Are we any closer to finding a cure?
Airdate: 
Tuesday, November 4, 2014 - 20:30
Channel: 
SBS

Australia has one of the highest food allergy rates in the world. 

Despite this, experts still don’t understand why people develop allergies, making it very hard for sufferers to manage or prevent them. 

This week we ask: why are more people being diagnosed with food allergies and is a cure a realistic possibility?

Presenter: Jenny Brockie

Producer: Stefanie Collett

Associate Producer: Amanda Xiberras 

Join the discussion by using the #insightsbs hashtag on Twitter, posting on our Facebook page

Web Extra: Information on current guidelines

For infant feeding advice please visit: Australian Society of Clinical Immunology and Allergy

For advice on handling allergies:

Transcript

JENNY BROCKIE:  Welcome everybody, good to have you with us tonight. Anne-Maree, you were recently at a function in Melbourne, I think you'd just started eating the entree, what happened? 

ANNE-MAREE ARTHUR: I had just started eating the entree Jenny which was goat's cheese and once I'd consumed it my lips started to well as did my tongue and that all happened in about twenty seconds, so considering I was also involved with the function that made things a little difficult. 

JENNY BROCKIE: Oh, so you were organising the function as well? 

ANNE-MAREE ARTHUR: As well as. So one of my work colleagues, her husband was at the function and he had one look and just thought I've got to get you to hospital which was really, well that was good in the sense that it was really close to St Vincent's.

JENNY BROCKIE:  And we've got a picture of you here? 

ANNE-MAREE ARTHUR: Lovely. 

JENNY BROCKIE:  It doesn't look like you now, I've hasten to add. How bad was it? 

ANNE-MAREE ARTHUR: Three adrenaline shots, so the anaphylaxis was evident immediately. And I've got that eczema asthma background so of course it was difficult to breathe and, yeah. 

JENNY BROCKIE:  You're 59, have you ever had that kind of reaction before? 

ANNE-MAREE ARTHUR: No, no. 

JENNY BROCKIE:  Have you had food allergies before? 

ANNE-MAREE ARTHUR: Had the odd food allergy but I had started using some goat moisturising lotion, naturally thinking it was a product that would be good for my skin, and I'd been using that sort of through the year and then one of the days I put it on my arms just went bright red and the heat was just amazing. So I obviously stopped using that. 

JENNY BROCKIE:  Did you have eczema or anything when you were using it? 

ANNE-MAREE ARTHUR: No. 

JENNY BROCKIE: Were you using it for anything like that? 

ANNE-MAREE ARTHUR: No, just as a moisturiser.

JENNY BROCKIE:  Had you had goats cheese before? 

ANNE-MAREE ARTHUR: Well I believe so but you know, I can't really remember. I certainly didn't have an allergic reaction like that. 

JENNY BROCKIE:  Robyn, how can a moisturiser cause a food allergy? 

PROFESSOR ROBYN O'HEHIR, ALFRED HOSPITAL: Well the clue was in what Anne-Maree was saying, a lot of these natural products do have food allergens in them such as the goat milk, and intact skin is a beautiful barrier to the immune system.  It stops bacteria and foreign allergens getting into the body but when you have eczema it can activate the immune system and sensitise the system as it did in her case. 

JENNY BROCKIE:  So does it have to be a food based product to create that food based allergy?  

PROFESSOR ROBYN O'HEHIR: To cause this sort of subsequent food anaphylaxis when she ate the food, yes. 

JENNY BROCKIE:  But I've seen food substances in lots of products? 

PROFESSOR ROBYN O'HEHIR: Exactly. 

JENNY BROCKIE:  You put on your skin? 

PROFESSOR ROBYN O'HEHIR: Exactly. 

JENNY BROCKIE: Is that potentially a problem for anyone who's allergy prone?

PROFESSOR ROBYN O'HEHIR: It's potentially a problem for people with allergy and eczema so it's inflamed and damaged skin. So if you have normal skin it's not a problem.

JENNY BROCKIE:  Have you seen it with the products? 

PROFESSOR ROBYN O'HEHIR: We have.   We've seen it with other patients with different goat preparations and also patients with some of the oat preparations.

JENNY BROCKIE:  Fascinating, I think a lot of people probably wouldn't realise all of this? 

PROFESSOR ROBYN O'HEHIR: I think that's right. I mean the point is with eczema anyway, moisturiser isn't meant to be applied to the normal skin and then the prescription ointments are applied to the damaged skin, but you can imagine when you do have a tendency to eczema, people just put it all over their skin or they pop in a bath wash and don't realise in fact that there is a risk.

JENNY BROCKIE:  What happened to the goat’s milk moisturiser? 

ANNE-MAREE ARTHUR: Gone. 

JENNY BROCKIE:  Gone, okay. Katie, how common are food allergies in Australia at the moment? 

PROFESSOR KATIE ALLEN, MURDOCH CHILDRENS RESEARCH INSTITUTE: Well unfortunately Australia seems to be the food allergy capital and certainly we've found in our own study in Melbourne of 5,300 kids that one if ten infants had challenge proven food allergy. 

JENNY BROCKIE:  One to ten?  

PROFESSOR KATIE ALLEN: So that's one in Melbourne in one study, but we think it's between 5 and 10 percent across all ages. So it's much less common in adults and it's certainly more common in infants and children. 

JENNY BROCKIE:  Has it stabilised or is it rising do you think? 

PROFESSOR KATIE ALLEN: Well it's been described as the new epidemic, you know?  As allergists we don't like to use the word epidemic, that's sort of more to do with infectious diseases but in fact we think it wasn't around thirty years ago and it's certainly around now.  So we think it has risen, we don't know whether it's continuing to rise or whether it's plateaued, we just don't know the answer at the moment. 

JENNY BROCKIE:  Do we know why? 

PROFESSOR KATIE ALLEN: Well that is the $64 million question. We pretty hot on the heel of what we think might be some of the key factors. We think it's something to do with modern lifestyle.

JENNY BROCKIE:  The modern lifestyle is a very broad area though, it doesn’t  narrow it down does it? 

PROFESSOR KATIE ALLEN: I think the things in the past, in some ways allergies had a bit of a bad name because we keep changing our views on what advice to give people. And so we try to come up with something that's, you know, going to be robust with regards to outcomes. 

