, one of the popular theories is that we are now more hygienic, we’re exposed to fewer bacteria and good bugs in particular. A lot of the evidence that supports this has probably come out of Europe recently. It’s been shown that if a family live on a farm, their children have a much lower risk for allergy problems, particularly asthma, than children who have grown up in the city. These studies came out of Germany.

JENNY BROCKIE: That might explain asthma but does it explain allergies to things like peanuts, for example?

PROFESSOR MIMI TANG: What we know is it’s very likely that the environmental influences that increase risk for different allergic conditions are probably very different. One of the clues to that was the fact that the rise in allergy problems has been staggered. So asthma seemed to rise very early, and at the moment prevalence rates really have plateaued if not even slightly fallen. Eczema and hay fever have risen together with asthma, they’re continuing to rise but at a slower rate. Now, most recently we’ve seen a very rapid rise in food allergy and anaphylaxis so it does seem that they haven’t all risen together, suggesting that different environmental factors might be playing roles in these conditions.

JENNY BROCKIE: But it does sound from the way you’re talking like there are a lot of theories around but nobody’s really come to a conclusion about what the answer is here, particularly with this rise in peanut allergies, yeah?

PROFESSOR MIMI TANG: Yeah, there are a lot of theories and there’s a lot of research going on to test some of these theories, but there is no hard and fast rules or facts that we can provide at this time.

JENNY BROCKIE: And meanwhile all the parents here are trying to work out how on earth this has happened to their children. Karen Jamieson you’re one of those people. Your eldest child, Kiara, has food allergies to nuts and eggs but your second child doesn’t, and you’re now expecting a third, I gather. What do you think of these theories that you hear about as to why this might happen?

KAREN JAMIESON: I think being very clean compared to my other, my second child. Kiara, we were very careful, we picked things up, we were very clean. We found out when she was about 15 months old with the swelling of the eye, she had traces of things. Since about the age of two she would she’s been on probiotics as well and zinc, flaxseed oil, and I’ve noticed we’re very careful but I’ve noticed her immunity has just built up.

JENNY BROCKIE: So you think you were very clean when you were dealing with this first child. What about the second child?

KAREN JAMIESON: No, not at all.

JENNY BROCKIE: Not at all.

KAREN JAMIESON: Not at all, drop something, no, you can have it.

JENNY BROCKIE: And does the second child have any allergies?

KAREN JAMIESON: No, not at all.

JENNY BROCKIE: That’s interesting. So you actually think…you would buy this theory, presumably, so this third child is going to be brought up in filth.

KAREN JAMIESON: A balance.

JENNY BROCKIE: OK, Jane Fricker, does that theory explain your situation at all?

JANE FRICKER: It doesn’t. And most of the theories don’t really cover Olivia. She was a second child, so not quite filth but she certainly didn’t have the pristine sterilised environment that that people often have with their first child. So, you know, she didn’t eat a lot of commercial packaged food, she didn’t have everything sterilised. None of those theories work. She definitely has the genetic predisposition to having allergies.

JENNY BROCKIE: So you have a background of allergies?

JANE FRICKER: The whole family has got varying degrees of hay fever, asthma, mild food allergies, allergies to animals, everybody’s got something. Livy just copped the lot.

JENNY BROCKIE: Sandy, is that the case with you?

SANDY QUINE: We both have allergies.

JENNY BROCKIE: Both parents?

SANDY QUINE: Both parents, yes.

JENNY BROCKIE: So the genetic theory sort of kicks in.

SANDY QUINE: Joshua was a second child so he was definitely living in more filth than the first one did.

JENNY BROCKIE: Second children always cop the filth by the sounds of it. Robert, what do you think of this theory about dirt and cleanliness and Western societies being over-clean and so on? Do you think it stacks up as part of an explanation?

DR ROBERT LOBLAY: Look, I think it’s probably relevant for the increase in allergies generally, as Mimi Tang pointed out, but it doesn’t explain what’s different about peanut. There’s always been egg and milk allergies, they don’t seem to have increased in anywhere near the same rate as peanut, if at all. And so something is different and we don’t know what.

