• Professor Adnan Custovic
  • Dr Adam Fox
  • Professor Aziz Sheikh
  • Professor Mukhopadhyay
Clinical Professor of Paediatric Allergy at the Imperial College London

There is a huge increase in the number of children with food allergies, according to Professor Adnan Custovic, Clinical Professor of Paediatric Allergy at the Imperial College London.

More than 2% of children nowadays will have food allergies of some kind. Something is fundamentally changing in our environment and lifestyle.

Hay fever has increased considerably in mid-twentieth century. Before then it was a very rare disease. Asthma increased between 1960s and the 1990s, and now we have an increase in food allergies. For example, 25 years ago allergy to Brazil nuts was described as a rarity and a curiosity. Now it’s becoming increasingly common.

Clearly this is not due to a single factor. There are multifactorial environmental and lifestyle changes at play such as cleaner living and ever increasing hygiene, changes in diet, an increase in processed food and food storage etc.

“I believe the cause of the epidemic in food allergies is environmental, although clearly genetic susceptibilities make some people more vulnerable to specific environmental factors.” - Professor Custovic

Prof Custovic believes there is a link between eczema and allergies.

“Children with eczema may have ‘leakier’ skin, and as a consequence be more susceptible to developing allergic sensitisation. If you think of the skin as a barrier between the body and the environment, if that barrier is more permeable, then the impact of environmental exposures may be more pronounced.”

“We and others have discovered that the way some children may become sensitised to certain foods such as peanut is not from eating them, but by being exposed to food allergens in their home environment, that are presented to the immune cells through the skin.”

“Some children with eczema get exposed to food allergens from dust in their homes, then develop allergy anti-bodies, and when they eat the food they may have a reaction.”

He says common foods allergies in young children are milk and eggs, while in older children and adults it’s peanuts and tree nuts, shellfish, fish and wheat. There has also been an increase in the number of people with severe reactions to bee and wasp stings, and another large group of patients are allergic to prescription drugs.

Prof Custovic, who has treated countless children suffering from allergies, says the symptoms of allergies come out in the skin with swelling, hives and sometimes worsening of eczema. The upper and lower respiratory tract will be affected causing breathing difficulties (blocked and/or runny nose, cough, wheezing). It is of note that severe childhood asthma is associated with food allergies.

Anaphylaxis is the most extreme life threatening type of allergic reaction, however fortunately deaths from anaphylaxis are rare.

Prof Custovic advises concerned parents. “It’s important to establish whether a child is truly allergic to a certain food or not. Diagnosis should not be based only on standard allergy tests (such as skin test or blood test to the whole peanut extract). For example, approximately 10% of children may have a positive standard allergy test to peanut, but only a quarter of them will have a true allergic reaction to peanuts (i.e., the result of allergy tests may be false positive).  There is a lot of anxiety in the community, and almost 20% of children avoid peanuts, most of them unnecessarily.”

“Get appropriate advice from trained professionals. Children need an accurate diagnosis and an appropriate management plan

“The main thing is don’t panic! The help is out there. This problem can be managed.

“We are on the brink of a new era, where we will be able to treat and cure food allergies. I am positive and optimist, because we need to fundamentally change the current approach of just avoiding certain foods, prescribing adrenaline auto-injectors, and hoping for the best. We need to be proactive to cure this disease.“

Helpful websites include Anaphylaxis campaign, Asthma UK, the National Eczema Society & British Society of Allergy and Clinical Immunology.

Consultant Paediatric Allergist at Guy’s and St Thomas’ Hospital in London

Dr Adam Fox, Consultant Paediatric Allergist at Guy’s and St Thomas’ Hospital in London believes it is important to take allergies seriously.

“There’s a lot of urban mythology and poor education about allergies and misconceptions lead to unnecessary anxiety.”

However there is also accurate and reliable information available to parents of children with allergies.