JENNY BROCKIE: Richard, are people becoming more allergic to more types of food? 

ASSOC. PROFESSOR RICHARD LOH, CLINICAL IMMUNOLOGIST: You can be allergic to almost any food. So we've seen patients who anaphylaxed to watermelon, to Kiwi fruit, so it's not just peanuts, tree nuts, fish, shellfish cow’s milk, egg, so there are unusual foods like cinnamon, spices can cause anaphylaxis.

JENNY BROCKIE:  Lots of people have allergies but what is the difference between an allergy and an intolerance because people use the word allergy very loosely. Can you describe the difference? 

ASSOC. PROFESSOR RICHARD LOH: When allergists talk about a true allergy, we often talk about IGE mediated.  That means there's a protein in the blood called IGE and this protein, when it binds onto certain cells in the body, releases chemicals and cause an allergic reaction. I'm Asian and many Asians are lactose intolerant. I lack of enzyme that breaks down a sugar they have in food and I have tummy upsets with it but that's one intolerance and there are many other things that you can be intolerant to.

JENNY BROCKIE:  An allergy affects the immune system though, it's an immune system issue? 

ASSOC. PROFESSOR RICHARD LOH: It's an immune response. 

JENNY BROCKIE:  Whereas an intolerance isn't, is that right? 

ASSOC. PROFESSOR RICHARD LOH: Yes, in most cases it isn't involving the immune system. 

JENNY BROCKIE:  So an allergy can be life threatening but an intolerance isn't, is that the bottom line with this? 

PROFESSOR KATIE ALLEN: Well allergies that are IGE can cause anaphylaxis. Allergies that are non IGE can't cause anaphylaxis. 

JENNY BROCKIE:  How is anyone to know that? 

PROFESSOR KATIE ALLEN: Well it's easy, skin prick test or a blood test.  It's so simple. In fact that's the one thing about allergy diagnosis, is we really know how to diagnose IGE mediated food allergy, we know that. 

JENNY BROCKIE:  Can some of the reactions be similar though between intolerances and allergies? 

PROFESSOR KATIE ALLEN: No, actually the reality is IGE mediated food allergy is quite distinctive and the children or the adult comes in and they have had an allergic reaction which the parents can identify. The child has just eaten their first bite of a peanut butter sandwich, they blow up like a Michelin Man, you know, have swollen lips and swollen face and they may vomit, they may have hives and they might start to cough and wheeze and they've got anaphylaxis. It's happened with a few minutes, the intolerance is a quite different presentation. 

JENNY BROCKIE:  Anne-Maree, have you become sensitive to anything else? 

ANNE-MAREE ARTHUR: Yes, seafood. 

JENNY BROCKIE:  Oh, so you didn't have that before? 

ANNE-MAREE ARTHUR: No. 

JENNY BROCKIE:  So that happened at the same time or around the same time? 

ANNE-MAREE ARTHUR: No, no, about three months later. 

JENNY BROCKIE:  All seafood or just crustaceans? 

ANNE-MAREE ARTHUR: All seafood. 

JENNY BROCKIE:  Wow, that's a big one? 

ANNE-MAREE ARTHUR: Yeah, except for all tuna in a can. I can eat that. 

JENNY BROCKIE:  You can eat tuna in a can, okay, great. Sam, your four year old has a range of anaphylactic allergies, how severe are his reactions if he eats certain foods? 

SAM HUDDLE:  He's had a number of anaphylactic episodes where it's an immediate respiratory response. Unfortunately he doesn't always swell up or puff up. 

JENNY BROCKIE:  So you can't see it in terms of that? 

SAM HUDDLE:  Yeah, and every time he's had an anaphylactic episode he's had a different presentation, but if he swelled every time it would almost be a little bit easier.

JENNY BROCKIE: How did you find out that he had this? 

SAM HUDDLE:  So he had chronic eczema at four months, at six months we had a skin prick test done that revealed he had an egg allergy. At nine months I'd cooked some roast carrots with a little bit of maple syrup and a tiny bit of mustard, I took one carrot out and mixed it with his and he ate the carrot and had anaphylaxis. So he's anaphylactic to mustard seed. Then we had skin prick testing done again at twelve months which revealed the peanut allergy. 

JENNY BROCKIE:  And you're second child is six months old, so what sort of advice have you been given regarding the two children? You've got a family history? 

SAM HUDDLE:  My husband and I both had childhood ex, sorry, asthma and hay fever and my husband may have had a little bit of eczema so we were going to be more prone to this. We didn't know this until after we'd had our son though. 

JENNY BROCKIE:  So what advice were you given with the first child and then with…

SAM HUDDLE:  Well because we didn't get any particular advice, so I ate peanuts, I ate everything apart from the foods that most pregnant women don't eat. I didn't drink any alcohol at all and I definitely ate peanuts and other nuts, eggs, I ate a lot of eggs towards the end of my pregnancy when I was baking a lot.

JENNY BROCKIE:  What about the second child though, were advice were you given about the second child? 

SAM HUDDLE:  So vitamin D supplement during pregnancy, definitely include eggs and nuts in my diet. That said, there was a softer recommendation about avoiding peanuts and I was also told to breast feed with my first son and with my second son as long as I could, so I breast fed my four year old until he was sixteen months. 

JENNY BROCKIE:  And your second child is now six months old, any signs of allergies? 

SAM HUDDLE:  Yeah. So he had, we think it's an allergic reaction to Keflex, they thought he may have had some infected eczema on his face and we…

JENNY BROCKIE:  Which is an antibiotic? 

SAM HUDDLE:  Yeah, but like a moderate allergic reaction so that was treated with steroid. And he has a non IGE mediated dairy allergy that we think that he's probably out grown that now. And he's also had an allergic reaction to avocado but it wasn't anaphylaxis, it was I guess a moderate allergic reaction. 

JENNY BROCKIE:  Richard, what is the current advice to pregnant women and to parents about small babies and toddlers and so on in terms of what to do?  

ASSOC. PROFESSOR RICHARD LOH: The current advice during pregnancy and breast feeding is just to have a normal diet. 

JENNY BROCKIE:  Now that's the opposite of what the advice was how long ago? 

