You are on page 1of 20

2/05/2016

The Impact of Food Allergy


for the individual, family & society

CH Katelaris
Professor, Immunology & Allergy,
Western Sydney University and Campbelltown Hospital
University of Melbourne May 2016

Outline
Food allergy-definitions, clinical description
Prevalence
Impact of food allergy epidemic:
1. Effects on quality of life:
- Individual
- Family
2. Impact on society
- schools, childcare
- food industry

Adverse reactions to food: Any abnormal clinical response


attributed to ingestion, contact or inhalation of any food, a food derivative or a food additive .

Non Toxic Toxic

Food Hypersensitivity

Food Allergy Non-Allergic


Immune-mediated Hypersensitivity

Food Allergy Food Allergy


IgE-mediated Non- IgE-mediated
Revised Nomenclature for Allergy.
Allergy 2001; 56:813

1
2/05/2016

Food Allergy-Definition

An adverse health effect arising from


a specific immune response
that occurs reproducibly
on exposure to a given food

Prevalence of Food Allergy


Perception by public: 20%
Confirmed allergy (oral challenge)
- Adult: 1-2%
- Infants/Children: 6-8%

Food allergy is increasing: between 1997-2007


(US figures)
18% increase in children < 18 yrs
Peanut allergy has tripled from 0.4% to 1.4%

Food Allergy in Australian infants


Osborne et al JACI 2011 Health Nuts study

2848 infants
Challenge proven prevalence:
Raw egg 8.9%
Peanut 3.0%
Sesame 0.8%
more than 10% of infants having challenge-
proven IgE- mediated food allergy to 1 of
these foods

2
2/05/2016

Prescott et al WAO J 2013


WAO J 2013

Causes of Food Allergy


90% food allergic reactions are caused by these
foods

Signs and symptoms of mild or


moderate reactions
Swelling of lips, face, eyes
Hives or welts
Tingling mouth
Abdominal pain, vomiting

3
2/05/2016

Anaphylaxis
Definition

a rapidly progressive, multi-organ, severe


systemic allergic reaction that can be fatal

Risks for anaphylaxis

> 90% of fatal reactions to foods have occurred in


children aged 5 years and older and involve food
known to be the cause of allergy

Most cases occur outside the home


25% in restaurants
15% school, work
others-friends houses etc - Pumphrey et al 2004
Bock et al 2007

Fatal Food Anaphylaxis


Frequency: difficult to quantitate
Risk:
- Underlying asthma - Delayed adrenaline
- Symptom denial - Previous severe reaction

History: known allergic food

Key foods: peanut/nut/shellfish/milk/ egg

Lack of rash

Anaphylaxis is VERY unlikely to occur from skin


contact or exposure to food odours

4
2/05/2016

Anaphylaxis in Australia

Parent-reported (Boros et al 2001)

0. 59 per 100 children

The majority of food allergic anaphylactic reactions occur in


preschool age children

Anaphylactic deaths (Liew et al 2009)

0.64 deaths per million per yr

> 90% of fatal reactions to foods have occurred in children


aged 5 years and older

Australian hospital data for anaphylaxis

All causes

Food -related

Mullins et al. JACI 2015

Impact of Anaphylaxis

Anaphylaxis (and the risk of it occurring) can:

- induce great anxiety


- lead to significant social and family disruption
impaired quality of life

The quality of life in a child with severe food allergy


has been reported as worse than a child with
diabetes

5
2/05/2016

Diagnosis in Food Allergy

Needs clear
understanding and
application of correct
tests with rational
interpretation

Skin tests, blood tests,


food challenges

Food Allergy Diagnosis

There is NO evidence (JUSTIFICATION) for:


Cytotoxic testing
ALCAT
Vega testing
allergy elimination
Hair analysis
Sublingual provocation
Kinesiology
Iridology
reviewed at http://www.quackwatch.com

6
2/05/2016

Food Allergy-Management
Avoidance of food(s)

Education is the key


Manage the risk of reaction
Parents/child
Caregivers
School
Community

Food Allergy-Management
Information and dietary Provision of an early warning
advice device
Dietician advice re
foods/substitutes/hidde
n ingredients/reading
labels
Provision of reliable
information re risks etc