JENNY BROCKIE: Are we eating more peanuts?

DR ROBERT LOBLAY: It’s a possibility but we don’t have enough information about what people used to eat to make a proper comparison. One thing that has been found is that peanuts become much more allergenic when they’re roasted compared with when they’re boiled. And a big difference between what people consume in Western countries compared with Asian countries is that in the Asian diet people eat boiled peanuts mainly.

JENNY BROCKIE: That’s interesting because I was going to ask you places like Vietnam and Thailand, particularly Vietnam where you get peanuts in lots of foods.

DR ROBERT LOBLAY: Whereas here we have roasted peanuts.

JENNY BROCKIE: And they don’t have high rate of peanut allergies in those countries?

DR ROBERT LOBLAY: No, they don’t. And here we have roasted peanuts and it seems as though the temperature at which the roasting happens is important as well, the higher temperature the more allergenic and the higher the flavour. So we think that maybe the food manufacturers are beginning to use higher roasting temperatures to improve the flavour may be one factor.

JENNY BROCKIE: And is there any evidence that women eating peanuts or nuts when they’re pregnant might increase the risk or not eating them might increase the risk?

DR ROBERT LOBLAY: Yes, there’s really only anecdotal evidence at the moment, although it’s quite impressive, in some people how when they’re breastfeeding, for example, or late stage of pregnancy a person might have really pigged out on a particular food, maybe a peanut butter lover, and the baby turns up having an allergy to that food.

JENNY BROCKIE: Linda Hodge, you’re a dietician in private practice. What do you think is behind the rise in food allergies? Have you got a theory? You might as well toss it in because everybody’s having a go at this. Do you have any explanation for why?

LINDA HODGE, DIETIAN, SYDNEY: Oh, no, it’s…so many things have changed over the last 20 years, so many things about our diet, so many things in our environment. I mean, if we look at what we eat now and compare it with what our grandparents ate, it is completely different. Every time scientists find that something is good for you, then it’s added to every food that you buy. So, you know, for example..

JENNY BROCKIE: So the days of meat and three veg are gone.

LINDA HODGE: Absolutely.

JENNY BROCKIE: Where people ate very simple food.

LINDA HODGE: Yes, that’s right.

JENNY BROCKIE: And now we’re eating all kinds of other exotic foods from different cultures and so on.

LINDA HODGE: That shouldn’t matter because different cultures have tolerated them time immemorial so that shouldn’t make any difference. No, I think it’s a balance problem. It’s possibly to do with the balance of foods and food chemicals that we’re having that might be having some influence in this.

JENNY BROCKIE: And just how much confusion do you think there is about food intolerance and allergies?

LINDA HODGE: Oh, well, whenever I see a patient I always have to explain the difference. They rarely know the difference between food intolerance and food allergies. I mean, food allergies are relatively easy to work out because they’re really quite obviousWHEREas food chemical intolerance is really quite difficult to work out because the food chemicals are found in such a wide range of foods and you can have little bits every day and not notice an acute reaction. It could be many days, weeks before you actually see a reaction as they build up.

JENNY BROCKIE: Because a lot of people wouldn’t think there were chemicals in foods. I think we’ve got a picture here of a range of vegetables, for example. Now, can you take us through what is meant here by low, moderate, high and very high. Let’s look at the low group first.

LINDA HODGE: Well, there are several chemicals in foods that natural chemicals in foods that have been identified as causing problems in some people. Salicylates, commonly known as aspirin, amines, and glutamates like MSG, and they’re responsible for the flavours in our food.

JENNY BROCKIE: And they’re naturally occurring foods?

LINDA HODGE: They’re naturally occurring.

JENNY BROCKIE: So there’s a low level of them in these foods we have here which are lentils and lettuce and cabbage. Are they lentils or peas?

LINDA HODGE: Green lentils. They’re all very bland. So bland foods tend to have low levels of natural chemicals but as the flavour increases, so here we have in the peas we have some natural glutamates occurring, in the asparagus and the sweet potato we’ve got lower levels or moderate levels of aspirin or salicylate.

JENNY BROCKIE: And let’s just quickly go through the next group. They’re the high groups, which again have high levels of these.

