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).
While studies of food immunotherapy to "switch off" food allergy have shown promising early results, they are not yet ready for widespread use. Thus management involves patient and carer education on how to avoid allergic triggers, what to do if they have a reaction, addressing higher risk situations (especially in teens attending parties and exposed to alcohol) and issues surrounding kissing and sexual intimacy, where allergic reactions are well described (7-10). In those considered at higher risk of serious reactions, provision of an adrenaline autoinjector may be required. The burden of avoidance and fear of an accidental exposure increases anxiety and results in reduced health-related quality of life.
To meet the challenge of increasing demand for education, ASCIA has developed a number of educational resources including national standardised emergency Action Plans and adrenaline autoinjector prescription guidelines. ASCIA with the assistance of unrestricted educational grants* has partnered with various state education and health departments to develop online education programs available at no charge from the ASCIA website (www.allergy.org.au). These departments have provided financial and logistical support for this long running project, which has emerged after extensive consultation and has now been endorsed by relevant state education and health departments. ASCIA training for childcare has also recently been approved by the Australian Children's Education and Care Quality Authority (ACECQA). Programs have been developed for school and childcare staff, health professionals, first aid providers and the broader community. In the last 3 months alone, over 80,000 teachers have registered for ASCIA anaphylaxis e-training for schools, with over 100,000 school and childcare staff undergoing ASCIA online training since the program was first launched.
ASCIA is a not-for-profit professional medical society. As a non-government organisation, ASCIA's educational activities are dependent on members donating their unpaid time for resource development, and funding derived from membership fees and unrestricted educational grants. Providers of unrestricted grants have no input into resource content or development.
More information about ASCIA is available at www.allergy.org.au/about-ascia
1. Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, Ponsonby AL, Wake M, Tang ML, Dharmage SC, Allen KJ; HealthNuts Investigators. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011 Mar;127(3):668-76.e1-2.
4. Herbert LJ, Dahlquist LM. Perceived history of anaphylaxis and parental overprotection, autonomy, anxiety, and depression in food allergic young adults. J Clin Psychol Med Settings. 2008 Dec;15(4):261-9.
8. Eriksson NE, Möller C, Werner S, Magnusson J, Bengtsson U. The hazards of kissing when you are food allergic. A survey on the occurrence of kiss-induced allergic reactions among 1139 patients with self-reported food hypersensitivity. J Investig Allergol Clin Immunol. 2003;13(3):149-54.