ASSOC. PROFESSOR RICHARD LOH: Probably five, six years ago.

JENNY BROCKIE:  Okay, so the advice has come right around the other way? 

ASSOC. PROFESSOR RICHARD LOH: It has. 

JENNY BROCKIE:  And why has it changed, Katie? 

PROFESSOR KATIE ALLEN: Well it's changed based on evidence and the evidence is that the delay in introduction of allergenic solids, so egg and peanut and cow’s milk,  doesn't protect you from allergy.  So the idea is that early introduction may protect you from allergy. So it's changed based on research. 

JENNY BROCKIE:  And how can you be 100 percent sure then that the advice you're giving now is the right advice? 

ASSOC. PROFESSOR RICHARD LOH: You can't. And the problem with Google is you can go on many, many sites and actually not know what's current.

JENNY BROCKIE:  So what to feed small babies? 

PROFESSOR KATIE ALLEN:  You can just feed children as you do for any other normal child, one food at a time, small amounts, increasing those small amounts and that's a safe way to introduce solids into an infant's diet. 

JENNY BROCKIE:  And if you've got a family history? 

PROFESSOR KATIE ALLEN: Same advice. 

JENNY BROCKIE:  Same advice? 

PROFESSOR KATIE ALLEN: Yes, there is no specific allergy related advice now. 

JENNY BROCKIE:  Robert, you’ve decided pretty much to ignore the current advice, you’re still suggesting pregnant women be careful about their exposure to certain foods.  Why? 

DR ROBERT LOBLAY, ROYAL PRINCE ALFRED HOSPITAL:  I think the first thing to say is that there's a difference between advice that you can give to people in the general population and people who have a history of allergies in the general population. I don't think the pregnancy is a big issue but I think what  happens after pregnancy when the baby's born is important and so we encourage people to, particularly with the nuts, to eliminate all the nuts out of the household and…

JENNY BROCKIE:  This is for people with a history? 

DR ROBERT LOBLAY: Where there's already one allergic child in the family. And it's not just what the mother's eating or isn't eating, it's what the whole family's eating. So we've been giving people that advice for a long time now and looking at the outcomes down the track, we've been following kids now for ten years and there's dramatic drop in the incidence of new allergies in people who took that advice compared with those who didn't. 

JENNY BROCKIE:  So you're talking, avoidance really? 

DR ROBERT LOBLAY: But I'm only talking about it for high risk people, already an allergic child in the family.

JENNY BROCKIE: Okay, can I throw this open a bit?  Do people have a question? 

ERICA RYAN: We're actually sisters and we grew up in a nut household and I think it actually benefited us greatly because it means that we check our food and I think kids that are raised in households that don't have that allergen in it are actually more vulnerable. They don't think about what they're eating and eventually I think you're just putting yourself at risk. 

JENNY BROCKIE:  Okay, so you're vigilant about this? 

ERICA RYAN: Yeah. 

JENNY BROCKIE:  Because you grew up in a house? 

ERICA RYAN: Yeah. 

JENNY BROCKIE:  Anyone else got a question at this point?  Yeah?

KRISTIN-LEE CAMPBELL: Yeah, we choose in our household to live completely allergen free so we are free from eggs and nuts inside the house only because we've got such small children. So it's the one place that they can, can be safe and not feel anxious. 

JENNY BROCKIE:  Bibiana, I know you're one of Rob's patients, you have a son with 17 allergies, is that right, food allergies? 

BIBIANA BEAUPARK: Food allergies and he is confident five of them could cause an anaphylactic attack.  When Antonio was first diagnosed, he got ten and as we go older he keep increasing it. So all his arm full of allergies, he react to all of them. Only last year finally we go to a level that we go okay, we're not getting more, that's good. 

JENNY BROCKIE:  Were you worried about your second child there in the photo? 

BIBIANA BEAUPARK: Yeah, Erica, when we decide to have Erica we ask actually the RPA because it was really tough with Antonio. We went for a whole six months with no sleeping, our baby was upset, cranky, crying, no one could settle him. So when you're thinking I'm going to get this risk again, you need advice. So we asked Dr Loblay what we can do and the advice was nuts, with Antonio I did have the craving of eggs, I eat eggs like going out of fashion, Antonio, one of the biggest allergies is eggs. 

JENNY BROCKIE: Is eggs, and your daughter? 

BIBIANA BEAUPARK: Erica does not have allergies, we're testing her three times, all three times it came clear. But Erica does have intolerance so fruits and vegetables is one thing Erica only tolerate in little, little amounts.

JENNY BROCKIE:  So what have you learnt that experience with your two children do you think? 

BIBIANA BEAUPARK: Well for us, be careful what I eat during my pregnancy, did make substantial change. One of the advices was to be conscious about what I eat.

JENNY BROCKIE:  Hard to get to the bottom of this though, isn't Katie, just what, you know, I mean it might be what you eat in pregnancy but it be something else? 

PROFESSOR KATIE ALLEN:  No, it's not going to be that. People get so excited about all this allergen exposure but it's impossible to get everything out of your diet because we all have to eat. So I think that there's a lot of focus on how to get things in and out of your diet but it makes it very complicated for families, they're very confused as a result. 

JENNY BROCKIE:  Peter, we hear a lot about hygiene and about how we're too clean and too careful and we're not exposed to enough I mean do you, do you believe that's the case and what sort of research are you doing?

ASSOC. PROFESSOR PETER VUILLERMIN, PAEDIATRICIAN: The notion that hygiene might be important came from studies that showed that kids who had more siblings were less likely to develop allergic diseases and then a series of studies that showed that kids from farming environments seemed to be at substantially reduced risk, in particular studies in Bavaria where you've got pregnant women and children looking after the cows during winter, they're almost sort of co-housed, they're in stables that are connected to the family house and these are very healthy kids.  

JENNY BROCKIE:  So we just need to all live with cows? That's the moral of the story?

ASSOC. PROFESSOR PETER VUILLERMIN: I think so. I'm married to a dairy farmer's daughter though. And there's a range of other factors that have been associated with reduced risks like pet ownership and…

JENNY BROCKIE: But people are allergic to pets too, how do you make that work?

ASSOC. PROFESSOR PETER VUILLERMIN: It's easy.  All of this might be acting influences on the composition of the gut flora in either the mother during pregnancy or the baby during early life or both. 