LINDA HODGE: Chillies in particular. You can tell by the flavour, the stronger the flavour generally the higher the level of chemicals in there.

JENNY BROCKIE: And very high?

LINDA HODGE: And very high, again, particularly tomatoes. Tomatoes in particular because they have such a combination, they have the glutamates, they have the aspirin, the salicylates, the amines, those lovely flavours that we all love.

JENNY BROCKIE: Monica, can I just talk to you about your daughter Eden a little bit, who’s six. Hello, Eden. Hi. Eden suffered from severe asthma a few years ago. Now, you believe it was connected with eating some fruits and we’ve got that graphic again of fruits which I’ll get put up here. You believe that her reaction was connected to some of these fruits that we’ve seen as well as foods with additives. Was that confirmed by a doctor?

MONICA HOPGOOD: No, we haven’t. We’re in a position where we live in a rural area. If we were to live in Sydney or Melbourne it would probably be a bit easier but we just find from, you know, having put Eden on an elimination diet and then challenged things.

JENNY BROCKIE: So what was she eating a lot of?

MONICA HOPGOOD: Well, it’s interesting because the things that she reacts to either she repels, like she doesn’t she’s never eaten tomatoes, strawberries, citrus fruits, avocados, the things that are high in salicylates.

JENNY BROCKIE: Why don’t you tell us, Eden? What are you trying to say?

EDEN HOPGOOD: I have tried strawberries and I have eaten watermelon.

JENNY BROCKIE: And what happened when you ate that?

EDEN HOPGOOD: Nothing.

JENNY BROCKIE: Nothing, OK. That’s good to hear.

MONICA HOPGOOD: Eden’s probably more of a build-upWHERE you talk about a delayed reaction, and particularly food additives even more so than the salicylates are an issue, MSG, sulfur dioxide. It’s a big problem for a lot of asthmatics. And we’ve found that if we avoid these things most of the time in Eden’s diet that she just doesn’t get asthma anymore.

JENNY BROCKIE: Joan Breakey, you’re a dietician in local practice in Brisbane. What do you make of all of this, hearing all these stories?

JOAN BREAKEY, DIETITION, BRISBANE: I suppose one of the things that I’d like to say is that allergy is a complex problem and we’re all looking at it from different angles. I came to it from working with hyperactive children who also were allergic. What happened was the additives, the natural chemicals, aggravated their hyperactivity. And the new research that’s just been published in the ‘Lancet’ has shown that additive colours cause hyperactive-type reactions in the normal population. So we’re saying that these additives make a difference and if they make a difference in the behavioural way, they can make a difference in the allergies in that group. So the total load, of all of these things matter. So I guess I’d say that the chemical load of food intolerance aggravates the underlying disorder, and one of the underlying disorders it aggravates is allergy.

JENNY BROCKIE: And when you say the chemical load, you mean the chemical load of the sorts of foods that we’ve seen up here.

JOAN BREAKEY: Additives and natural chemicals. Yes, exactly. So it’s kind of what I call diet detective work where people can lower things down and then gradually work out what they can manage. And that each person is different.

JENNY BROCKIE: Is it any different to earlier generations, what we’re seeing at the moment?

JOAN BREAKEY: I see lots of parents who say that, “If I had not been well looked after I would have died because my secondary infections and the asthma and then get pneumonia,” and so on. And only three generations ago our parents used to talk about the fact that somebody had seven children but only three of them survived to adulthood. So I think the fact that we’re able to look after people also makes a difference.

JENNY BROCKIE: Now, Rob Loblay, how close are we to finding any answers to all of this, any real answers that we can hang on to?

DR ROBERT LOBLAY: We’re a long way away from finding a cure once an allergy has already developed. But we’re a long way down the track in terms of knowing how to manage them once they’ve developed.

JENNY BROCKIE: With things like this EpiPen that we saw for people to carry. How many people here are carrying an EpiPen tonight? A lot of hands up over here, yes, quite a lot. OK. Rob, what should people do in the meantime? Apart from carrying EpiPens when they know they have this kind of allergy or their child does, what else can people do, particularly with young children?

