Geographic variation may give clues to food allergy

“Geographic variation may provide insights into some of the causes of food allergy in Australia”, states a Canberra based allergy specialist in separate articles published in the December edition of Annals of Allergy Asthma and Immunology and online in the journal Pediatric Allergy and Immunology.

Working with Drs Sunday Clark (University of Pittsburgh), and Carlos Camargo (Harvard Medical School), Dr Raymond Mullins, a Canberra-based allergy specialist, examined nation-wide prescription rates for infant hypoallergenic formulae (given to babies with multiple food allergies), EpiPen devices (used to treat life-threatening allergic reactions) and hospital admissions for serious allergic reactions (anaphylaxis).

They found that hypoallergenic formulae and EpiPens were prescribed much more often to young children in southern compared to northern sunnier regions of Australia. Hospital admissions for anaphylaxis were also more common in southern regions. The authors examined a number of factors to try to explain their findings including regional differences in income, employment, housing density, socioeconomic status, housing or population density, or access to medical care.

“The only thing that fell out was latitude (distance from the equator), and thus indirectly intensity of sun exposure and indirectly, ability of the skin to make vitamin D from sunlight”.

“Our findings likely represent real regional differences in rates of food allergy and anaphylaxis in Australia. Taken together with similar findings in the USA, this raises the possibility that lesser sun exposure and lower vitamin D levels might be one of several factors playing a role in triggering food allergy”.

“Indeed, a similar geographic pattern has been described with other immune system related diseases such as multiple sclerosis and type I diabetes” say Mullins. “We also know that vitamin D influences the developing immune system in many ways and that low levels are seen in many individuals in Australia. And in the last few years, low vitamin D levels have been implicated in increasing the chance of getting hay fever and asthma as well”.

But the authors caution against over interpreting their study. “This is not the answer to the food allergy epidemic we have seen in the last decade. If confirmed to play a role, vitamin D will likely be one of many factors playing a role in food allergy development. And it’s important that people don’t discard the “safe-sun” message that has prevented so many skin cancers in Australia”.

“Allergic disease in general, and food allergy in particular, is a major public health issue in Australia. ‘Generation A’ – the ‘allergy generation’, has already been born. We need to identify causative factors to help with the development of preventive strategies to stem the ongoing increase, and we need to encourage clinical studies to better treat those with already established disease. It’s early days yet, but our results lay an important foundation for further work on vitamin D and allergy.”

Surviving Christmas Feasting

Christmas is synonymous with feasting, particularly with our family (although I have firmly told myself that the feast is for one day only – or three – but not the whole season!).

I am happy to say that it hasn’t been an issue so far for us at our family gatherings (our extended family gatherings range from 30 to 50 people on Christmas Day). But I know that for others it’s not so easy.

We have just run a feature in the summer issue of Allergy Today on Surviving Christmas, so if you haven’t received the magazine subscribe now and have a jolly good read (I say!).

Here are a few pointers on eating out safely taken from the feature:


1. Let your friends and colleagues know you have a food allergy and what to do if you have a severe reaction. Make sure you take your medication with you, and show your friends where you keep it.

2. Contact the restaurant in advance, if possible, and avoid their peak times. It can be very difficult for staff to take care of your needs when they are extremely busy.

3. Explain your allergy to the manager and discuss the menu.

4. Simple meals with no sauces are usually the safest, for example pan-fried steak, with a side of steamed vegetables.

5. Remind all staff that all ingredient labels must be checked for the presence of the food you’re avoiding.

6. Ask about cross contamination controls in the kitchen: is your meal being prepared with clean utensils, saucepans, chopping boards etc? Have oils used for deep frying been used for frying other foods?

7. Check your meal before eating it.

8. If you had a successful meal, don’t forget to thank the staff. A simple thank you goes a long way!

What are some of your experiences with catering for your, or your child’s, food allergy?

I am particularly interested to hear how adults with food allergies manage to negotiate the Christmas do.

So post away!

Food foraging

When we talk about food allergies, it's usually the serious issues. But there is an amusing aspect, and that's the lengths we are driven to forage for safe food.

A case point is what happened with our local allergy support group a couple of days ago.

An eagle-eyed member noted that K-Mart was selling Kinnerton chocolate - and at only $4. For those of you not in the know, Kinnerton chocolate is the Holy Grail of chocolate for people with milk or peanut allergy. It used to be stocked in some of the main supermarkets but this stopped earlier this year, leaving us high and dry. And one bar usually costs close to $7 a bar.

