When food attacks

A surge in allergies has left young children exposed and parents desperate for clear information.

Imagine you have a happy and healthy young baby.

You give them their first taste of scrambled egg at breakfast time — just a teaspoon — and suddenly their lips swell, a rash appears and they begin coughing and struggling to breathe.

Testing confirms your child has food allergies that could make them very ill, or even kill them.

Research shows life-threatening anaphylaxis among Australian children is increasing.

What’s more, some children can have this severe reaction within seconds of even minor contact with certain foods.

Families who manage a child with a severe allergy to common foods know the daily struggle.

Every meal requires meticulous planning and attention to detail. Going out to birthday parties is particularly fraught and play dates with friends require vigilance.

Allergic diseases, including eczema, asthma, hay fever and food allergies, now affects 30-40 per cent of the Australian population.

It’s driven by inflammation and hypersensitive immune responses to the environment.

While one in every four children will suffer from eczema and asthma, one in every 10 will have at least one food allergy.

This worrying surge in food allergies has seen young children bearing the brunt of the epidemic.

The problem is, the science of allergies is still relatively young and parents are desperate for clear information because without it, they are left feeling powerless.

They just want to improve the life of their child and the good news is, there is an abundance of exciting research under way.

The highly-respected Telethon Kids Institute and the $26 million ORIGINS project are among the centres where scientists are working hard to uncover more answers and share this information with families and health providers.

Here, Dr Michael O’Sullivan, a clinical immunologist at Perth Children’s Hospital and research associate at Telethon Kids Institute, answers some common food allergy questions with the most up-to-date, reliable advice.

Q What does current research say about food allergy prevention?

A There’s some things that we’re confident reduce the risk of allergies, others that have been found not to work, and a long list where more research is needed — much of which is under way.

During pregnancy and breastfeeding, there’s no benefit in restricting your diet to avoid certain allergens.

Also, there’s not enough proof that probiotics prevent food allergies in order to routinely recommend them for either mum or baby.

However, including up to three serves a week of oily fish in a mum’s diet might help — and it has other health benefits.

“Hypoallergenic” — or other special infant formulas — are not useful for allergy prevention.

Introducing solid foods at around six months (but not before four months) and including peanut and cooked egg regularly in the infant’s diet before one year of age reduces the risk of allergy to those foods.

Q What new scientific findings are coming out that parents may not yet be aware of?

A While food allergies can happen in anybody, having eczema is a strong risk factor for developing food allergy.

Many families will be aware that guidelines now recommend introducing the common allergy-causing foods before children turn one, but it is also important to keep giving those foods regularly — provided your child isn’t having immediate reactions to them — to reduce the risk of developing an allergy.

Eliminating foods from the diet in children with eczema should only be done in consultation with an allergy specialist and dietitian as it may increase the risk of developing an immediate reaction to the food when it is re-introduced.

Q We are planning to start a family soon. What can I do to protect my future child from developing food allergies?

A Even if you do everything “right”, some children will develop allergies.

There are changes in the immune system at birth in babies who go on to develop allergies and other immune conditions where mum’s health and diet before and during pregnancy is important for their future child.

If you or anyone in your household is smoking, start trying to quit now.

Exercise regularly, eat a healthy, varied diet during pregnancy and try to include up to three serves of oily fish or other sources of omega-3 fatty acids a week.

Q Is exclusive breastfeeding from birth a proven protective factor against developing allergic disease?

A No. Current evidence suggests that breastfeeding neither causes nor prevents food allergy.

However, there are other benefits of breastfeeding for mum and baby, so try to breastfeed if possible for at least six months, including while starting to introduce solid foods.

Q People have suggested my child’s allergic disease is the result of having a caesarean and from keeping my house too clean. Could this be true?

A No. We still don’t understand why allergies develop in any given individual, and the immune system is so complex that no single thing can explain why allergies develop in one person and not another.

In the case of caesarean sections, a recent study estimated that there may be one more case of food allergy for every 200 caesarean deliveries.

Q Is it safe for my child to be given just a little bit of the allergy-causing food very occasionally, such as at a birthday so they do not miss out entirely?

A For most allergies, we advise that children strictly avoid that food, even at special events like birthday parties. Otherwise, unfortunately, they will miss out on a lot more of the party if they end up having an allergic reaction.

Some children may be advised by their doctor that it is safe to eat a small amount of the food they are allergic to, such as cakes or biscuits baked with egg, but in that situation it would be better to try those foods for the first time when you can keep an eye on them in a familiar environment, rather than when you’re out at a party.

Q I feel nervous about school. How do I ensure my allergic child’s safety there?

A Get in touch with the school as early as possible to discuss your child’s allergies and what strategies they already have in place for other students. By giving the school plenty of notice, they can work with you to develop a management plan and arrange additional training for staff from an anaphylaxis educator if required.

Allergy & Anaphylaxis Australia can help you here too.

Make sure you provide the school with a current action plan and any medications that have been prescribed, and that the medication is stored somewhere safe but easily accessible.

Teach your child what they can do to manage their allergies at an age-appropriate level. For instance, young children might be taught to only eat food that their parents have checked first.

Q What’s your advice if we are travelling overseas with someone who has a serious food allergy. Should we even go?

A You’ll need some planning but that shouldn’t stop you taking an overseas holiday with someone who has a food allergy.

See your doctor before you go to make sure you have an up-to-date anaphylaxis action plan and travel plan and all of the medications you need for the duration of your trip, and they are in your carry-on luggage along with medications.

Make sure your travel insurance policy covers food allergies and anaphylaxis as pre-existing conditions.

Let the airline know about your allergy and think about taking your own food for the flight.

If you’re travelling to a country where you’re not fluent in the language, take a written translation explaining your allergies with you that you can show whenever purchasing food and/or consider self-catering accommodation options.

Want to know more? Visit preventallergies.org.au

Eggs, milk and nuts

More than 90 per cent of childhood food allergies are to common foods such as hen’s eggs, cow’s milk, soy, peanuts, tree nuts, wheat, fish and shellfish.

Generally speaking, children grow out of allergies to egg, milk, soy and wheat by school age as their tolerance grows but allergies to peanuts, tree nuts and shellfish tend to be more persistent and can remain for life.

Research under way right now

A mother’s diet and her environment during pregnancy can have a big influence on her baby’s immune system, which begins developing before birth.

Scientists are pretty confident now that mum’s gut health plays an important role in the way her baby’s immune system develops.

To find out more, Telethon Kids Institute is involved in the SYMBA Study which gives mothers a prebiotic fibre from the second trimester of pregnancy until six months after her baby is born.

They want to know whether it will reduce the development of allergies in their children.