DR ROBERT LOBLAY: Well, the first thing to do is to make sure that the allergies have been properly diagnosed because a child with one allergy has quite a high chance of having another one. The second point is to be very careful about avoiding contact with the allergen so that reactions don’t occur. And then the last thing, of course, is to have the rescue medication, the EpiPen, available at all times in case there’s an accidental exposure.

JENNY BROCKIE: Mimi Tang, are there any promising developments on the horizon do you think with research in this area?

PROFESSOR MIMI TANG: There certainly are. I mean, there are lots of studies ongoing. But I agree with Rob, really, a cure is probably a long way away. There are studies looking at immunotherapy, or I guess the community might know of it as allergy shots. So we know that immunotherapy works for hay fever and allergy to pollens, for example.

JENNY BROCKIE: How does immunotherapy work?

PROFESSOR MIMI TANG: Immunotherapy works by delivering small doses on a regular basis of the allergen somebody’s allergic to, and over time that teaches the immune system to become tolerant to that allergen and it no longer induces the symptoms that it used to. The problem with food allergy is that studies have been trialled but they were associated with quite severe systemic reactions, anaphylaxis essentially, and so standard immunotherapy for food allergy was shelved.

JENNY BROCKIE: Mimi, in the meantime, though, should people with children under three be avoiding these high-risk foods? I mean, it seems to me that it’s a bit of a scary scenario for the parents of small children. If you don’t know and the only way you’re going to find out is an anaphylactic reaction, is it better to avoid some of these foods?

PROFESSOR MIMI TANG: I don’t know that that’s the right answer. But there is some evidence that communities where there’s early introduction of peanut, for example, in IsraelWHERE babies are weaned on a peanut snack called Baby Mum-Mum snack, there are actually very, very low rate of peanut allergy. There is peanut sensitisation, that means you have a positive skin test to peanut, but the rates of allergy to peanut are extremely low. And there is now some question arising should we in fact be introducing foods early because that’s the natural way to develop tolerance. And, you know, are the rising rates in peanut allergy related to our recent policies of delaying introduction of highly allergenic foods. I think that’s a difficult question.

JENNY BROCKIE: I’d like to test that with some of the people here. What do you think, Velencia, of that theory?

DR VELENCIA SOUTTER: I mean, it’s not something for which there’s a black and white answer and I think it would be entirely wrong to say “This is the right way to do it and that’s not the right way to do it.”

JENNY BROCKIE: But what advice do you give parents in the meantime?

DR VELENCIA SOUTTER: Well, that’s a little bit difficult because you can’t just say, “Oh, well, you shouldn’t give the children this food,” because not everyone is going to be at risk. But there are some foods for which you should be a little bit more cautious about how you first trial it.

JENNY BROCKIE: Such as?

DR VELENCIA SOUTTER: Well, for instance, egg. I mean, something like giving a baby uncooked egg, I mean, when I was younger and when, you know, I had my children, I mean, it was simply heresy to contemplate giving your child uncooked egg at the start. You gave them fully cooked egg and that kept going for a while before you ever gave them soft egg.

JENNY BROCKIE: So there’s a big difference between cooked egg and uncooked egg?

DR VELENCIA SOUTTER: Absolutely, that’s the first thing. And the next thing is, I mean, people never used to consider giving.. Before the early ’90s peanut butter was never offered as a food to young children. It suddenly became very fashionable when..

JENNY BROCKIE: So you’re really saying don’t give it to them, that seems to be..

DR VELENCIA SOUTTER: In most ways, yes.

JENNY BROCKIE: And particularly if you’ve got a history. It sounds like if there’s a history of allergies in your family, be a bit more careful as well with these things. Would that be right, Rob?

DR ROBERT LOBLAY: Yes, I think so. But what I think what Velencia’s alluding to is the form in which the food is offered is important. So peanut butter is different from the rusks that Mimi was talking about that the kids in Israel are being given.

DR VELENCIA SOUTTER: Yes, I mean they’re not given peanut butter in those rusks. You’ve got to actually kind of know that..

