Food allergy is common in early childhood. Avoidance of known allergic triggers is the mainstay of management, as potential future treatments such as food allergen immunotherapy remains in the realm of ongoing research at this time.
Since accidental exposure can occur despite best efforts, management of children with severe allergies, who are at risk of anaphylaxis, requires development of a broad management plan in schools and childcare including:
- age appropriate education of allergic individuals and their peers
- staff training in the recognition and management of allergic reactions
- development of strategies to reduce the risk of accidental exposure including individual health care plans
- an emergency response plan for when exposure does occur.
ASCIA guidelines for prevention of anaphylaxis in schools, pre-schools and childcare were recently published in the Journal of Paediatrics and Child Health and are available from the ASCIA website: www.allergy.org.au/health-professionals/papers/prevent-anaphylaxis-in-schools-childcare
Blanket food bans are not recommended by ASCIA, although restricting some important food allergens (such as nuts) may have a place in reducing the risk of accidental exposure in very young children who are too young to be relied upon to avoid contact with potential allergic triggers themselves, either by ingestion or cross contamination of equipment like toys or play services.
Including new asthma and anaphylaxis information
Many individuals with severe allergies, who are at risk of anaphylaxis, also have asthma and sometimes it can be difficult to differentiate between anaphylaxis and asthma symptoms.
To help address this issue the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak medical society for immunology and allergy in Australia and New Zealand, has recently included a new “Asthma and Anaphylaxis” module into its updated versions of ASCIA anaphylaxis e-training for schools, childcare services and the community.
ASCIA anaphylaxis e-training courses for schools, childcare services and community have been developed to provide ready access to high quality, consistent, reliable and evidence based anaphylaxis education throughout Australia and New Zealand.
The updated ASCIA anaphylaxis e-training courses include the following important changes:
- New asthma and anaphylaxis module – which provides clear guidance on how to respond in an emergency situation regarding anaphylaxis and asthma, as it is sometimes difficult to differentiate between the two conditions.
- Updated ASCIA Action Plans – which provide guidance on how to manage mild or moderate allergic reactions and anaphylaxis, including when and how to give the adrenaline autoinjector. For these reasons, ASCIA Action Plans should always be kept with the adrenaline autoinjector.
- Updated information about adrenaline autoinjectors.
- Amendments to terminology to ensure consistency with revised ASCIA Action plans and other ASCIA education resources.
The updated ASCIA Action Plans include the following important changes:
- Revised wording regarding CPR – by stating “Commence CPR at any time if person is unresponsive and not breathing normally”, which is consistent with the Australian Resuscitation Council (ARC) wording.
- Revised wording regarding asthma – by stating “If uncertain whether it is asthma or anaphylaxis, give adrenaline autoinjector first, then asthma reliever medication.” and inclusion of a tick box in the personal (red and green) versions to indicate if the person has asthma.
- Space to include a larger photo of the individual in the personal (red and green) versions.
The updated ASCIA Action Plans can be freely downloaded from the ASCIA website by doctors, patients or their care-givers from:
It is important to note that:
- ASCIA Action Plans are medical documents and therefore must be completed and signed by the individual’s medical practitioner (GP or specialist).
- Parents of children with food allergy/anaphylaxis are encouraged to visit their GP yearly to renew ASCIA Action Plans for the new school year, to be re-trained in the use of their adrenaline autoinjector device (if prescribed), and check if any new problems have arisen that might suggest the need for availability of an adrenaline autoinjector (e.g. new regular asthma, new or more serious allergic reaction).
Allergy and other immune diseases are amongst the fastest growing chronic and complex health conditions in Australasia – affecting one in four children and adults in Australia and New Zealand.
The Australasian Society of Clinical Immunology and Allergy (ASCIA) said the rapid rise has resulted in an urgent need for new research to understand the reasons for the increasing prevalence and to help find potential new treatments and cures.
Today in Perth, ASCIA will launch the Allergy and Immunology Foundation of Australasia (AIFA) to fund high quality education and research projects into disorders of the human immune system in Australia and New Zealand.
Two important new anaphylaxis resources are now available on the ASCIA website:
1. ASCIA Guidelines for prevention of anaphylaxis in schools, preschools and childcare
2. Translations of Fact Sheet for Parents of Children at Risk of Anaphylaxis
ASCIA Guidelines for prevention of anaphylaxis in schools, preschools and childcare
These Guidelines provide strategies to minimise the risk of accidental allergen exposure in schools, preschools and childcare services and replace the previous version that was published in 2004.