Dr Fox says: “The key organisations I trust and recommend to parents include Allergy UK, the Anaphylaxis Campaign and Asthma UK.“

“An allergy, he explains, is an inappropriate response to something that should be harmless. The immune system gets it wrong! We don’t fully understand why. Instead of recognising that dust mite, peanuts or milk are nothing to worry about, the body massively over reacts to the point of being potentially harmful to the patient.

“There are a lot of theories as to what sets the body off. When our immune system is working properly it can tell difference between substances that are harmless and ignores them and what is potentially dangerous and responds in the way it does to germs, such as bacteria or viruses, to protect us

“Atopy – the allergic tendency, is in fact another response which is not ignoring, or not responding to an infection to protect the body but inappropriately over-responding with hypersensitivity.

“This is an inherited tendency - a genetic predisposition – that some of us have which gets triggered by our environment. Some don’t have it in their DNA to get allergies while others do. It’s a complex interaction between our genetic predisposition and the outside world.” 

 

Dr Fox says there has been a rise in allergies in the space of 30 to 40 years. However there is also a rise in awareness of the conditions and good evidence to suggest the rate of asthma is settling down.

“Cases of anaphylaxis from food allergies are much more common than they were a few years ago.”

“Symptoms of a food allergy include swelling and itching around the mouth and for some patients this can spread to tummy upsets, vomiting and diarrhoea.

“An allergy to pollen includes the classic hay fever symptoms such as an itchy and blocked or runny nose, sneezing and sore eyes.

“My advice for parents of children with allergies, hay fever, asthma or eczema is to make use of the excellent information and support available. It’s important to get a proper diagnosis and learn to self-manage conditions.  

We can treat these conditions very effectively with medications or desensitisation.”

Professor of Primary Care Research and Development at University of Edinburgh

Anaphylaxis is an extreme allergic reaction and hospitalisation from episodes has increased in the UK and US according to the Professor of Primary Care Research and Development at University of Edinburgh, Prof Aziz Sheikh.

He says: “Anaphylaxis occurs rapidly within minutes and is potentially life-threatening. It’s a generalised reaction involving a number of body systems, especially the airways causing breathing difficulties and the cardio-vascular system causing a drop in blood pressure.

“In the context of food allergy triggered anaphylaxis, if children and adults with allergies avoid the triggers such as milk, eggs, peanuts, tree nuts, then the risk of reaction is negligible. However in the case of accidental exposure it’s wise to carry an adrenaline auto-injector pen, which is self-administered. The shot of adrenaline dilates the airways and increases blood pressure. It can be life-saving.

“Auto-injector pens can be prescribed by GPs to patients with a history of anaphylaxis or at risk of episodes. It is crucial to carry one in case of emergencies.

Prof Sheikh says: “In some individuals allergies can be treated with immunotherapy, which administers small doses of the allergen to stimulate the immune system’s protective mechanism.”

The professor is involved with collaborative research across 13 universities in his capacity as Director of the Asthma UK Centre for Applied Research. He works with innovative post-graduate students and also treats children in his clinical practice

He explains that an allergy is an aberrant immune reaction to harmless material in the environment such as food, pollen or dust mite that triggers an inflammatory response.

“We sometimes summarise the reactions to patients as ‘Itch, Sneeze and Wheeze’ because allergies most commonly affect the skin, nose and breathing. The inflammation is caused by a histamine release.”

“In some cases there’s a link between allergies and eczema. However many types of eczema have nothing to do with allergies. And late onset asthma is typically unrelated to childhood allergies.

“A clinical assessment and allergy testing is important. For the majority of people with allergic disease it is possible to gain control through careful assessment and management by trained GPs and specialists.

“In the vast majority of cases we can improve the quality of life, although not necessarily cure allergies as yet.

“People should be reassured. We are collaboratively moving in right direction in understanding and treating allergies.

“Joining patient charities such as Asthma UK, Allergy UK and The Anaphylaxis Campaign  can be helpful. They are very good at providing useful online resources and promoting a partnership model with medical practitioners. Together we are aiming for good control of allergies in children and all ages”

Chair of Paediatrics at the Royal Alexandra Children’s Hospital & professor and researcher at the Brighton and Sussex Medical School

Professor Somnath Mukhopadhyay, the Chair of Paediatrics at the Royal Alexandra Children’s Hospital and professor and researcher at the Brighton and Sussex Medical School, has devoted his career to understanding allergies and asthma in children.