Food Allergy Management

Adrenaline if indicated
- how and when to use

7
2/05/2016

Immunotherapy for food allergy

Significant advances but not ready


for clinical practice

The degree to which a person enjoys the


important possibilities of his or her life

Quality of Life Toronto model

Quality of Life Toronto model

Toronto University Quality of Life Model is based on the


categories of :
being - who one is
belonging - how one is/is not connected to one's
environment
becoming - whether one achieves one's personal goals,
hopes, and aspirations

University of Toronto 2004

8
2/05/2016

Measures of Quality of Life (QoL)


Impact of Food Allergy
Examines and measures emotional, social and
physical factors

Gives a measure of personal perceptions,


expectations and coping styles

Provides a means of improving management,


care & experiences of patients & families

Impact of Food Allergy


Quality of Life (QoL)
Issues
There is no cure for food allergy
Morbidity is low and mortality rare
BUT
Impact on daily life and emotional states
significant on child and family
Studies show consistently detrimental impact
of food allergy on several aspects of QoL

Quality of Life Studies


General health
Family life
Effects on parents
Effects on young people

9
2/05/2016

Quality of Life studies-


general health
Parental perception of decreased general health
in food allergic child compared to healthy general
population - Sicherer et al 2001
Parents of 9 yr olds: significantly worse physical
functioning, more social limitations, poorer
general health than children with no allergic
disease Ostblom et al 2008
Children with peanut allergy-greater impact on
physical health than normal siblings King et al 2009

Quality of Life studies-family activities


Disruption to many activities
Avoidance of social activities

Limitations in eating outside


home-avoidance of take away
meals, restaurants, friends
houses

Anxiety surrounding holidays,


camps, excursions ,parties
Following a negative food
Everyday activities such as challenge and re
shopping and eating out introduction of a food, social
frightening for child and seen as life of child & family
life threatening improves significantly
Mistrust of others food
preparation

Quality of Life studies-


parental attitudes

Many have separation anxiety


Hypervigilance accompany older child to
social activities etc; avoid school excursions
etc
Move to home schooling
Parents recognise hypervigilance as a problem
Overprotection can extend to young adults

10
2/05/2016

Quality of Life studies-Adolescents


Crave peer group understanding and support
Embarrassed to carry Epipen, wear medicalert
bracelet
Some will engage in risk taking especially if
cannot remember original reaction
Those who have experienced anaphylaxis may
show post traumatic stress disorder withdrawn,
anxious, socially isolated
Some examples of eating disorders developing in
food allergic teenagers

Quality of Life studies-


external influences
Reactions of other people
Major frustrations expressed around
lack of public understanding
unwillingness to accommodate needs
inconsistent medical information

Quality of Life studies-


external influences
Food Labelling
Labelling often hidden, misleading
Difficulty understanding
Precautionary labelling can lead to
unnecessary restrictions
One study- only 54% parents avoiding peanuts
could correctly identify their presence on a
label Joshi et al 2002

11
2/05/2016

Societys adaptation to the epidemic


Childcare/preschools/schools

Major impact in childcare centres, preschools


and schools

Policy development to balance needs and


freedoms of both food allergic and non
allergic children

Steps in Prevention of Food Anaphylactic


Reactions in Children in Schools, Preschools &
Childcare Centres
(i) Obtaining medical information about children
at risk by school, preschool or childcare centre
personnel
(ii) Education of those responsible for the care of
children concerning the risk of food anaphylaxis
(iii) Implementation of practical strategies to
avoid exposure to known triggers
(iv) Age appropriate education of children with
severe food allergies

Food Policy Measures specific to


School age Children
Risk minimisation with regard to particular
foods (peanuts and tree nuts) is indicated

school canteens - removal of items with nuts as an


ingredient

asking parents of classmates not to have peanut butter


sandwiches if a class member in early primary years is
allergic

school camps - foods containing nuts are not taken or


supplied

12
2/05/2016

Food Policy Measures specific to


School age Children
implementation of blanket food bans or
attempts to prohibit the entry of food
substances into schools are not recommended

Impractical-lack of evidence of the effectiveness


of such measures

for school age children an essential step is to


develop strategies for avoidance in the wider
community as well as at school

School policies (cont.)


