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Last Saturday, I attended Allergy UK’s first annual conference at St Thomas’ Hospital, London. It was an incredibly informative day, combining some fascinating insights on the latest allergy research, together with stacks of practical advice on managing allergies day-to-day.

My family has been part of the allergy world for two years. On 30 April 2012, my then 20-month-old son suffered severe anaphylaxis when he bit into a peanut butter cookie, resulting in a three day spell in intensive care. In addition to his peanut allergy, eczema and asthma, we’ve since discovered he has a host of environmental allergies (grass, cat, dog, house dust mite). He had his second anaphylactic reaction in May last year, which our allergists believe was triggered by grass pollen. I was therefore attending first and foremost as a “nut mum”, but one with more than a passing interest in asthma and grass allergy too.

The overriding takeaway point for me was the need for allergy parents to know about the NICE guidelines on Food allergy in children and young people and Anaphylaxis. When should your GP refer you to an allergy clinic? When should you be offered skin prick tests? When should you be prescribed an EpiPen? These guidelines have the answer.

I’ve set out below the top tips I picked up. They’re based on my scribbles from the day – any errors are mine alone! I’ve inserted any relevant weblinks I can find.

Research on allergy management

Every reaction we’ve experienced with D has been an “immediate”, IgE mediated reaction. I haven’t got any first hand experience of “delayed” allergies or intolerances. So Professor Howarth’s explanation of how different adverse reactions are categorised was very helpful.

Professor Howarth and Dr Jo Walsh both used a diagram to explain this. Here’s my jotted copy, amalgamating the two:

Reaction-diagram

During the panel discussion, an audience member asked whether intolerances could turn into allergies. Apparently, it might be that although an allergy doesn’t show up on skin prick tests (SPT) to begin with, it IS developing in the gut. The more exposure the child then has to the allergen, the more they become sensitised, until eventually the allergy shows on a SPT. So whilst, as the SPT results were initially negative, it might appear that an intolerance has become an allergy, it was in fact an allergy developing all along.

Although the experts believe that allergy is an interaction between environment and genetic factors, some patients have no family history of allergic conditions.

Today, 1 in 6 children have asthma and 40% of teenagers have hayfever.

The link between gut bacteria and allergies

One area researchers are looking at is the link between allergies and the profile of bacteria in a child’s gut. Studies have shown that reduced “microbial diversity” in the gut leads to an increased likelihood of asthma.

The normal gut process means a child becomes tolerant to foreign proteins. So scientists are researching how an abnormal bacterial profile might stop this tolerance from happening.

They are looking at various factors which “influence the infant microbiome”, for example:

  • Whether the mother chews the baby’s food before giving it to the baby (apparently this is common in some cultures).
  • Breastfeeding.
  • Skin contact.
  • Normal birth vs c-section (some studies have pointed to an increased asthma risk for children born by Caesarian).

What can parents do to reduce a child’s allergy risk?

There’s no magic answer to this one … yet.

There was a 2006 study (Perkin & Strachan) which suggested drinking unpasteurised milk had a protective effect. (I hasten to add, it wasn’t suggested we all start doing this – it was highlighted as an interesting link!)

Taking probiotics during the final weeks of pregnancy (and giving them to your young baby) might help… or might have zero impact. The data is conflicting.

The allergic march

The allergic march is where a child goes on to develop a range of atopic conditions. Typically the march will progress from food allergy > eczema > asthma > hay fever. One heartening stat was that food allergy is unlikely to begin after 6 years of age.

A child’s exposure to allergens

Professor Howarth discussed the link between a child’s exposure to food allergens and the risk of that child developing an allergy. Some experts now believe that both too little exposure OR too much exposure can lead to an increased risk.

The LEAP study is one to watch. This is currently investigating the issue of whether peanuts should be avoided or introduced early into a child’s diet.

The results of immunotherapy trials have been promising. Fleischer and colleagues carried out a sub lingual immunotherapy trial, where drops of peanut are given under the tongue. Researchers at Addenbrooke’s recently reported the outcome of their oral immunotherapy trial (where children were given peanut solution to drink).

