Post on 04-Apr-2018
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Ahistoryoffoodallergy
Theevolvingstoryovertwodecades
ByDavidReading
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1976:foodallergyinthepubliceye
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Adefinition
of
allergy
Allergy occurswhen
the
immune
system
reactsadverselytoafoodorsubstancethatis
harmlessformostpeople.
Anaphylaxis isattheextremeend severeandrapidlyoccurring.
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Foodintolerance
Doesnot
generally
involve
the
immune
system.
Requireslargeramountsoffood.
Symptomstakelongertooccur.
Symptomsmayincludeheadache,digestivediscomfort,
sluggishness.
Example:lactoseintolerance.
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My skirt doesnt fit. It
must bean allergy.
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Milestonesin
allergy
research
HughSampson's
work
on
food
challenges
and
predictivevaluesforskinandIgEantibody
assays.
HughSampson'sidentificationofasthmaasthemajorriskfactorforfatalanaphylaxis.
Isleof
Wight
research
showed
ahuge
rise
in
peanutallergyamongchildren.
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Sarahsstory whyIgotinvolved
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Tragedy a
catalyst
for
change
JosephineTurner,
aged
17,
died
1992
after
eatingapretzelcontainingpeanutbutterat
herschool.
MichaelaMortimer,aged16,died1993aftereatingapeanutwaferatherschool.
RachelONeill,aged26,died1993aftereatingpeanutsinaThaimealservedinarestaurant.
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1993
paper
on
anaphylaxis Foodsareamajorcauseofanaphylaxis. Paucityofdataonprevalenceorfrequencyof
deaths.
Deathsmaybewronglyrecorded.
Allergen
avoidance
easier
to
advocate
than
undertake.
Theformationofaselfhelpgroupwouldput
pressure
on
manufacturers.Foodinducedanaphylaxis deathcanandmustbeavoided.(BJCP,1993).DavidHide.
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Thegrowth
of
support
organisations
AsthmaUK:Rootsgobackto1927
CoeliacUK:1968
FAAN(intheUSA):1991
AllergyUK:1991
TheAnaphylaxisCampaign:1994
Othersaroundtheworld
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TheAnaphylaxis
Campaign
Helpsindividuals
with
severe
allergies.
Seekstoensurehighqualityallergenlabelling.
Promotesawareness
in
the
catering
sector.
Runsonlinetrainingforschools.
Variousinformation
tools
magazines,
websiteetc.
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The1990s:amediascarestory
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Amothers
letter,
1994
Mylittle
boy
suffered
avery
severe
allergic
reactiontoasliceofcakeinarestaurantwhile
we
were
on
holiday.
The
cake
contained
walnuts.IamterrifiedIwilllosehim.Weare
livingwithatickingtimebomb.
fromtheAnaphylaxisCampaignfiles
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Thepatients
lifeline
EpiPen developedbasedonCombopenfor
chemicalwarfare
antidote.
1980:EpiPen launchedandregisteredinUSA.
Late1980s:EpiPen availableonnamedpatientbasisinUK.
1996:EpiPen registeredinUK.
2001:Anapen registered
in
UK.
2010:Jext registeredinUK.
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Themid
1990s
NicholasSoames
launched
an
awareness
campaignthroughoutindustry.
Retailersand
manufacturers
began
to
develop
robustpolicies.
Industryorganisations(e.g.BRC,FDF)developedcodesofpractice.
ECdiscussedmandatoryallergenlabelling.
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Actionsby
MAFF
and
the
FSA
Allergyawarepackaimedatcaterers.
Webguidanceforindustryandconsumers.
Consumerattitudesurveys.
Maycontainguidancepublished.
Guidanceforcatererspublished.
PLUStheFSAsmajorallergyresearchprogramme.
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Adviceoneatingpeanuts
1998:GovernmentCommitteeonToxicity
issuedguidance
for
families
on
introduction
of
peanutsintothediet.
Mothers
in
atopic
families
may
wish
to
avoid
peanutswhilepregnantandbreastfeeding.
TranslatedinthemediaasMotherstobetoldto
avoid
peanuts.
(Advicerescinded2009).
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FurtherUK
deaths
1995:Lucie
Crawford
died
after
eating
a
Chinesetakeaway.
1995:
Louise
Westlake
died
during
her
companysChristmasdinner.
1998:LauraThrasherdiedonherfirstnightatCambridgeUniversity.
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Victim:Olympic
athlete
Ross
Baillie
1999: Ross ate a
coronation chickensandwich notknowing itcontained nuts.
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Commonsstatement,
June
1999
EdwardDavey,
MP:
When
afit,
gifted
young
athletediesbecauseofafewbitesofa
chicken
sandwich,
it
is
surely
our
duty
to
ask
whetherhisdeathandotherslikeitcould
havebeenavoided.
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2003:new
legislation
on
allergens
Europeanlegislation
requires
the
mandatory
labellingof11allergens(plussulphites)inpre
packed
food. Thisabolishedthe25percentrule.
