Ahistoryoffoodallergy

Theevolvingstoryovertwodecades ByDavidReading

1976:foodallergyinthepubliceye

Adefinitionofallergy
Allergy occurswhentheimmunesystem reactsadverselytoafoodorsubstancethatis harmlessformostpeople. Anaphylaxis isattheextremeend severe andrapidlyoccurring.

Foodintolerance
Doesnotgenerallyinvolvetheimmune system. Requireslargeramountsoffood. Symptomstakelongertooccur. Symptomsmayincludeheadache,digestive discomfort,sluggishness. Example:lactoseintolerance.

My skirt doesnt fit. It must be an allergy.

Milestonesinallergyresearch
HughSampson'sworkonfoodchallengesand predictivevaluesforskinandIgEantibody assays. HughSampson'sidentificationofasthmaas themajorriskfactorforfatalanaphylaxis. IsleofWightresearchshowedahugerisein peanutallergyamongchildren.

Sarahsstory whyIgotinvolved

Tragedy acatalystforchange
JosephineTurner,aged17,died1992after eatingapretzelcontainingpeanutbutterat herschool. MichaelaMortimer,aged16,died1993after eatingapeanutwaferatherschool. RachelONeill,aged26,died1993aftereating peanutsinaThaimealservedinarestaurant.

1993paperonanaphylaxis
Foodsareamajorcauseofanaphylaxis. Paucityofdataonprevalenceorfrequencyof deaths. Deathsmaybewronglyrecorded. Allergenavoidanceeasiertoadvocatethan undertake. Theformationofaselfhelpgroupwouldput pressureonmanufacturers.
Foodinducedanaphylaxis deathcanand mustbeavoided.(BJCP,1993).DavidHide.

Thegrowthofsupportorganisations
AsthmaUK:Rootsgobackto1927 CoeliacUK:1968 FAAN(intheUSA):1991 AllergyUK:1991 TheAnaphylaxisCampaign:1994 Othersaroundtheworld

TheAnaphylaxisCampaign
Helpsindividualswithsevereallergies. Seekstoensurehighqualityallergenlabelling. Promotesawarenessinthecateringsector. Runsonlinetrainingforschools. Variousinformationtools magazines, websiteetc.

The1990s:amediascarestory

Amothersletter,1994
Mylittleboysufferedaverysevereallergic reactiontoasliceofcakeinarestaurantwhile wewereonholiday.Thecakecontained walnuts.IamterrifiedIwilllosehim.Weare livingwithatickingtimebomb.
fromtheAnaphylaxisCampaignfiles

Thepatientslifeline
EpiPen developedbasedonCombopenfor chemicalwarfareantidote. 1980:EpiPen launchedandregisteredinUSA. Late1980s:EpiPen availableonnamedpatient basisinUK. 1996:EpiPen registeredinUK. 2001:Anapen registeredinUK. 2010:Jext registeredinUK.

Themid1990s
NicholasSoameslaunchedanawareness campaignthroughoutindustry. Retailersandmanufacturersbegantodevelop robustpolicies. Industryorganisations(e.g.BRC,FDF) developedcodesofpractice. ECdiscussedmandatoryallergenlabelling.

ActionsbyMAFFandtheFSA
Allergyawarepackaimedatcaterers. Webguidanceforindustryandconsumers. Consumerattitudesurveys. Maycontainguidancepublished. Guidanceforcatererspublished. PLUStheFSAsmajorallergyresearch programme.

Adviceoneatingpeanuts
1998:GovernmentCommitteeonToxicity issuedguidanceforfamiliesonintroductionof peanutsintothediet. Mothersinatopicfamiliesmaywishtoavoid peanutswhilepregnantandbreastfeeding. TranslatedinthemediaasMotherstobetold toavoidpeanuts. (Advicerescinded2009).

FurtherUKdeaths
1995:LucieCrawforddiedaftereatinga Chinesetakeaway. 1995:LouiseWestlakediedduringher companysChristmasdinner. 1998:LauraThrasherdiedonherfirstnightat CambridgeUniversity.

Victim:OlympicathleteRossBaillie

1999: Ross ate a coronation chicken sandwich not knowing it contained nuts.

Commonsstatement,June1999
EdwardDavey,MP:Whenafit,giftedyoung athletediesbecauseofafewbitesofa chickensandwich,itissurelyourdutytoask whetherhisdeathandotherslikeitcould havebeenavoided.

2003:newlegislationonallergens
Europeanlegislationrequiresthemandatory labellingof11allergens(plussulphites)inpre packedfood. Thisabolishedthe25percentrule. Molluscsandlupinadded2006.