Another member was so determined not to miss this deal that she got her kids up at the crack of dawn, dropped them off at the school gate right on opening time, and then sped across town to get to K-Mart before any other similarly motivated people got there before her. She managed to get a good stash of bars, and kindly left a few behind, but I suspect she has since called all other K-Marts to grab the same deal!

A couple of Easters ago I had a similar adrenaline-pumping experience when I discovered there were some huge Easter eggs available - again from K-Mart. Like most other allergy-affected families, Easter has never been a chocolate indulgence due to the fact there is very little available. So I was beside myself with excitement to think that my daughter would finally have a giant Easter egg. Unfortunately, they had all sold out — except for one right in the heart of Manukau. The store would not hold it, so my husband was despatched to complete the mission. It was a very anxious wait in case some other allergy folk got their dirty little hands on it. Mission, however, was accomplished.


What are some of the lengths you have gone through to get a particular food or to check whether it is safe?


Inga

PS It is somewhat sad to think of the excitement we go through when we discover a new food available to us!

Travelling with food allergies

There is no doubt about it: travelling with food allergies takes a lot of forward planning. You can’t simply book your ticket online and turn up at the airport like everyone else. In most cases, you need to go through a sales centre, disclose your food allergies and then think about what sort of nutritious meals and snacks you can pack. This is further hindered by security measures on liquids.

And you can expect more of a headache if you have to carry an auto-injector. I remember a security guard carrying my daughter’s EpiPen and escorting us through Brisbane international airport after our check-in person tried to wrestle the injector away from us (despite our doctor’s letter). We refused to be parted, thus the escort (as it was another security guard told them it was ridiculous and let us resume control of the EpiPen).

Considering we have no option but to travel by air, what can we expect from airlines? Penny, our chief executive, went to the Food Allergy and Anaphylaxis Alliance meeting in the USA in September and there was a lot of vigorous discussion on this topic.

The general consensus was we can’t expect airlines to guarantee safe meals. This is because meals are being prepared by different caterers, in different parts of the world, and under a wide range of legislation.

What we should expect is for airlines to allow us to take our own food on board. In some cases, flight attendants are kind enough to put your food into their convection ovens to heat up, but this is that at their discretion (and if you go down this route, you will need to put your food in something that is not going to melt!).

We should also expect airline staff to be trained in an emergency response to anaphylaxis and to be able to administer adrenaline auto-injectors if required. Most airline staff receive first aid training, and Virgin and British Airways staff receive five days of training, including life support, and do an annual refresher. Virgin Airlines Australia staff are now trained in recognising and treating anaphylaxis. We think all airlines should follow Virgin’s steps. At the opposite end of the spectrum, one airline has forced passengers at risk of anaphylaxis to sign a form that says they will pay all costs if the airline has to turn around in an emergency. Members of the Food Allergy and Anaphylaxis Alliance are currently investigating this.

In the meantime, recent research indicates that we need better education all-round, and particularly within our food-allergic community. A letter published in last month’s Journal of Allergy and Clinical Immunology looked at self-reported allergic reactions to peanuts and tree nuts on commercial airlines. The study surveyed 471 people known to have severe peanut, nut or seed allergies. Almost 10 per cent of those surveyed (45) reported reactions and, alarmingly, only 12 of these people notified their flight attendants. Peanuts were the main culprit. Six people went to an emergency department after the plane landed.

In the majority of cases, the allergic reactions were a result of eating the airline food. The study noted that while a proportion of people believed the reaction was to inhalation of peanuts, there has not been enough evidence to support this, even from other similar studies. The authors suspect the reactions are due to some form of ingestion, for example, getting allergen on their hands.

What are your thoughts on airline travel?

• Do you think airlines should minimise risk for those with peanut allergies but not serving peanuts? What sort of experiences have you had when travelling?


• How have you managed your meals, particularly on long-haul flights?


• Another important question is: how easy is it for you to find out airlines’ policies on food allergies and anaphylaxis?


• How do you get hold of the relevant person at the airline?


• What can we suggest to airlines to make travel easier for food allergy sufferers?

We would love to hear your experiences, and your input will help us with information we are putting together on travelling with allergies.

If you prefer not to comment on the blog, but still wish to share your experiences, you can email me at inga@allergy.org.nz.

Inga Stünzner
Information Officer

Welcome to Allergy New Zealand

Hello everyone.



We are finally joining the 21st century with the creation of our very own blog! We plan to do a weekly post, and invite you to share your views and any news.



Watch this space closely for our first post, which will be appearing before the end of the week.



The Allergy New Zealand Team

www.allergy.org.nz