They have recently been published in the Journal of Paediatrics and Child Health (JPCH) 49 (2013) 342-345 http://onlinelibrary.wiley.com/doi/10.1111/jpc.12166/abstract and the PDF has also been posted on the ASCIA website with permission from Wiley Publishing and the JPCH:
Translations of Fact Sheet for Parents of Children at Risk of Anaphylaxis in NSW
Fact sheets for parents of children diagnosed to be at risk of anaphylaxis in, including translations into other languages are now available on the ASCIA website in the anaphylaxis resources section:
The Australasian Society of Clinical Immunology and Allergy (ASCIA) has released the ASCIA Allergy and Immune Diseases in Australia (AIDA) Report with the aim of these conditions being recognised as one of the 7 most important and prioritised chronic disease groups and a National Health Priority Area in Australia.
ASCIA President, Clinical Associate Professor Richard Loh states "Allergy and immune diseases are among the fastest growing chronic conditions in Australia. Almost 1 in 5 Australians has an allergic disease and this is increasing."
"Allergic diseases impact significantly on the quality of life of those who have the condition as well as those who care for them. Whether you are managing persistent allergic rhinitis or life threatening anaphylaxis, these conditions impact on every day of your life. Increased awareness of these conditions and improved access to patient care is vital as these conditions continue to increase in prevalence and impact on our community", said Maria Said, President of Allergy & Anaphylaxis Australia.
"Whilst the increasing prevalence of allergic disease, particularly the increase in food allergy prevalence, has been reported widely in the media, immunodeficiency diseases are serious, potentially life-threatening conditions that are also increasing in number and complexity", said A/Prof Loh.
"1 in 20 Australians are affected by autoimmune diseases, many of which impact tremendously on their quality of life", he said.
ASCIA seeks recognition of allergy and immune diseases as a prioritised chronic disease group and a National Health Priority Area to assist in raising awareness nation-wide as well as a national approach to improving the prevention and management of these conditions.
Food Allergy - A Rising Global Health Problem:
This week the World Allergy Organization (WAO) has announced the 3rd annual World Allergy Week (8-14 April 2013) with the theme of Food Allergy - A Rising Global Health Problem.
Food allergy is rising in prevalence in both developed and developing countries, especially in children, so there is a need for enhanced education and patient care services worldwide. During World Allergy Week 2013, the Australasian Society of Clinical Immunology and Allergy (ASCIA), a member of WAO would like to highlight the issue of Food Allergy and Quality of Life.
Food allergy is common in Australia, and predominantly affects young children. In the most accurate estimate of food allergy in Australia performed thus far (1), the HealthNuts study based in Melbourne, Victoria, demonstrated food challenge proven incidence of food allergy at age 12 months to be much higher than previously suspected; food allergy overall (10%); peanut allergy (3%); raw egg (8.8%) and sesame seed (0.8%). Estimates of food allergy in older children are 3-5%. An estimated 1.3% of Australian adults have food allergy (2).
Food allergy and anaphylaxis are conditions where the threat of reaction is ongoing but when another reaction will occur is unpredictable. Nor is it easy to predict if reactions will worsen or become life-threatening (anaphylaxis) as 1/3 of patients with anaphylaxis have food-induced anaphylaxis with first known exposure and 80% of fatal anaphylaxis cases have had previous milder reactions without dangerous features.
Current death rates appear to be relatively low (3), although this may increase with time as current young children with peanut/ tree nut allergy age. Concentrating on death rates alone, however, underestimates the ongoing impact on quality of life experienced by patients and their carers on a daily basis (4-6).
The Australasian Society of Clinical Immunology and Allergy (ASCIA) has developed ASCIA anaphylaxis training for first aid (community) in response to the recognised need for quality anaphylaxis training for the general community. This course provides ready access to high quality, consistent, reliable and evidence based anaphylaxis education throughout Australia and New Zealand.
It has been released this week and is now available free of charge from the ASCIA website: www.allergy.org.au/patients/anaphylaxis-e-training-first-aid-community
Anaphylaxis is a potentially life-threatening allergic reaction that requires urgent medical treatment.