Whylupin?
Sweetlupinisgrownforitsedibleseeds. Theseedscanbeeatenraworusedtomake flour. ReactionsoccurontheContinent and occasionallyintheUK.

ReactionstolupinintheUK
Amanwithpeanutallergyreactedtoameat pie.Thepastry importedfromFrance containedlupinflour. AwomanreactedtoanAsdaappleflanandan onionring.Bothcontainedlupinflour. Awomanreactedtobreadboughtatanin storebakery.Thebreadcontainedlupinflour.

The next one on the list?

Theriseinkiwifruitallergy
KiwiintroducedintheUKlate1960s. The1980s emergingcasesseenmainlyin adults. The1990s severecasesbecomingcommonin childrenandinfants.

Othertriggersinclude...

Buckwheat one to watch?

Allergytobuckwheat
AmajorallergeninJapan wherelabelling is mandatory. Notatruecereal relatedtorhubarb. Usedinsavoury pancakes,Japanesenoodles, Russianblinis. UKcase: Ayoungwomansufferedanaphylaxis aftereatingcanaps. Thewomantestedpositivetobuckwheat.

Theriseinmaycontain
Ihadalwaysthoughtfoodlabellingwasthere tohelpandprotecttheconsumer.ButnowI wonderifitreallyexiststoprotectthefood industry.
Motherofanallergicchild

Ateenagersview
Foodcompaniesputnutwarningson everythingtocoverthemselves.Ijustcant believetheriskisreal.Illeatanythingwitha warningonit.
FromthefilesoftheAnaphylaxisCampaign

Ashoppersview
"Weignoreallmaycontainwarningssince wefoundoneonacabbage.
FromthefilesoftheAnaphylaxisCampaign

Isthisalittle extreme?

Can of milk with a nut statement!

And a packet of chewing gum!

Foodallergyalerts
TheAnaphylaxisCampaignsendsoutallergy alertstoallergicmembers. 36alertssentoutin2006. 58in2007. 65in2008. 46in2009. 40in2010.

Productalerts examples
Undeclaredegginspaghettibolognese.Packaging hadbeenprintedusinganoldartworkfile. Apackagingerrorinvolvingpumpkinandredpepper soup.Someproductcontainedmushroomand celeriac soup. Gheeinabiriyaninotidentifiedascomingfrommilk. Achocolatecoveredpeanutfoundinapackof chocolatecoveredraisins.

Theadventoffreefrom
Werefedupwithyoutellinguswhatwecant eat.Willsomebodytelluswhatwecan eat.
acommoncomplaint.

Thedownsideoffreefrom
Shopperstakeshortcutsandignorethe ingredientlist. Thephrasefreefromsuggestsanabsolute value.Consumersexpectittomeantotal absence. Somefreefromproductshavebeentestedto revealtraces. Peoplehavereacted.

A mistake with free from

Casehistory
Packsofcarobiceswerelabelled100percent dairyfree. Atoddlerreacted. Testswerepositiveformilk. Onecarobsamplecontained1.6percent casein,theother2.7percent. Thesuspectbatchwasrecalled.

Themessage
Foodcompanieswishingtolabelproducts freefromXmustbeconfidentthereis virtuallynochanceofcrosscontact.

Newrulesonglutenlabelling
NewregulationscomeintoforceJanuary 2012. Glutenfreestatementwillmeanthe productcontains20ppmorlessofgluten. Verylowglutenwillmeannomorethan 100ppm. FSAsaystestingwillberequiredtosupport theseclaims.

Thequestforthresholds
Isthereadosebeneathwhichpeopleare unlikelytoreact? Cansafelevelsbesetthatindustrycouldwork to? Researchismovingclosertofindinganswers.

Hopeforthefuture
Canwestopchildrenbecomingallergicto foods? TheEATandLEAPstudieswanttoshowthat introducingallergenicfoodsearly mayprevent allergyfromdeveloping. Thischallengesestablishedthinking. LEAPisworkingwithpeanut. EATwithmilk,peanut,fish,wheat,eggsand sesame.

Hopeforthefuture
Canallergybecured? 2011:ResearchersatAddenbrookes achieve furthersuccessindesensitisingchildrento peanut. Oralimmunotherapy(OIT)worksbyintroducing smallamountsofpeanutintochildrensdietsand graduallybuildinguptolargeramounts. USresearchersalsohavingsuccesswithOITand withsublingualimmunotherapy(SLIT).

Pleasestayintouch
FoodAllergySupportLtd. david.reading@foodallergysupport.com Tel:07904979562 www.foodallergysupport.com