JENNY BROCKIE:  So what are you doing, you're collecting people's poo I understand, is that your research, lots of it? 

ASSOC. PROFESSOR PETER VUILLERMIN: Not just me. We have a team of people that collect. 

JENNY BROCKIE:  What are you doing?  What are you trying to find out? 

ASSOC. PROFESSOR PETER VUILLERMIN: So we've recruited over a thousand pregnant women from the two hospitals where almost all the babies in the region are born over a three year period and we've collected, poo samples from the mothers during pregnancy and the babies at birth, one, six, twelve months, and planning to repeat that at two, three years and beyond. 

JENNY BROCKIE:  And what are you finding? 

ASSOC. PROFESSOR PETER VUILLERMIN: Well, I think, you know, it's too early for us to really talk about what we are finding. What we are looking at is the composition of the mother and the baby's gut flora and we're really trying to test some of the ideas that have been quite nicely drawn out in animal models that suggest particular types of organisms during early life might play a key role in stimulating the immune system to go down a sort of healthy pathway. And over the next six to twelve months we'll be cracking open the freezers and taking our poo samples out and extracting DNA and sending it off to collaborators in America and in Adelaide and trying to get robust answers to these questions. 

JENNY BROCKIE:  Rob, what did you want to say? 

DR ROB LOBLAY:   Yeah, look I think there's an important point to make about the types of allergies that are becoming more prevalent because egg and milk allergy has always been there. The big thing that's changed is peanut and the other nuts and it began about twenty years ago. First a trickle, then a little more, then a flood, and that happened about fifteen years ago.

JENNY BROCKIE:  Why, why is that happening? 

DR ROB LOBLAY:  If this was simply lifestyle or hygiene or stress, it should affect all those allergies pretty much the same way. The thing that's changed is the nuts and what seems to have been happening is for some reason people are being exposed in a different way or to larger amounts of nuts, initially peanut and now other nuts, than they used to be before. So we've got an epidemic of nut allergies that wasn't there before. 

JENNY BROCKIE:  And that's because we're eating them more do you think? 

DR ROB LOBLAY: Well nobody knows, nobody knows why but there's got to be something different. I mean if you look at the admission statistics for anaphylaxis in hospitals, in the young age group it shot up like exponentially and most of it is nut anaphylaxis. 

JENNY BROCKIE:  And that's where you get the really severe reaction too, isn't it? 

DR ROB LOBLAY: Exactly. 

JENNY BROCKIE:  Katie? 

PROFESSOR KATIE ALLEN: Rob's not quite right in fact, in our health nut study egg allergy was 9 percent of the general community with expressing some sort of egg allergy, but we know that half of those have already outgrown their egg allergy by two to three years of age. So what we do know is that peanut allergy and tree nut allergy are more likely to be lifelong and therefore they look like they're more prevalent as well. 

JENNY BROCKIE:  Phoenix, you're nine, is that right?

PHOENIX O'CONNOR:  Yes. 

JENNY BROCKIE:  And tell me what your favourite things are to eat? 

PHOENIX O'CONNOR: Um, ice cream, cake, chocolate. 

JENNY BROCKIE:  And Saxon, you're Phoenix's twin brother but you can't eat all the same stuff as him. Can you tell me why you can't eat the same stuff? 

SAXON O'CONNOR: Because I have some allergies which stop me from eating some foods. 

JENNY BROCKIE:  Okay, so what are you allergic to? What kind of things can't you eat? 

SAXON O'CONNOR: I can't really eat eggs, peanuts - I can't really have mandarin, oranges, bananas, grapes, watermelon. 

JENNY BROCKIE:   What about strawberries, can you eat strawberries? 

SAXON O'CONNOR: No, I can't eat those either. 

JENNY BROCKIE:  Okay, anything else? 

SAXON O'CONNOR: I think that's it. 

JENNY BROCKIE:  Yeah, that's a lot though, yeah? And what's that like for you not to be able to eat those things? 

SAXON O'CONNOR: Doesn't really bother that me much, I don't really notice it. 

JENNY BROCKIE:  What about when he's eating them? 

SAXON O'CONNOR: I don't really care.  

JENNY BROCKIE:  Okay, do you ever find yourselves fighting about it? 

PHOENIX O'CONNOR: He sometimes tells me not to eat it in front of him, that's about it. 

JENNY BROCKIE:  That might be fair enough, actually, if he's really feeling like he wants to, he wants to eat it. Don't you think? 

PHOENIX O'CONNOR: Mm-mmm, yeah. 

JENNY BROCKIE:  Yeah, okay. Karen, the boys are fraternal twins so I just wondered whether you exposed them to different foods when they were babies? 

KAREN O'CONNOR: No, they were exactly the same. They were breast fed till they were eight months old and introduced solids at six months and it was all organic vegetables. 

JENNY BROCKIE:  Do you have any allergy, any allergic history?

KAREN O'CONNOR: Not to food, no. 

JENNY BROCKIE:  To anything else? 

KAREN O'CONNOR:  Just hay fever, that's about it.  But Saxon is anaphylactic to egg whites and nuts, peanuts. 

JENNY BROCKIE:  What happens if you have those things Saxon?

SAXON O'CONNOR:  I've had peanuts once. 

JENNY BROCKIE:  What happened? 

SAXON O'CONNOR: Made me cough a lot and not really much happened, just made me cough really loud and it was like all jammed a little bit. 

JENNY BROCKIE:  And their dad, does he have any allergies? 

KAREN O'CONNOR: He's allergic to bees but no food allergies at all. 

JENNY BROCKIE:  Katie, how much is environmental and how much is genetic? How much is what you eat and how much is this in your genes no matter what? 

PROFESSOR KATIE ALLEN: I mean the big question of family history is an interesting one for food allergy because certainly with asthma and allergic rhinitis which is hay fever and eczema, the genes seem to be incredibly important so I just always say if you have one person with a family history, then you've got a 40 percent chance you've got allergy. If you've got two people with a family history, then you've got an 80 percent chance you're going to have some sort of allergy. But the same doesn't seem to be true for food allergy, but we think the increased risk is actually across both the barriers with the family history and those without and that's what makes us think that actually the environment may be something that's more important for food allergy than it is for the other allergic diseases. 

