Preventing allergies – a Twitter essay

Unknown-1RIGHT NOW, as I type, many of the world’s top and absolutely bestest allergists and allergy experts are gathered in Houston for the American Academy of Allergy, Asthma and Immunology annual meeting. Later tonight, the UK’s Professor Gideon Lack will reveal the data from the long-awaited LEAP (Learning Early About Peanut Allergy) study into how best to prevent peanut allergy in young children.

In the run-up, I have been following the tweets from the great and the good gathered at the conference and the most amazingly informative string of posts has just come through from Canadian allergist Dr David Fischer. He calls it a Twitter essay on LEAP. Genius, and I felt it was worth sharing so I’ve pasted it below. (If you want to follow Dr Fischer on Twitter he’s @IgECPD and if you want to follow the conference tweets search the hashtag #AAAAI15.)

‘How we got to the leap study and what’s at stake’: A Twitter Essay by David Fischer, MD

1. There are 2 known ways of inducing tolerance (ie preventing allergy) in children: high zone tolerance and low zone tolerance

2. The concept of low zone tolerance is that if you’re not exposed to something you can’t become sensitized/allergic to it

3. Concept explains why North Americans become allergic to animals they’re exposed to (cats/dogs) but not, say, Tasmanian Devils 

4. Original theory behind strict avoidance of food allergy introduction until older ages in children based on low dose tolerance theory

5. High zone tolerance is when large early exposures induce tolerance. This is the plan of the LEAP study

6. The problem with the low zone tolerance idea in the West is that the strict avoidance of these foods is impossible 

7. Most patients reacting to peanut have with 1st exposure, but it’s not their 1st. Traces in packaged food & skin exposure in homes problem

8. A few Physician groups put out warnings based on Strict Avoidance/Delayed Introduction. That timed with increase in food allergy rate

9. These Guidelines were reversed years ago, allowing for earlier introduction of foods to children…with the hope of it being preventative

10. An Aussie study has already shown that introducing cooked egg between 4-6 months of age appears to prevent sensitization to egg 

11. Dr Lack (LEAP study author) has already noted that the rate of peanut allergy in Israel (where peanut is 1 of the 1st foods) is lower

12. Lack feels it’s a race against time to induce oral tolerance to peanut before intermittent trace exposures (esp skin) induce allergy

13. What we find out today is whether we can literally PREVENT peanut allergies through early peanut introduction. Stay tuned

Note: I asked him if he would mind clarifying ‘intermittent’ in this context and he replied: “From a food perspective I would mean small exposures such as feeding a child foods that have ‘traces of nuts’ instead of nuts.”

So there you have it. Now waiting on that LEAP* data.

The LEAP trial took 640 children aged between four months and 11 months of age who were identified as high risk for peanut allergy (based on an existing egg allergy and/or severe eczema). They were randomly split into two groups – consumption or avoidance. Those in the consumption group were to consume a peanut-containing snack with three or more meals per week; those in the avoidance group were not to ingest peanut-containing foods, both until the age of five. Here is more on LEAP from the BSACI and the Anaphylaxis Campaign.

**UPDATE** And here we have it – feeding peanuts to young infants with heightened allergy risk dramatically reduces the odds that a peanut allergy will develop. Follow the links to the study findings in the New England Journal of Medicine, an article in the New England Journal of Medicine blog here, the Allergic Living report here and The Telegraph here. Worth noting that Professor Lack has stressed that infants showing early signs of peanut allergy (those with skin prick test reactions greater than 4mm) were excluded from the study and effects of peanut consumption in this group remain unknown. But this is properly groundbreaking stuff…

 

 

 

 

 

 

 

 

 

 

 

 

 

Living on the egg-dge

IMG_2273SORRY, sorry. Just trying to find a way to express how daring my day was. Because today I took Baby Two for scrambled eggs.

It’s been almost exactly a year since the last time we managed to get some scramble down her – last December, on my birthday, during one night away from Sidney when Sadie was still too small to be left with her grandparents overnight.