Bullying by provoking food allergic children
with food to which they are allergic should be
recognised as a risk factor and addressed by
anti-bullying policies

Societys adaptation to the epidemic


food industry

FACTS
The majority of deaths from food anaphylaxis occur
outside the home

For most cases of fatal food anaphylaxis the victim


knew the food involved and believed the food being
consumed was safe

13
2/05/2016

Restaurants, food outlets


Sources of accidental exposures in food
preparation
-un-informed staff
- lack of labelling
- cross contamination
- food residues on utensils
- contamination of cooking oils

Need is for knowledge, education, training


within the food industry at all levels

Food Labelling
Significant public health issue
One of the greatest causes of anxiety for parents with
food-allergic children
The requirement for more information balanced by
need for clarity
Ability of parents of food-allergic children to accurately
read food labels is very poor , primarily because of the
complexity and ambiguity of information provided

In some cases poor labelling practices may also lead to


unnecessary restrictions to a childs diet

Mills et al 2007

14
2/05/2016

Declaration of substances
2003 food labelling legislation introduced to Australia & NZ

Must be declared :
cereals containing gluten and their products, namely, wheat, rye,
barley, oats, spelt and their hybridised strains other than where
these substances are present in beer and spirits
crustacea and their products
egg and egg products
fish and fish products
milk and milk products
peanuts and soybeans and their products
added sulphites in concentrations of 10 mg/kg or more
tree nuts and sesame seeds and their products
Discussion regarding lupin underway

http://www.afgc.org.au/

Food Labelling

In Australian supermarkets 65% of products


contain one or more precautionary warnings
to any of the nine most common food
allergens (peanuts, tree nuts, milk,egg, soy,
wheat, sesame, crustaceans, fish)

Zurzolo et al JACI in Practice 2013

15
2/05/2016

Zurzolo et MJA 2013

Australia the Allergen Bureau


Established in 2005 as an initiative of the
Australian Food & Grocery Council Allergen
Forum, and operates on a membership basis

The overall objective is to share information and


experience within the food industry on
management of food allergens to ensure
consumers receive relevant, consistent and easy
to understand information on food allergens

VITAL
The VITAL (Voluntary Incidental Trace Allergen Labelling)
system is an essential standardised allergen risk assessment
tool for food producers

VITAL allows food producers to assess the impact of allergen


cross contact and provide appropriate precautionary allergen
labelling on their products

VITAL was developed to make a single simple standardised


precautionary statement available to assist food producers in
presenting allergen advice consistently for allergic consumers

16
2/05/2016

VITAL
Threshold levels based on published LOAEL(lowest
observed adverse effect level) data with a 10-fold safety
factor

When the amount of allergen present is above the


threshold level (but not at sufficient amounts to be listed
as an ingredient), manufacturers use an advisory
statement with the format
may be present
No advisory warning is recommended if levels are lower
than this cut-off

17
2/05/2016

Summary
Food allergy is now a common problem in our
society and must be managed at a societal level
Diagnosis of food allergy has a major impact on
QoL
The only management at present is avoidance
and preparedness to treat an acute reaction
Society must respond to protect those at risk
At childcare centres, preschools
Primary school and high school
Community at large food outlets, restaurants
Food labelling improvements

Questions ??????

18
2/05/2016

Food Allergy- why the Epidemic???


Hygiene hypothesis

How we grow and process food

Greater environmental exposure to food allergens

How foods are introduced to infants and toddlers


delayed vs early introduction

Vitamin D insufficiency

Zurzolo et al JACI in Practice 2013

Time trends in anaphylactic


admissions & Deaths
(Liew et al 2009)

19
2/05/2016

Legal Responsibility to those with


food allergy
On 30 June 2009, the Federal Court of Australia
handed down a fine of $210,100 in a Comcare
prosecution of the Commonwealth of Australia,
acting through the Chief of the Army for a
contravention of the Occupational Health and
Safety Act 1991 (the OHS Act) by the Australian
Army Cadets (AAC) in the course of conducting a
three day training course known as Bivouac 2007 at
the Wombat State Forest in Central Victoria in
March 2007

Fix this up do coronial inquests for next yr

20

You might also like