JENNY BROCKIE:  Patrick Ow in Melbourne, you have five kids, the two youngest have allergies. Tell us what they react to? 

PATRICK OW: The first born in Australia has severe allergies to peanuts, all nuts, milk, eggs and shell fish.  And the second born in Australia has a very minor reaction to peanuts, milk and shell fish and eggs. 

JENNY BROCKIE:  What about the other three who were born overseas? 

PATRICK OW: The other three older ones were born in Malaysia and they do not have allergies at all and we are the first in our own respective families to have allergies. 

JENNY BROCKIE:  Okay, what do you make of that? 

PATRICK OW: Well, what we think was that it could be the hygiene. We could also think about the environment.

JENNY BROCKIE:  Katie, what does Patrick's story tell us about what's going on? 

PROFESSOR KATIE ALLEN: Well it does get back to this concept of you know the migration effect. So in our study we found that Asian parents have much a lower rate of allergy themselves than Australian parents, but children who are born from Asian parents in Australia are three times more likely to have food allergy. And the effect particularly is for those who've come from a developing country as opposed to those who've migrated from places like Europe. So we think there's something in the developing country that's a protective factor.

JENNY BROCKIE:  What does your family back in Malaysia think about this, about the two children having allergies who were born here?

PATRICK OW: Really weird, because none of us have it. When we told our families about it, they were very surprised and very shocked about this whole allergy, food allergies. Not sure whether they understand the seriousness of allergies as is in Melbourne or Australia. It's something very foreign to them.

JENNY BROCKIE:  Bibiana, you've got your hand up because you're from Colombia.

BIBIANA BEAUPARK: Yeah, I'm from Colombia and we come from a background where we don't have allergies either. We are fussy eaters. It's not in our culture. So my parents come and visit us. They say, we don't have eggs, we don't have - they say so oh, no, rice milk. You can't have eggs.

JENNY BROCKIE:  When did you come here?

BIBIANA BEAUPARK: When I was 21.

JENNY BROCKIE: Alright, so your children were born here?

BIBIANA BEAUPARK: Yes. And I also guess, you found the same, it's a very isolating, to have a child with allergies. Your friends that you thought were your friends for a long time, have difficulties to understand that now life has changed. So there's a lot of people stop inviting you to things, to inviting you to parties. They're scared of cooking something that might affect Antonio.

JENNY BROCKIE: Well given the prevalence of potentially life threatening allergies in children generally in Australia, let's have a look at how one school is handling it. 

 

ST. JOHN BOSCO CATHOLIC SCHOOL VIDEO PLAYED:

LEE SCOLA: We have students from Year 6 that collect our first aid bobbing boxes. We are two first aid boxes that will go out onto every playground.

FIRST AID OFFICER:  Okay darling, what have you got?

LEE SCOLA: Our first aid officer in the office will place the epipens into those boxes according to the playground roster. The first aid boxes are very flourscent orange boxes that can't be missed.

ALL: Good morning Mrs Scola.

LEE SCOLA: Our first reminder is about remembering not to share food. We only eat the food that our parents have sent for us to eat. Or that our parents have ordered via the tuck shop.

MOTHER: When I go to buy anything new, I always investigate thoroughly. For example, our popcorn doesn't come with any list of ingredients. I rang the company and they sent me a list of ingredients which we put up there for display.

LEE SCOLA:  We do have a process of identifying students in our school that have food allergies. Those children wear a yellow badge on the collar of their uniform. We can never guarantee that our school is 100% nut-free. We endeavour to minimise that risk at all costs.

  

JENNY BROCKIE:  Lee, why make the school nut free? Why have you taken it that far? 

LEE SCOLA, ST JOHN BOSCO PRIMARY SCHOOL:  We have a number of students at our school that have an allergy to nuts, some mild, some moderate, and some obviously that have anaphylaxis. So it's just one of our strategies. We constantly educate our students as well as our parents, as well as our staff, in ensuring that they have a really solid understanding of what it is. 

JENNY BROCKIE:  Have you had incidents at the school? 

LEE SCOLA:  Touch wood, no, we haven't in the time that I've been there, but even prior to me being at the school, no, we haven't. 

JENNY BROCKIE:  Katie, what do you think about the idea of nut free schools?

PROFESSOR KATIE ALLEN: Look, it's a very vexed question and every school seems to interpret it slightly different. Even though allergen minimisation is recommended, it's not recommended to necessarily ban certain foods and that's partly because, you know, there are so many foods children are allergic to and you can't ban all foods.  And secondly, if a child leaves a school and goes down to the local cafe, you know, if they're not aware that they shouldn't be eating foods that they don't know the content of and they're not sure of what they're eating, then they may take unnecessary risk. So it may give a false sense of security. 

JENNY BROCKIE:  Karen, what do you think about the idea of nut free schools? 

KAREN O'CONNOR: My boys don't go to a nut free school but I'm okay with that. I have full faith in them, they recognise which children are anaphylactic and they advise the teachers. I think it's different when they're really young, I prefer those places to be like nut free because it can potentially kill a child. 

JENNY BROCKIE:  Kristen, what about you, your kids are going to school soon? 

KRISTIN-LEE CAMPBELL: Yeah, at the moment they're at a day care centre that is nut and egg free as much as it can be which is amazing for us. Two of our children have anaphylaxis.  The school we're sending them to is not completely nut free but they've got to grow up and potentially live with this for the rest of their life so we don't want to shelter them.

JENNY BROCKIE:  And how sever is their reaction? 

KRISTIN-LEE CAMPBELL: Anaphylactic. 

JENNY BROCKIE:  And have you had something that you thought was really live threatening? 

KRISTIN-LEE CAMPBELL: Yes, yes, our little girl who was eighteen months old at the time had hazelnut chocolate and had anaphylaxis and then six weeks away too I was making a nut free cake, which you know, mother of the year I thought I was doing a wonderful job and I gave my son the spatula to lick and he, who had had eggs every day of his life, had an anaphylactic reaction to the raw egg in the cake mix. 

JENNY BROCKIE:  We've got a picture of him there, poor little poppet, look at him? 

KRISTIN-LEE CAMPBELL: Yeah, it was taken a good couple of hours after his reaction. 