Since then it’s been playing at the back of my mind. Every few months some article or other pops up on my Twitter feed proclaiming that avoidance of certain foods could actually lead to the development of allergies. Continue reading “Living on the egg-dge”

Attack of the ice cream (when accidents happen)

252562895_99c2c7b661TODAY A TODDLER put an ice cream covered finger in my baby girl’s mouth.

My first reaction was to yell ‘Noooo!’ and whip her out of her pushchair to douse her mouth out with a wet wipe.

Then I started to panic that she might react (so far she appears allergy free but Sidney’s doctor advised we delay the introduction of egg, nuts and sesame to his little sister until she is properly tested later this autumn). Then I began to shake, thinking: “Oh my God, what if someone had done that to Sidney?”

Continue reading “Attack of the ice cream (when accidents happen)”

Support group dates…

I’VE BEEN very remiss in blogging about these but the food allergy parents’ support group is trundling on happily, with different get-togethers happening in different parts of London. The next two are in Ealing and at St Mary’s Hospital in Paddington, but there are plans for another north London one, hopefully in November. I’ll keep you posted. Continue reading “Support group dates…”

It’s all of them

RECENTLY I posted about how the ludicrous blanket “nut, sesame, blah” trace warnings on just about everything in Sainsbury’s had driven me to tears.

Well, in the interests of fairness I’ve just come across the exact same thing in Waitrose. I can understand it on the baked goods and cakes, and even the olives and deli bits. But, again, I ask you: fish?

I nearly got kicked out of the bloody shop for taking this pic. Can you believe it (big security guard hulking over to tell me to cease and desist)? But I told him to bugger off.

Fight for your right to party!

SO, HERE we are surrounded by the debris of a summer get-together. But unlike the old days it’s not cig butts and wine bottles; this time I’m talking grapes, free from biscuits, and two empty pots of tea, because today we hosted the allergy parent support group for the very first time.

You only realise how keyed up you are about mass gatherings with a food allergic child when you are finally able to hold or go to one without any worries. No-one this afternoon was going to turn up with a peanut butter sandwich in a lunchbox – and I didn’t have to warn anyone of the dos and don’ts in advance. Continue reading “Fight for your right to party!”

British Airways – a rant

Airbus A319 takes off from London Heathrow Airport

I’M GOING to dash this off very quickly as I don’t have a heap of time but am too angry not to rant. In short: we are travelling, as we often do, with BA in Europe this summer and, as you may or may not know, our 18-month-old Sid is severely allergic to – among other stuff – nuts.

I know from previous experience that BA is uniquely unhelpful when it comes to dealing with nut allergy onboard. Their website clearly states (as if this gets them off the hook) that they will not make cabin announcements and won’t ban nuts from flights. Privately, crew have told me on more than one occasion that this has been deemed a ‘human rights’ issue – laughable, this, but apparently it may be against the human rights of passengers who wish to eat peanuts to ban them from doing so. Words fail. Continue reading “British Airways – a rant”

A quick thought

A QUICK thought on the Free From Food Awards that occurred to me as I was scribbling up the winners’ list.

Not only is there an absence of properly nut free stuff amongst them but there are very few foods that are safe for those with multiple allergies. Heaps of gluten free (and dairy free) out there, which is obviously laudable, but I’m worried that gluten free is becoming the fall back for anyone who wants to claim a ‘free from’ or ‘allergy friendly’ tag.

The supermarkets are among the worst culprits – they’re showering us with their ‘free from’ ranges but precious few of the products are safe for nut or egg allergy sufferers. Unless all the main allergens are covered it’s a bit of a box-ticking exercise, no?

That’s why Bessant and Drury’s win for their (*deep breath*) egg free, soya free, nut free, gluten free, dairy free, vegan ice cream caught my eye. (I think they’re probably wheat free, too, but need to check on that.) They’ve created a product that is not just aimed at the food allergy market but that can still declare itself to be allergy safe for many. I’d like to think this is the future for free from foods: not a specialist niche but an attempt to create properly luxury products that exclude the main allergens, but where taste is all.