And yet the cause of allergies remains to some extent a mystery!

The professor explains: “I don’t think we really know the one cause! We have linked allergies with certain things in the blood like individual forms of Immunoglobulin E. When your body comes into contact with certain substances that it’s primed to react to, reactive molecules increase in the blood and the child is more vulnerable to developing face swelling or other problems. This is the classic way of defining an allergy.

“However my colleagues and I published a paper in 2008 where we tracked the signs of allergy-related disease in very little babies and we could find absolutely no effect on the blood. It is thus not clear what an allergy is in the young child, the most vulnerable of the population. There is still a lot of ambiguity. In older children and adults it becomes clearer what’s happening in the blood but still there remains much ambiguity.

“We need to look more at the symptoms in the child. We can use blood tests but at end of day we need to be guided by the individual patient.

Professor Mukhopadhyay says anaphylaxis is an acute reaction to a substance from outside the body.

“If the body is primed to react in a powerful way it can go into shock and serious  difficulty in breathing or total collapse, which is extremely dangerous, life threatening and frightening for the patient and those witnessing the attack. However anaphylaxis can usually be quickly reversed with the right medicines.

What are the signs and symptoms of allergic reaction? “With acute reactions, for example the child with peanut allergy who bites on a peanut and his mouth starts tingling and swelling, then his  face and throat  swells. It can often be stopped there if mummy gives him some anti-histamine medicine. On the other hand it could get worse with his upper and lower airways closing. The child makes a croupy or  wheezing sound because he cannot breathe properly and can become unconscious and collapse. “

There is a great deal of support available these days to parents and children with allergies.

 

“Like never before, there is now an opportunity to access excellent information,” says Prof Mukhopadhyay.

The professor, who trained for many years in Dundee, is dedicated to sharing the latest knowledge about allergies with GPs and nurses. He conducts webinars and meetings for  GPs and other doctors around the world. He conducts collaborative research with colleagues  across Europe and believes that opinion leaders need to be accessible to GPs, health specialists, patients and families.

“GPs need to take a good allergy history and perform confirmatory blood tests if necessary to gain a better idea of what’s going on in the patient.

He believes that allergies are inextricably related to asthma and eczema.

He explains: ”The skin molecule called filaggrin is like a staple from a stapler that holds together the thin paper-like sheets of keratin. If filaggrin the staple works well these layers lie firmly together however if the staple is weak the keratin sheets are all over the place and the skin becomes permeable to allergens.

“This is a key link between allergens entering the skin and causing allergic reactions and asthma attacks. The filaggrin works beautifully in most children but in about 10 per cent of children there is a genetic defect and the filaggrin molecule is defective and so the staple does not hold the filaggrin sheets together.”

“The key message I’d like to get out to parents of children with allergies is that every child is different. Historically we have been guided principally by  broad-based randomised controlled data and we have devised protocols in medicine treating the entire population as a large unified body. We now have much additional information that allows us to take a more individualised approach for patients.

“A series of important discoveries over the last 15 to 20 years points to the fact that some medicines do not work for every child. The primary resource for parents to deal with an asthma attack has been the blue inhaler used to open up the airways. But what if it doesn’t work? It is possible that it may not work in some children even if the parents are administering the inhaler properly? What does mum and dad do then? This is a difficult and frightening situation. If mums and dads feels their child’s inhalers are not working, it is important to discuss this with their doctor or nurse

“We must understand that every child is different. We now know that allergies and asthma form an umbrella with different strands of diseases inside. It’s great to use an umbrella to block out the rain however when treating patients each of whom have different underlying causes leading to their individual patterns of disease and their different treatment responses, it may be better to use more specific form of therapies that are relevant to each patient.”

It is important for patients to continue using their medicines as prescribed by their doctors and to talk to their doctor or nurse if they feel their medicine is not working.