It is therefore essential to know how to recognise and respond to an anaphylaxis emergency as well as implement appropriate risk minimisation strategies to prevent exposure to known allergens.
ASCIA anaphylaxis e-training for first aid (community) has been designed to be undertaken by the broader community such as parents, friends, carers, patients, workplace or student colleagues, and club members.
The ASCIA President, Clinical Associate Professor Richard Loh states "It is important to increase awareness of anaphylaxis in the broader community. This course has therefore been developed to help patients, parents, carers and other community members manage life-threatening allergic reactions by educating people about how to identify and respond to anaphylaxis."
As we enter the Christmas and New Year holiday period it is timely to reflect on the vast achievements of the Australasian Society of Clinical Immunology and Allergy (ASCIA) over the past year, particularly in education, as well as the continuing collegiality of ASCIA members, as demonstrated so well at ASCIA 2012 in Wellington, New Zealand.
November and December 2012 have been particularly busy months for ASCIA education projects, and the following documents have recently been added to the ASCIA website anaphylaxis resources section www.allergy.org.au/health-professionals/anaphylaxis-resources :
- Revised ASCIA Action Plans for Anaphylaxis and Allergic Reactions (2013 versions)
- New ASCIA anaphylaxis parent fact sheets – NSW, WA and Australasian versions
- New ASCIA anaphylaxis and food allergy health professional information papers
Other new or updated ASCIA website information includes:
- Updated ASCIA dietary avoidance for food allergy patient information sheets www.allergy.org.au/patients/food-allergy/ascia-dietary-avoidance-for-food-allergy
- ASCIA 2013 Annual Scientific Meeting – www.ascia2013.com.au
Updated versions of the ASCIA Action Plan for Allergic Reactions and ASCIA Action Plans for Anaphylaxis have been released by the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak medical society for allergy and clinical immunology in Australia and New Zealand.
The 2013 versions of the following ASCIA Action Plans are now available free of charge at: www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-action-plan-for-anaphylaxis :
- ASCIA Action Plan for Anaphylaxis personal (EpiPen or Anapen versions) - provided to patients with food, insect or medication allergy who have been prescribed an adrenaline autoinjector.
- ASCIA Action Plan for Anaphylaxis general (EpiPen or Anapen versions) - used as posters or stored with adrenaline autoinjectors in first aid kits.
- ASCIA Action Plan for Allergic Reactions - provided to patients with allergies who have not been prescribed an adrenaline autoinjector.
These ASCIA Action Plans provide guidance on how to treat mild or moderate allergic reactions and severe allergic reactions known as anaphylaxis, in an emergency. They indicate when and how to give the adrenaline autoinjector (EpiPen or Anapen). Therefore, it is essential that an ASCIA Action Plan for Anaphylaxis is always kept with the adrenaline autoinjector, wherever it is located, including home, school, childcare, workplace or even if it is carried by the individual.
Allergic rhinitis (commonly known as hay fever) is the most common allergic disorder in Australia and New Zealand, in both children and adults. To address the need for evidence based education in this area, for medical practitioners working in primary care, ASCIA has developed two new free online courses:
- ASCIA allergic rhinitis e-training for health professionals
- ASCIA immunotherapy e-training for health professionals
These courses have been released this week and are now available on the ASCIA website: www.allergy.org.au/health-professionals/health-professionals-e-training
These courses aim to provide accurate, consistent and evidence based education for primary care practitioners on how to effectively manage allergic rhinitis, when to refer patients to specialists and how to safely administer ongoing (maintenance) allergen immunotherapy (sometimes referred to as desensitisation), one of the treatment options for some patients with moderate or severe allergic rhinitis.
Based on self-reports, allergic rhinitis affects approximately 15% of Australians1. Studies have shown that moderate to severe persistent allergic rhinitis significantly impacts quality of life2. Allergic rhinitis can affect day to day functioning including affecting the learning ability of children at school and productivity of adults at work.
Primary care practitioners play an important role in the management of allergic rhinitis. Many patients with mild to moderate allergic rhinitis can be appropriately managed by their general practitioner or paediatrician. Patients with moderate or severe allergic rhinitis may need to be referred to a clinical immunology/allergy specialist, particularly for initiation of allergen immunotherapy.
ASCIA spokesperson Dr Sam Mehr said that the waiting list to see a specialist in immunology and allergy is too long and primary care practitioners can assist by assessing patients for appropriate referral.