Sydney Medical School immunologist studies food allergy increase

17 June 2014

Dr Robert Loblay, Sydney Medical School Immunologist and Director of the Allergy Unit at Royal Prince Alfred Hospital, has said that the incidence of food allergy has increased in Australia in the past 15 years or so, but also all over the developed world.

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Dr Loblay said the biggest increases in food allergy prevalence has been in peanut and tree nut allergies.
“The reasons are complex, but most likely due to changes in dietary habits. Unlike egg and milk allergies, which almost all kids grow out of before they reach the end of their teens, in most cases of nut allergies, they persist into adult life and pose an ongoing lifelong risk,” he said.
“Following a sharp rise in clinical presentations in the late 1990s, we began surveying central Sydney childcare centres at five-year intervals and it looks like the incidence of food allergies has reached a plateau in the past ten years; however, even though the incidence of new cases of food allergies may have reached a plateau, the prevalence (total number of cases in the whole community) is set to continue rising steadily for the foreseeable future—at least until we can figure out how to prevent nut allergies developing in the first place.
“Nationally, the most recent study of the rate of admission to hospital with food anaphylaxis increased significantly in the years between 1995 and 2006, most dramatically in the 0-4 year age group.
“School and childcare policies for prevention and management of anaphylaxis were developed in the mid-2000s and are now fairly well established in all states.
“There seems to be good awareness in the school sector of the need for children at risk to have an anaphylaxis action plan such as the one developed by Australasian Society of Clinical Immunology and Allergy, and to have an adrenaline auto-injector (EpiPen, Anapen) readily available.
“The looming issue at present is that the early wave of kids who developed nut allergies as infants and toddlers in the late 1990s are now growing up, leaving the relatively sheltered environments of school and home, and venturing out into the more hazardous world of adult life including eating out, socialising, work, and travel,” the Sydney Medical School immunologist said.
“The transition can be difficult and there are many hidden hazards including kissing—about which parents are often in denial during the early-mid teens.
“Adolescents can get complacent if they haven’t had any serious reactions in recent years. They want to be like their peers, they take risks, they think they’re bullet-proof, and some get slack about carrying their adrenaline syringes when they go out.
“Since many kids are allergic to multiple different nuts, the risk of accidental exposure and serious reactions is multiplied accordingly.
“In coming years we can expect to see more potentially life-threatening anaphylactic reactions occurring out in the community. Although death from food anaphylaxis is relatively rare, we can expect it to increase unless effective prevention measures are instituted.
“The greatest risk is amongst teenagers and young adults with persisting nut allergies and a history of asthma.
“The time has come to develop wider community awareness campaigns, but professional bodies, health departments, food industry and regulators have not yet begun to grapple seriously with the issue,” Dr Loblay said.

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