JENNY BROCKIE:  Gosh, poor little thing. So now what do you do in the house?  Do you keep those things out all together or do you have them? 

KRISTIN-LEE CAMPBELL:  So we do at the moment. It's the one place that, yeah, we're not, we don't feel stressed and anxious and the kids can relax and you know, I like to give my kids a kiss good night and if I've eaten something I feel like I can't, so. 

JENNY BROCKIE:  Sorry, go on. 

KAREN O'CONNOR:  If we go like to parties and whatever and people will say what can't we have and if I know that they do have peanut butter a lot I just say would you mind to get your kids to brush their teeth prior? And it's the same like if you have peanut butter you'd have to. 

KRISTIN-LEE CAMPBELL:  Yeah, or a glass of wine or you know. 

KAREN O'CONNOR:  Wash your hands before you embrace the child. 

JENNY BROCKIE:  How do people react to this sort of stuff? 

KRISTIN-LEE CAMPBELL: I think they think you're a little bit crazy sometimes but it comes to life or death with your children so you don't, you know, you learn to live with…. people either accept it or they don't and you know, that's just how it is. And sometimes it takes them to see a reaction sadly enough for them to realise how serious it is. 

AARON CAMPBELL: I think they sometimes think we're making it up, it gets to that point. Kristin was in hospital and I was feeding the kids by myself, two tins of spaghetti, identical, one big one, one little tin. One's made in Australia, one's made in New Zealand.  The little one, I thought oh, this will be great, take it to day care, full of egg, identical labels - simple as that and I'm meant to be on top of it. So for other people who know zero about, it just must be completely overwhelming because I'm overwhelmed at times about it, so... 

JENNY BROCKIE:  Karina, let's have a look at your situation at home with your son Anatoly. 

 

ANATOLY’S VIDEO PLAYED:

 

ANATOLY SCHEMEN: I am seven. Oh yeah. Oh yeah. I'm allergic to dairy, eggs, cheese, and nuts.

KARINA SCHEMEN: Sesame and of course to dust.

ANATOLY SCHEMEN: Did I say dairy?

KARINA SCHEMEN: So you grab the bananas. The whole environment at home is basically for him, suited to his needs to his allergies.

ANATOLY SCHEMEN: Ice-cream, but not ice-cream.

KARINA SCHEMEN: How good is that? We found lots of substitutes and so our whole diet has changed as a family.

ANATOLY SCHEMEN: Well, I have eaten something, something like that has cheese in it. One, two, three. Hmmm. But as soon as I eat it gets like, itchy in my throat. I almost can't breathe a little bit.

KARINA SCHEMEN: So he's got his nasal sprays and the steroid one and then the Epipen.

ANATOLY SCHEMEN: I have to take the bloody Epipen. Which you have to go like, one, two, three.

KARINA SCHEMEN:  So you take the safety cap off and you hold your thumb around and then the needle comes out here.

ANATOLY SCHEMEN: Eight, nine, ten... Tissue - wipe,  wipe, wipe the blood off.

  

JENNY BROCKIE:  He's quite a livewire, your Anatoly, isn't he?  He obviously knows the drill too, doesn't he? 

KARINA SCHEMEN:  Completely. 

JENNY BROCKIE:  How far have you gone though, to protect him? 

KARINA SCHEMEN: I guess I also didn't want to over protect him but when he was diagnosed at six months he was allergic and anaphylactic to so many food products, like I was left wondering what can he eat?   And so to create a safe haven at home, we had to eliminate a lot of foods so that at least at home he would, he would have that place where, yeah, he doesn't get anaphylaxis. 

JENNY BROCKIE:  Now you've stopped work, is that right? 

KARINA SCHEMEN: I guess I've had to. I just was called to the school so many times, my son is very, as you could tell he's very vivacious, he's alert, he's aware, but in a way it's also an anxiety because he could see he's different from the other kids and other parents don't always understand and they think you're over reacting. And I guess he did stop breathing once when he was one year old so it does make you just a lot more anxious. 

JENNY BROCKIE:  So are you anxious as well, do you think? 

KARINA SCHEMEN: I think so, okay, my son needs protection, he need his education at the moment while he's young.

JENNY BROCKIE:  Is he still at school? 

KARINA SCHEMEN: No. 

JENNY BROCKIE:  So you're home schooling him? 

KARINA SCHEMEN: Yes, we're not home schooling him to isolate from it. It's just because his anxieties were so much, it was affecting his behaviour and we thought that it was behavioural.

JENNY BROCKIE: Olivia, how much of this do you see? You're a psychologist and you're interested in this area? 

OLIVIA KEENE, CHILD PSYCHOLOGIST: Yeah. 

JENNY BROCKIE:  How much do you see anxiety coming with this issue of allergies? 

OLIVIA KEENE: Look, anxiety goes hand in hand with allergies and I kind of think anxiety is really sort of anticipatory stress, if you like, like the brain sort of flipping forward in time to a what if this happens. What if that happens?  As soon as, you know, you go to imagine what if this thing happened, what if I ate this and I had an allergic reaction?  Physiologically it will still, the same response will kind of kick in. 

JENNY BROCKIE:  And what about separating what's the child's anxiety and what is the parents' anxiety? 

OLIVIA KEENE: Yeah, it's a really difficult area because we're designed to be emotionally enmeshed with our kids, both need to be handled and actually sort of separating out, working with the child and the parent as much as possible to try and get them to own what is theirs.  You'll say to a young person, particularly for a young child, if you're feeling sort of scared is that yours or mum's? And often they'll say mum's. So okay, if you're feeling scared is that yours or mum's and eventually they'll go mine. Okay, so who's the only person in this whole universe who can actually change that? Me.  It's important to note as well that we all have certain levels of anxiety and it is functional. So if I saw a child who had allergies and they didn't have a certain level of anxiety around it I'd be concerned. 

JENNY BROCKIE:  You'd be worried? 

OLIVIA KEENE: Yeah, that they weren't actually able to put things into place or to think ahead and what do I need to do to kind of minimise my risk there?  So it's on a sliding scale but then you see it turns into dysfunctional anxiety in some extreme cases where, you know, that really by the time I see them they actually, they're only eating two foods and drinking water. 