In time, the principles from these trials might be applied to other allergens such as egg and fish.

Vitamin D

Research trials are looking at whether being given Vitamin D can reduce the risk of asthma and allergy. The theory is that people with high levels of Vitamin D have a reduced allergic response. Urticaria (itchy hives) has also been linked to low vitamin D levels.

A lot of the UK receives insufficient sunlight for the required levels of Vitamin D. Sunscreen also blocks 99% of dermal vitamin D synthesis. We may need to increase our time outdoors and up our Vitamin D intake from food or supplements.

A basic understanding of allergy and treatment

Maureen Jenkins (Director of Clinical Services, Allergy UK) talked about the different allergic conditions and shared tips for allergy and anaphylaxis management. These were the key points for me:

  • Allergy is an immune system response to a normally harmless substance in a sensitised atopic person.
  • Allergy is proved by both testing (for example, a positive skin prick test) and a clinical history (symptoms).
  • An interesting point was that not all asthma, rhinitis and eczema is allergic (although most is).
  • For an allergic reaction, there is always inflammation (of the skin, eyes, airways, gut).

Types of allergic condition

  • Food allergy affects 6-8% of children. It often begins with milk (which is usually outgrown by 2-3), then egg (which is usually outgrown by 3-5), then more once a baby is weaned.
  • Peanut allergy has tripled in the last decade.
  • If a child has severe eczema, they are more likely to get food allergies too.
  • Eczema is a faulty skin barrier, which means both that moisture escapes and that bacteria and infection seep in. Itching at night leads to a disturbed sleep, which in turn leads to lethargy and poor concentration.
  • Hayfever (allergic rhinitis) is like having a bad cold a lot of the time. 40% of children with hayfever drop a grade between their mock GSCE and their final GCSE. This goes up to 70% if they are taking a sedating anti-histamine.
  • Hayfever can trigger asthma attacks, so if you have asthma it’s important to have your nose checked too.
  • Asthma can lead to poor sleep and therefore reduced concentration. It can also cause anxiety – breathing difiiculties are frightening. Asthmatics often avoid exercise (for fear of making their symptoms worse) or social situations (if, for example, self-conscious about coughing).
  • Hives (utricaria) are for the most part not related to allergy.
  • Some people have recurring angiodema (deep swelling), without knowing why.

Allergen management

  • Avoid your allergens.
  • Take your medication as prescribed. Take preventative medicines. ASK your doctor how to use the medicines properly.
  • For eczema, “moisturise copiously”! You should be getting through 1 tub of eczema cream a week.
  • ALWAYS carry your adrenaline auto injectors (and practice regularly with a trainer pen).

Anaphylaxis

Symptoms include:

  • Airways in spasm – so you wheeze or can’t talk (in a school setting, don’t assume a child is okay if they’re not talking).
  • Flushing.
  • Nose running.
  • Rapid heart rate.
  • Dropping blood pressure.
  • Feeling of impending doom.

The advice to lie the patient down and raise their legs is so that you get the blood to their head.

You need a second EpiPen if they are showing no response after 5 minutes.

The key points are:

  • Control asthma.
  • Always carry your auto-injector.

Child allergy (Birth to 12 years)

In the afternoon, I attended GP Dr Jo Walsh’s workshop on child allergy.

The first part of the session focussed on the difference between allergies and intolerances, specifically the difference between cow’s milk protein allergy (CMPA) and lactose intolerance. I learned that as an intolerance is to do with digestion, symptoms such as a skin reaction, reflux or respiratory symptoms show a doctor that something is not just an intolerance.

Although a child can outgrow CMPA, they can then be left with a lactose intolerance because the bowel wall has been damaged, and the child can’t then absorb lactose (the sugar in milk) properly. One interesting point was that you need to stick with an elimination diet for 4-6 weeks, before you can say it isn’t working (to give the bowel chance to repair, if damage is leading to the symptoms).