I think the Free From Food Awards are a wonderful, important thing, but next year I would like to see a few more nut frees, sesame frees, soya frees and egg frees alongside the no gluten and no dairy winners. That’s not just a challenge to the awards, it’s a rallying cry to the industry. Please?

* UPDATE 25/4/12 Would you believe it, I’ve since found out that Bessant and Drury’s ice-cream isn’t ‘nut free’ after all. It’s made in a factory where nuts are present. Unfortunately their website states ‘nut free’ here, which I’m sure is just an oversight and a result of the fact that labelling laws are so confusing. Still, only serves to prove my point, I guess! They remain egg, soya, gluten and dairy free…

Parents need support, too… so here it is

When your child is diagnosed with a string of severe food allergies, it comes as a proper thwack in the guts.

I remember leaving our first paediatric allergy appointment, where skin prick tests showed Sidney was allergic to a catalogue of stuff, including the dreaded peanut, and crying in the car on the way home – well, until my crying set Sid off and I pulled myself together sharpish.

Of course there are far worse things that can happen but knowing that, and appreciating it, doesn’t mitigate the shock. You’re sent reeling: all those half-dreamt notions of taking your toddler to buy an ice-cream in the park, cooking up your favourite childhood treats, skipping round some halcyon village green fete (because we have a lot of those in Hackney) and buying freshly iced fairycakes for an impromptu summer picnic.

Then you start panicking about the next reaction: will it be anaphylaxis? Will you be with him? Will the EpiPen be enough? And schools: how can he possibly ever go to school without you to wipe down all the surfaces and ramraid every other child’s lunchbox for illicit peanut butter? And parties. And days out to cafes. And holidays. And what about this new thing called allergy bullying I’ve just been reading about? And what the hell do you do when every label on everything in the supermarket seems to contain that damn trace of nuts?

...but they didn't warn us about the rednecks....

All of the above are reasons I decided to start this blog. When I looked, in desperation and panic, for something, somewhere, to tell me how to cope, what to buy, where to go, I found that, while the likes of Allergy UK and Anaphylaxis Campaign do very good and important jobs, a lot of the info is incredibly doom-laden. Pics of kids with horribly swollen faces; tales of horrendous reactions in farflung places, miles from the nearest hospital; posters warning of the dangers of travelling anywhere without your EpiPen.

But there seemed to me very few places parents could go to find and share info and advice on everything from allergy-friendly places to eat, the foods and products they buy, recipes they rely on and tactics they adopt for kids’ parties, schools and the like.

Plus, as they say, strength is in numbers. There’s a whole host of misinformation and misunderstanding about allergy swilling about, and an appalling lack of basic training on cross-contamination and allergy-friendly foods within the catering industry, not to mention the shockingly unhelpful labelling of prepacked goods. So a group of parents with the same agenda can perhaps help to persuade a local supermarket to stock a better ‘free from’ range, or a local cafe to improve its allergy-friendly provision, or a nursery to get its allergy policy together, far better than a lone mother or father on a mission might.

All of that is why support for (and between) parents of kids with food allergy is vital. And it’s why I’m so pleased that our hospital, St Mary’s in Paddington, is to become the first hospital allergy clinic in the country to set up a parent support group.

Backed by a £30,000 grant from the Imperial College Healthcare Charity, the first meeting will be held in Ealing on Saturday 21 April, with consultant paediatric allergist Dr Robert Boyle and Katherine Phillips from the allergy team to host and answer any questions. See here for full details.

Says Dr Boyle: “We’re delighted to be able to set up such a useful resource for parents of children with food allergy.

“Parents of food allergic children can have greater knowledge about some things – such as local places to eat or where to buy ‘free from’ food – than healthcare professionals and may be best placed to advise and inform other parents. We are pleased to be able to put them in touch with each other.”

The plan is to roll the scheme out across London, if all goes well – and I am very happy to say I will be helping to launch the second support group meeting, in the Stoke Newington area, this summer.

For more info check back here, follow me on @foodallergyuk or see the St Mary’s support group site at www.allergysupportgroup.org.uk. If you wish to attend one of the support groups or to host one near your home email info@allergysupportgroup.org.uk.