“Allergy is the most common chronic diseases in Europe. Up to 20% of patients with a severe debilitating form of their condition struggle dealing with the fear of a possible asthma attack, anaphylactic shock, or even death from an allergic reaction” European Academy of Allergy & Clinical Immunology (2016).

£900m is spent annually on allergies & £68m on hospital allergy-related admissions in the UK (Houses of Parliament 2014).

Allergies are caused by an immune response to common items e.g. milk, eggs, tree nuts, dust mites, pollen, animal skin/hairs, latex & medication. Eczema, asthma & rhinitis (hayfever) are the main allergic disorders with the highest incidence rates in children in the UK (Royal College of Physicians (RCP)2010).

Our immune system protects us from bacteria, viruses & parasites by producing antibodies against them. IgE is the antibody immunoglobinE most reactions are linked to.

IgE-mediated reactions are immediate & non IgE-mediated are delayed & caused by other processes.

IgE-mediated Non IgE-mediated
Skin Pruritis (itchy skin), erythema (red skin), urticaria (hives), swollen face, lips & around the eyes Eczema, erythema, pruritus
Gastrointestinal
System
Nausea, vomiting, abdominal pain, swollen lips/tongue Reflux, infantile colic, faltering growth, blood/mucus in stools, constipation, food refusal, loose/frequent stools
Respiratory
System
Sneezing, coughing, runny/itchy nose, wheezing, shortness of breath,

Other symptoms may be present, along with anaphylaxis, a potentially life-threatening reaction to insects, food, medication or latex. Treatment is needed immediately with adrenalin (The National Institute for Health & Care Excellence (NICE) 2011).

Genetics & the environment are linked to an increase in allergies. The RCP found 6-8% of children have at least one IgE-mediated food allergy, i.e. 2% egg & 15% cow’s milk. Tolerance to these allergens are developed by many infants. Allergy UK describe food intolerance as “an adverse reaction to foods with symptoms” e.g. skin problems, diarrhoea, bloating. This must not be mistaken with food allergy.   

NICE (2011) have produced guidance on the diagnosis & management of food allergy.

Assessment

  • By an appropriate healthcare professional e.g. GP, includes an allergy-focused clinical history (family history, symptoms, foods, feeding history mother’s diet if baby is breastfed) &
  • Physical examination.

Diagnosis – IgE-mediated Food Allergy

  • A skin prick test &/or
  • Blood tests.

Patch testing, oral food challenges & skin prick tests must be conducted in a safe hospital setting, where anaphylaxis can be treated.

Diagnosis – Non IgE-mediated Food Allergy

  • Referral to a Dietitian &
  • Trial elimination of the suspected allergen for 2-6 weeks & slow re-introduction.

e.g. cow’s milk, egg, wheat, peanuts & tree nuts. For breast fed babies, mother’s diet will be assessed & a cow’s milk free diet may be advised. Specialist infant formulas may be prescribed for formula-fed babies, however soya-based milk is not advised for babies under six months old.

Vega test (acupuncture), applied kinesiology (muscle testing), serum-specific IgG (blood test) & hair analysis testing, are not recommended in the diagnosis of food allergy.

Information & Support

Information which is age appropriate should be offered to the child, young person, parent or carer, based on the suspected allergy, anaphylaxis, vaccination, diagnosis & referrals. Advice is given regarding foods/drinks to avoid, suitable alternatives, food labels, trial elimination & the re-introduction of foods.

Support groups available & their contact details is essential.

Referrals

A referral to secondary or specialist care may be necessary, depending on the allergy-focused clinical history.

Tips on Eating Out

  • Check the restaurant’s menu online
  • Ring in advance to discuss the menu, policy on food allergy & allergies
  • Speak to your waiter/waitress or the chef on arrival
  • Check your meal choices are suitable & ask for alternatives if needed
  • Be aware of possible cross-contamination at buffets & salad bars
  • Medication must always be carried
  • At children’s parties, always explain their allergies & management &
  • Always read food labels (British Dietetic Association 2012).

The Food Standards Agency (FSA) implemented the labelling of 14 food allergens to customers & handling allergens in the kitchen, on non-pre-packed & packaged food in 2014.

Future

To date there is no national allergy strategy. NICE (2011) recommend investment in training at a national level for extra training posts in allergy; which will lead to earlier diagnosis of food allergy in children.

Support Groups


References: available upon request

British Dietetic Association (2012) Food Allergy & Intolerance Specialist Group. Wheat Free Diet. Birmingham.

European Academy of Allergy & Clinical Immunology (2016) (online) Advocacy Manifesto: Tackling the allergy crisis in Europe – Concerted Policy Action Needed. Accessed 12/01/19 available from https://bit.ly/2SbygLZ

Food Standards Agency (2014) Food Allergy & Intolerance. Accessed 12/01/19, available https://bit.ly/20xKhdx

Houses of Parliament (2014) The Parliamentary Office of Science & Technology: Childhood Allergies. Postnote, Number 467, July 2014.

NICE (2011) Food Allergy in Children & Young People. Diagnosis & Assessment of Food Allergy in Children & Young People in Primary Care & Community Setting. Manchester. Available www.nice.org.uk/guidance/cg116

Royal College of Physicians (2010) (online) Allergy Care: Still Not Meeting the Unmet Need. Accessed 12/01/19. Available https://bit.ly/2TjCyyc. London: RCP 2010

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