JENNY BROCKIE:  Richard, tell us about food challenges. How do food challenges work and what are they for? 

ASSOC. PROFESSOR RICHARD LOH: Can I also say a little bit about anxiety as well? I'm not sure it may reassure people but if you look at fatalities, which is the worst outcome, I'm not aware of any deaths from peanut allergies under the age of five years anywhere in the world. Okay, no deaths under the age of five.

JENNY BROCKIE:  Under five?  And that's where people worry the most?  

ASSOC. PROFESSOR RICHARD LOH: Exactly, and also perhaps to reassure people as well from touching, from coughing, getting life threatening anaphylaxis is really, really rare. You've got to eat the food. So if the fear is that somebody can cough on your child after eating peanuts and your child can die from it, then I would say that the risk is higher from being struck by lightning than it is from that event.  The concept of food challenges, we do it for various things sometimes for various reasons some children would be tested at the skin or blood test and it's positive they've actually never had a history of ever reacting to the food. And many of my patients know that I skin test positive to rice and my blood test is positive to rice.  I have rice almost every day so that term we use is sensitise but not necessarily can be allergic.  So we often then introduce foods in a hospital environment, so we assess risk and in most cases you find that the child actually isn't allergic but has allergy antibodies and sensitised.

JENNY BROCKIE:  Erica, you're twenty, you're allergic to nuts and you had a food challenge when you were younger.  How did it go? 

ERICA RYAN:  It turned out really horribly.  So I've always had an allergy to nuts but when I went through puberty the skin test was inconclusive. So I went in for the nut challenge and so they gave me increments of peanut butter over time, and I didn't have any reaction whatsoever and everyone was getting really excited, and then I had the half tablespoon and it was fine and then after an hour they gave me another half tablespoon and within 45 seconds I couldn't breathe. They had to call a respiratory arrest code in the hospital. They gave me seven or like more adrenaline shots.  They almost had to intubate me, it was very terrifying. 

JENNY BROCKIE:  Very terrifying, yeah, how long ago was this? 

ERICA RYAN:  It was first term into year 7 and then since then I've never looked at nuts again. 

JENNY BROCKIE:  Yeah.  Hannah, how did it affect you, having your sister like that? 

HANNAH RYAN: Well obviously it was pretty scary so I was only eight at the time and I wasn't at the hospital when she had the challenge, I was with my mum and my other sister who doesn't have any allergies. 

JENNY BROCKIE:  Do you have any? 

HANNAH RYAN: Yeah, I'm allergic to nuts as well. I don't go anywhere near nuts. 

ERICA RYAN:  You've never had a reaction though, you never actually had…

HANNAH RYAN: No, I've never had a reaction.  They actually, I just got retested and they want me to do the almond challenge in the hospital which obviously I don't really want to do considering what happened to Erica. 

JENNY BROCKIE:  Erica how much has it changed your behaviour now, like in terms of what you do?  Your boyfriend Joshua is here, I mean how does it affect the both of you for example? 

ERICA RYAN:  So before he had a sandwich and I won't let him kiss me because I'm not confident that it won't have anything in it. But he also, on grand final day he bought footy mix, just picked off the shelf and came back with it and it had nuts in it and I was like oh, I can't eat it and then he was just eating it and I kind of was just like sitting on the other side of the room and he had to go wash his hands and brush his teeth before he'd come near me again. 

JENNY BROCKIE:  Tricky, eh? 

JOSHUA:  Yeah. 

JENNY BROCKIE:  Patrick, you wanted to say something? What did you want to say? 

PATRICK OW: Yes, I was.  Basically I've got a house full of five kids and I'm very mindful that we have to make sure that Esther and Ben is not excluded from the family activities.  So our house is not peanut free. So what we try to do is to challenge Esther and Ben to try different food, bits and pieces of it, and to help them, try them and see how the reaction would be.

JENNY BROCKIE:  Okay, can I just ask you then, are you talking about giving them things you know they have a reaction to but it's a mild reaction? Or are you talking…

PATRICK OW: Yes, yes. So what we try to do is try to give them small quantities of hard boiled and soft boiled eggs just for them to taste it and we will obviously watch for the reaction, because they may be able to eat it so we don't know until we kind of push the boundaries and encourage them to eat the food. 

JENNY BROCKIE:  Patrick, I have to tell you that our medical people here are looking very worried by your little experiment. I want to know why. What do you, what do you think about what Patrick's doing? 

ASSOC. PROFESSOR RICHARD LOH: You can't guarantee, if a child's had moderate reactions, that the next reaction will be moderate. It could be severe. Every child is an individual. I would caution these challenges at home.

JENNY BROCKIE:  Okay, Katie what do you think? 

PROFESSORKATIE ALLEN: Yes, I think the community is getting this sort of idea that oh, we should just sensitise at home and we don't believe that's a good thing because they may have a nasty reaction. 

JENNY BROCKIE:  Okay, Patrick, your reaction to hearing that? That it's risky what you're doing? 

PATRICK OW: Well we just have to be careful. It is risky but we have to try to see what else they can eat and extend that they can eat.

JENNY BROCKIE:  Okay, Robert? 

DR ROBERT LOBLAY:  With egg it's a different story. Once they tolerate baked egg in small amounts they can experiment a little bit at home. It's an entirely different story with nuts. Never ever do this at home with nuts. 

JENNY BROCKIE:  Do you do it with nuts Patrick?

PATRICK OW: No. 

JENNY BROCKIE:  Okay. Sam, I know that last week your four year old did a food challenge for almonds, how did he go? 

SAM HUDDLE:  He seems to have passed which is good, so that was his third food challenge. He's previously passed hazelnut a couple of years ago so he had a Nutella day on Saturday where he gets to eat Nutella and that's how we keep up his exposure every week. 

JENNY BROCKIE:  So you've got to keep the exposure going once you've had a success?  

SAM HUDDLE:  Yes. Then a year ago he did a baked egg challenge and he failed and he'd previously at eighteen months had anaphylaxis in eating cake crumbs off the floor at playgroup.

JENNY BROCKIE:  Okay, so this is really touch and go, isn't it?