JENNY BROCKIE: But most people don’t know this stuff. I mean, the average parent would just think a piece of toast with a bit of peanut butter on it.

DR VELENCIA SOUTTER: That’s a recent development in terms of our eating lifestyle. I mean, I can well remember the first peanut anaphylaxis that I came across in a baby and it was child that was in a Karitane, which is one of these, sort of places where parents go. And this was a 7-month-old child with severe eczema was given a peanut butter sandwich for her lunch and had a massive anaphylaxis. And I went, “Who in their right mind would give a 7-month-old baby with eczema a peanut butter sandwich?”

JENNY BROCKIE: Well, somebody who doesn’t know this stuff. I mean, a lot of people don’t know.

DR VELENCIA SOUTTER: But the point was I then started having a blitz of education because I realised that there had been this trend towards offering babies peanut butter which had sort of sprung up from some do-gooding idea that it might be a worthwhile thing to do.

JENNY BROCKIE: And you’re saying it’s not a worthwhile thing to do by the sound of it?

DR VELENCIA SOUTTER: No, it’s not.

JENNY BROCKIE: That’s what I’m trying to get to – what’s the advice of parents.

DR VELENCIA SOUTTER: I mean, peanut butter is not the way to certainly offer babies peanut as their first food. As Mimi says, it may be important that we offer these foods in the right form at the right age but certainly not like that.

JENNY BROCKIE: Yeah, and I think a lot of people don’t know what that means, what does the right form mean. Martha?

MARTHA BAPTIST: I was actually given advice with our son Alex to give him peanut butter because he was underweight, to try and fatten him up, and that actually was advice that was given me to early on by a dietician.

DR VELENCIA SOUTTER: But we do see that quite a lot, that parents are advised to do things which you would… they would never have been advised. You know, there became a trend in the early ’90s as well that if your breast milk didn’t seem like it was good enough you ate more nuts, for instance. I meanWHERE did that come from?

JENNY BROCKIE: So there’s a real need for education along this. There sounds like there’s a huge gulf between what people know and what they don’t know. Karen Jamieson, Kiara starts school next year, how are you feeling about that?

KAREN JAMIESON: Very anxious and nervous about it all. I mean, we’ve been so safe with her and you can’t be complacent because you’ve been so safe, you just never know. And she’s very mature for her age. She knows if we go out, if we’re at the shop and someone offers her a lolly or anything, she straightaway says, “Does it have traces of nuts?”

JENNY BROCKIE: You straightaway say no, do you, Kiara? And why do you do that? What do you think would happen if you had that lolly?

KIARA JAIMESON: I’d get sick.

JENNY BROCKIE: Maree El-Chaar, we’ve been talking a lot tonight about children at school and you’re a second grade teacher. You’ve been teaching for 25 years. How do you deal with this in a school?

MAREE EL-CHAAR, PRIMARY SCHOOL TEACHER: We take it in our stride. I mean, we have a plan in place, it’s a comprehensive management plan and an action plan if something does go wrong.

JENNY BROCKIE: Have you had children in your class with anaphylaxis?

MAREE EL-CHAAR: Yes, I’ve got one at the moment in my class, he’s allergic to nuts.

JENNY BROCKIE: Do you think most people are aware of how serious it is, most other parents, or can be?

MAREE EL-CHAAR: We do inform our parents on enrolment that this is a nut-free school and we do have children with food allergies at our school. They are aware they’re not supposed to send nut products to school for lunches or for the snack bars, and most of them do accept that fact.

JENNY BROCKIE: Most of them but not all of them?

MAREE EL-CHAAR: We do have…initially we do have a few parents who say, “Well, my child can’t eat anything else but a peanut butter sandwich or Nutella sandwich for lunch.” And we just say, “Well, this is our policy and this a life-threatening situation for these children, you just have to adhere to the policy.”

JENNY BROCKIE: Maria, you’re from Anaphylaxis Australia which is a support group for people with allergies, and you have a son with anaphylaxis. What would you like to see happen in relation to all of this?

