The Australasian Society of Clinical Immunology and Allergy

(coinciding with the 17th ASCIA Annual Scientific Meeting 7-10 September 2006)

Food allergy seems more common these days, and the risks of serious allergic reactions (or even death) are commonly debated. So what is the real risk?

In a paired "Opinion Piece" in last week's British Medical Journal (BMJ), Professor Allan Colver (Newcastle, UK) claimed that the risks from food allergy were grossly over-rated, that those at highest risk could not be predicted, and that provision of emergency medication like injectable adrenaline (EpiPen) not only fuelled anxiety, but also was a futile exercise in most cases.

Countering these arguments, Professor John Hourihane (Cork, Ireland) explained that the major triggers for food allergy were common staples of Western diets (eg dairy products, egg, peanuts, nuts, wheat and soy), impossible to avoid with certainty, and the most common cause of serious allergic reactions (anaphylaxis) in the community.

Discussing this "Opinion Piece" at this week's conference of the Australasian Society for Clinical Immunology and Allergy held in Sydney this week, Dr John Ruhno (Sydney), Medical Adviser to Anaphylaxis Australia, stated that: "It's important to have some perspective here. You need to know that allergy services are relatively underdeveloped in the UK compared to Australia. In the absence of widespread specialty allergy services, often the only recourse to managing food allergy in the community is to offer an EpiPen".

"We're better off than our UK counterparts where there is a severe shortage of Allergists, particularly in paediatrics" said Assoc Prof Pete Smith (Queensland), "but the lack of any public hospital allergy services in some parts of Australia like Queensland or Tasmania, is a major cause of concern".

Dr Raymond Mullins (Canberra), commented that "Food allergy and anaphylaxis are conditions where the threat of recurrent symptoms is chronic, but the event itself is unpredictable. Seeing a young child turn from being well one minute, to a distressed swollen infant is a frightening experience for all concerned. This is a serious condition, and we should treat it as such".

Dr Robert Loblay (Sydney), Chair of the ASCIA Anaphylaxis Working Party, explained Professor Colver's arguments were undermined by high quality population surveys of food allergy incidence and severity.

"Quoting irrelevant media headlines or the relatively low risk of death does not discount the major impact an accurate diagnosis of food allergy has on the individual of their family.

"Food allergy, at least in children, is a modern epidemic that fills our waiting rooms, and is a real condition, not one diagnosed by the local naturopath. They can produce dramatic and potentially dangerous symptoms such as rapidly spreading hives and skin swellings, vomiting or difficulty breathing, and in extreme cases anaphylactic shock, requiring emergency treatment".

"Taking a chronic and currently incurable medical condition seriously is not just about death. The impact on individuals and their family, places an enormous social, financial and emotional burden that requires enormous resources, that we currently do not have in abundance".

Final comments came from Dr Karl Baumgart (Sydney), ASCIA President, who stated that "Modern allergy management is not about guesswork. Our Society has developed a number of evidence based guidelines for management of food allergy and anaphylaxis, when it is appropriate to prescribe EpiPen and downloadable educational material from our website".

For more information, contact the Australasian Society for Clinical Immunology and Allergy (www.allergy.org.au).