PROFESSORKATIE ALLEN: I think yes and no, I think you have to be careful about people's opinions and again what we do know, we do know how to diagnose and how to manage food allergies. There's absolutely no question about that.  What we don't know is the severity.  So we can't predict mild, moderate and severe.

JENNY BROCKIE:  Anne-Maree, we've talked a lot about pregnant women and babies tonight but what's it like for you developing an allergy now at this stage? 

ANNE-MAREE ARTHUR: When I first developed my goats cheese allergy I was not serious about it. I knew how ill I was that night but in the next few days I thought oh, that was pretty dangerous, but as time's gone on and I've read more about it, I've become far more vigilant about how I'm managing it.

JENNY BROCKIE:  Scott, you've had a different experience to that? 

SCOTT ARCHBOLD: Yeah, it's interesting, I was always taught not to eat nuts and I'm 27 now and  through the years I've had sort of various reactions, pretty mild like an itchy throat, swollen tongue or whatever.  But about two weeks ago I've had quite a life threatening reaction, ended up in resuscitation at St Vincent's Hospital.  Me and my girlfriend just had ice cream in an ice cream shop and it was just from a contaminated scoop, like I had to use the Epipen and I honestly thought I was going to die. Like…

JENNY BROCKIE:  That must have been terrifying? 

SCOTT ARCHBOLD:  Oh it was, yeah, so scary. I've never had a heart attack but it felt like that what was happening and my throat was so swollen and I tried to vomit but I couldn't vomit. Like I felt like I had gastro from both ends but I couldn't control it and yeah, I was nearly blacking out and my girlfriend Kasey stabbed me with the Epipen.

JENNY BROCKIE:  Katie, how do you explain that? 

PROFESSOR KATIE ALLEN: Yeah, it is completely the unpredictability of the condition, we really don't know the answer to that and that's what makes people so worried about having this food allergy, is you don't know if you're going to a mild reaction or a severe reaction. And that's why we give the same recommendation, if you've had a mild reaction, avoid the food.  We just know you should avoid the food. 

JENNY BROCKIE:  Robyn, tell us a little about the work that you're doing and the research you're doing to try and find a treatment for peanut allergy? 

PROFESSOR ROBYN O'HEHIR: Okay, well we're very excited, we're working on a new so-called spy therapy which is a new class of treatment and what this involves is we've identified the critical fragments of the major peanut allergens which can be administered into non-inflamed skin to induce clinical and immunological tolerance and the fragments themselves are short and they don't bind the allergy antibody so they're not able to produce anaphylaxis. And this is still evolving but we're particularly excited about this approach because spy therapy for house dust mite, cat allergy and graft pollen allergy has just gone through very successfully clinical trials in Canada and it's using the same approach, using some of our early research in those  allergens. 

JENNY BROCKIE:  Are we going to find a cure for all of this, what do you think?

PROFESSOR ROBYN O'HEHIR: I think that the spy therapy is the most exciting, it's not all gloom and doom.  I think it really is a good news story in some ways.

JENNY BROCKIE:  Maria, you want a government, a national strategy on this? 

MARIA SAID, ALLERGY AND ANAPHYLAXIS AUSTRALIA:  Yes, we do.  We want best care, optimal care for anyone with allergic disease anywhere in Australia and currently there are different things being done well in some areas, but there is a lot that is not being done well. People should not have to wait eighteen months to see an allergy specialist. Precautionary labelling is a huge issue and food choices have decreased for people with food allergy. The food service industry is a huge, you know, we have people have wonderful experiences but then we hear horrific stories.

JENNY BROCKIE:  What about the cost of all of this?  I mean how much is covered by the PBS and how much does it cost to - how much do Epipens cost, for example? 

MARIA SAID: Look, Epipens and Anapens now can be prescribed on the PBS so people who fit the criteria can have two devices prescribed and it will cost them $36 for the two devices. However, you know, people with a food allergy or insect allergy often have asthma, eczema, allergic rhinitis, and much of the medication is not subsidised.

JENNY BROCKIE:  Kristin? 

KRISTEN-LEE CAMPBELL:   At any given time we've got eight Epipens on scripts at all times, you know two for day care for each child, two in each child's pack.

JENNY BROCKIE:  How much are they each? 

KRISTIN-LEE CAMPBELL: Well we're entitled to two for $36 but then the other six is $120 a pop which will last twelve months.

JENNY BROCKIE:  At the other end of this is there any evidence that Epipens are being over prescribed to people?  Katie? 

PROFESSOR KATIE ALLEN: I mean that's a very good question to ask, there has been a publication showing that there's been a major increase in the prescription of Epipens and some people have argued maybe there's an over prescription of Epipens.  But we're missing one very important piece of data in my opinion and that is how many of these Epipens are being fired off?  If the rates of anaphylaxis or the rates of death are low and it's because people are firing off the Epipens, then that's good. But if they've got an Epipen and no one's actually using them, either because they don't know how to use them or when to use them, then there's no point in prescribing them and there may be an over prescription of Epipens. 

JENNY BROCKIE:  Richard, will we solve the problem or the riddle, I suppose, of food allergy any time soon? 

ASSOC. PROFESSOR RICHARD LOH: Five years ago I told patients three to five years and now we're here. I don't think that we're going to find a cure for food allergies but there is hope in terms of desensitising, either by injections or orally or drops under the tongue.

JENNY BROCKIE:  Robert, do you think we will have a major breakthrough any time soon in this area?  

DR ROBERT LOBLAY: I'm not expecting anything dramatic. I'm fairly optimistic that we will learn how to pick people who are highest risk in the feature, maybe via genetic screening. 

JENNY BROCKIE:  Maria?   

MARIA SAID:  I've been told that, you know, we have a cure three years down the track since 1990. There's a lot of great research that's happening but I think we need to put as much emphasis on the fact that food allergy is manageable if you're educated. 

JENNY BROCKIE: Katie, what do you think, how optimistic are you? 

PROFESSOR KATIE ALLEN:  I'm extremely optimistic because this is a new problem. So there must be something that we are doing differently. It's go t to be something that we can turn around. If we can do that, then I think there's a good chance we will prevent some, if not all, food allergies in the future. That's my great hope, anyway.

JENNY BROCKIE:  Okay, we do have leave it there, thank you all very much more joining us tonight. That is all we have time for here but let's keep talking on Twitter and Facebook.