Molluscs
and
lupin
added
2006.
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Whylupin?
Sweetlupin
is
grown
for
its
edible
seeds.
Theseedscanbeeatenraworusedtomakeflour.
ReactionsoccurontheContinent andoccasionallyintheUK.
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Reactionsto
lupin
in
the
UK
Aman
with
peanut
allergy
reacted
to
ameat
pie.Thepastry importedfromFrancecontainedlupinflour.
Awoman
reacted
to
an
Asda
apple
flan
and
an
onionring.Bothcontainedlupinflour.
Awoman
reacted
to
bread
bought
at
an
in
storebakery.Thebreadcontainedlupinflour.
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The next one on the list?
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Therise
in
kiwifruit
allergy
Kiwiintroduced
in
the
UK
late
1960s.
The1980s emergingcasesseenmainlyinadults.
The1990s severecasesbecomingcommoninchildrenandinfants.
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Othertriggersinclude...
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Buckwheat one to watch?
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Allergytobuckwheat
AmajorallergeninJapan wherelabelling is
mandatory. Notatruecereal relatedtorhubarb.
Used
in
savoury pancakes,
Japanese
noodles,
Russianblinis.
UKcase: Ayoungwomansufferedanaphylaxisafter
eating
canaps.
Thewomantestedpositivetobuckwheat.
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Therise
in
may
contain
Ihad
always
thought
food
labelling
was
there
tohelpandprotecttheconsumer.ButnowI
wonder
if
it
really
exists
to
protect
the
food
industry.
Motherofanallergicchild
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Ateenagers
view
Foodcompanies
put
nut
warnings
on
everythingtocoverthemselves.Ijustcant
believetheriskisreal.Illeatanythingwitha
warningon
it.
FromthefilesoftheAnaphylaxisCampaign
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Ashoppers
view
"Weignore
all
may
contain
warnings
since
wefoundoneonacabbage.
FromthefilesoftheAnaphylaxisCampaign
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Isthisalittle
extreme?
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Can of milk
with a nutstatement!
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And a packet of chewing gum!
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Food
allergy
alerts TheAnaphylaxisCampaignsendsoutallergy
alertsto
allergic
members.
36alertssentoutin2006.
58in
2007.
65in2008.
46in
2009.
40in2010.
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Productalerts examples
Undeclaredegginspaghettibolognese.Packaging
had
been
printed
using
an
old
artwork
file. Apackagingerrorinvolvingpumpkinandredpepper
soup.Someproductcontainedmushroomand
celeriac soup.
Gheeinabiriyaninotidentifiedascomingfrommilk.
Achocolatecoveredpeanutfoundinapackof
chocolatecoveredraisins.
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Theadvent
of
free
from
Werefed
up
with
you
telling
us
what
we
cant
eat.Willsomebodytelluswhatwecan eat.
acommoncomplaint.
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Thedownsideoffreefrom
Shopperstakeshortcutsandignorethe
ingredientlist.
Thephrasefreefromsuggestsanabsolutevalue.Consumersexpectittomeantotal
absence.
Somefreefromproductshavebeentestedto
revealtraces.
Peoplehavereacted.
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A mistake with free from
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Casehistory
Packsofcarobiceswerelabelled100percent
dairyfree.
Atoddlerreacted.
Testswere
positive
for
milk.
Onecarobsamplecontained1.6percentcasein,theother2.7percent.
Thesuspectbatchwasrecalled.
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Themessage
Food
companies
wishing
to
label
products
freefromXmustbeconfidentthereis
virtuallynochanceofcrosscontact.
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Newrulesonglutenlabelling
NewregulationscomeintoforceJanuary
2012.
Glutenfreestatementwillmeanthe
productcontains
20ppm
or
less
of
gluten.
Verylowglutenwillmeannomorethan
100ppm.
FSAsaystestingwillberequiredtosupporttheseclaims.
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Thequest
for
thresholds
Isthere
adose
beneath
which
people
are
unlikelytoreact?
Can
safe
levels
be
set
that
industry
could
work
to?
Researchismovingclosertofindinganswers.
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Hopeforthefuture
Canwestopchildrenbecomingallergicto
foods? TheEATandLEAPstudieswanttoshowthat
introducingallergenicfoodsearly mayprevent
allergyfrom
developing.
Thischallengesestablishedthinking.
LEAPis
working
with
peanut.
EATwithmilk,peanut,fish,wheat,eggsandsesame.
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Hopeforthefuture
Canallergybecured?
2011:Researchers
at
Addenbrookes achieve
furthersuccessindesensitisingchildrento
peanut.
Oralimmunotherapy(OIT)worksbyintroducingsmallamountsofpeanutintochildrensdietsand
graduallybuilding
up
to
larger
amounts.
USresearchersalsohavingsuccesswithOITandwithsublingualimmunotherapy(SLIT).
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Pleasestayintouch
FoodAllergySupportLtd.
david.reading@foodallergysupport.com
Tel:07904979562
www.foodallergysupport.com