MARIA SAID, ANAPHYLAXIS AUSTRALIA: Look, I think since my son was diagnosed, he’s now 17, I’ve been waiting for a cure. And parents slowly get to the point where they accept that OK, well we’ve got to manage this in the real world. It’s all about education, it’s about learning how to manage it whilst living a normal life. It’s about primary schools, you know, doing what they can to minimise risk and that certainly can mean asking parents not to send in, you know, say, whole eggs or meringue or peanut butter because, you know, young children eat with their whole body and they like to be quite physical with each other and so forth. Anaphylaxis is generally from ingestion but people can have touch reactions as well. They might just get..

JENNY BROCKIE: Or like Dallas’s daughter can just inhale the vapour from a satay, I think you said, yep.

MARIA SAID: Yeah, and that is really scary for the parent and it’s scary for the teacher as well if it’s the teacher caring for the child. So it’s about everyone working together to reduce risk and, you know, letting the child live a very, very normal life. It can be done.

JENNY BROCKIE: Martha, we’ve heard a lot about EpiPens tonight. Was one of those EpiPens available to your son when he was at the kindergarten?

MARTHA BAPTIST: Yes, we left Alex at the kinder with an EpiPen and staff had advised us that they did know how to administer it, but when it came time to give it to Alex the first staff member injected herself in the thumb. A second staff member tried to give a second EpiPen but didn’t take the safety cap off so he didn’t receive any adrenaline then. So it was quite…quite devastating.

JENNY BROCKIE: So you would be presumably wanting people to learn in schools how to use these, yeah?

MARTHA BAPTIST: Absolutely, yeah. I think there needs to be annual training of staff, any staff member that’s caring for a child with anaphylaxis and also just regular practice with a trainer EpiPen.

JENNY BROCKIE: It’s been a really big thing for you to come on to this program tonight, I know, and I really appreciate it. If there’s one message you want to get out to people watching, what would it be tonight?

MARTHA BAPTIST: I suppose it would be just for the broader community, I suppose, to take it seriously as a health issue. And just also I suppose to respect parents who are concerned about their children’s welfare.

JENNY BROCKIE: And to not roll their eyes and think that they’re exaggerating, yeah?

MARTHA BAPTIST: Yeah, it makes life a lot harder.

JENNY BROCKIE: Well, look, thank you very much for joining us, I do appreciate it. Thank you to everyone else too for sharing your stories with us tonight. It’s been great to have you here.

END

Anaphylaxis on the rise, tell us something we don’t know

This is sad, but true, Anaphylaxis is becoming more widespread. This is taken from Yahoo news todayhttp://au.news.yahoo.com/071012/2/14nrc.html

This comes on the back of a fantastic TV show concerning anaphylaxis, aired here in Australia this week on the SBS show called Insight. I’m looking at getting the tape of it, and will post more details once I get the show.

The number of Australians hospitalised for severe life-threatening allergic reactions has more than doubled in the past 15 years, a new report shows.

A major review of hospital figures has found a massive increase in anaphylactic attacks, with reactions triggered by food causing the biggest jump.

The rise was felt by people of all ages, but young children, particularly boys, were hardest hit, according to the study by the Australian Centre for Asthma Monitoring published in the international Journal of Allergy and Clinical Immunology.

Researchers studied hospital admissions and deaths in Australia from 1993 to 2005 to work out trends in anaphylaxis, a severe reaction which causes parts of the body to shut down.

They also looked at rates of hives and angioedema, the allergic swelling of the face, lips and tongue.

Results showed that, as in the UK and US, admissions increased in all three conditions and especially for food-related anaphylaxis in children under five, said co-author Professor Guy Marks said.

“There was a continuous increase in the rate of hospital admissions for each of these conditions, but the nature and (cause) differed between adults and children,” Prof Marks said.

Hospitalisations attributed to anaphylaxis more than doubled over the study period.

There was also an increase in admissions attributed to angioedema among older people, which may be related to adverse reactions to medications, he said.

Among children, admissions for allergic conditions were more common in boys than girls but among adults the gender difference was reversed.

The authors could draw no direct conclusions about underlying reasons for increased rates of hospital admission for these conditions.

The increase may reflect an increase in the incidence or an increase in their severity, or a combination of these, Prof Marks said.