Symptoms of a delayed food allergy can include:

  • Skin – eczema (although an acute reaction can also flare eczema).
  • Bowel (anything from colic down to diarrhoea).
  • Respiratory (but it is often difficult to differentiate this from a small child just being snuffly).

As regards allergy testing, the NICE guidelines Diagnosis and assessment of food allergy in children and young people in primary care and community settings set out the best practice for GPs when a food allergy is suspected. There is also information on the guidance for parents.

Testing should be carried out “based on the results of the allergy-focused clinical history”. So, there needs to have been a reaction history, and a specific IgE blood test needs to be done for just one food. GPs shouldn’t be doing screens of blood tests for lots of different foods.

The guidelines set out when a child should be referred to an allergy clinic. The criteria include:

  • Faltering growth and gastrointestinal symptoms.
  • Significant eczema and the parent suspects food allergies might be the cause.
  • Persisting parental suspicion of food allergy, despite a lack of supporting history.

Many GPs don’t have expertise in allergy. So, if you are being refused a referral, but fit the NICE referral criteria, it might be a good idea to show the guidelines to your GP…

There is also NICE guidance on anaphylaxis. This provides that under 16s who have had emergency treatment for suspected anaphylaxis should be admitted to hospital. Before being discharged from hospital, the family should be given advice on anaphylaxis, an adrenaline auto-injector and be referred to a specialist allergy service.

As regards nursery and school, the advice was to build trust. Start by finding out if they have any experience of dealing with children with allergies. If your school doesn’t have allergy policies in place, examples can be found on the web. Effective safeguards can include a “red plate” system, where allergic children’s meals are checked twice: by the kitchen and then by the nursery staff in the child’s room. Beware of hidden dangers, such as cereal boxes being used when the children are playing shop. You can download emergency allergy action plans from the BSACI website.

Teenage allergy (13 to 18 years)

Dr Helen Brough (paediatric allergy consultant) hosted a session on the daily impact of allergies, asthma and eczema for adolescents.

Several parents attending the session reported that their teenage food allergic children now refused to eat at restaurants when out with their friends. They would sit and have a drink whilst their friends ate a meal, even it was a restaurant they had eaten at safely with their family in the past. This was an eye opener for me. You think you are doing all the right things by taking your child to restaurants and showing them how to inform the staff about the need for a nut free meal, however a teenager might still prefer to miss the meal than draw attention to themselves in front of the restaurant staff or their peers.

Whilst peanut allergy, for example, has been shown to lead to more anxiety than diabetes, there is not much psychological support. For these types of issues cognitive behavioural therapy (CBT) can be useful. Your child may be able to be referred to Child and Adolescent Mental Health Services (CAMHS) in respect of this.

Another issue covered was the age that a child might be expected to be able to self administer adrenaline. This tends to be any time from 10 years of age onwards.

How Allergy UK can help you

Towards the end of the conference, Sarah Stoneham (Allergy UK Trustee) gave an update on the work of Allergy UK, which also described her own family’s allergy journey since her daughter suffered anaphylaxis as a baby. The stand out tips for me included:

  • As well as a helpline (01322 619898), there is a web chat facility on the Allergy UK website.
  • There is a support contact network, where you can be matched with people with similar issues.
  • Allergy UK sell a range of translation cards, from the basic (I have an allergy to…) to restaurant cards and emergency cards.

In summary…

So, all in all, an extremely informative day… and those are just the sessions I attended! In addition, there was also a workshop on adult allergies (which looked at, for example, occupational allergy) and demonstrations for nasal sprays, adrenaline auto injectors and eczema creams.

Thinking of going in 2015? I’ll definitely see you there!

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Do you…

  • Have a child with allergies/asthma/eczema, who is 10-years-old or younger?
  • Live in or around Greater Manchester?
  • Want to meet up with other allergy parents in the same boat, to share information and swap practical tips?
  • … whilst your child(ren) have a play?

If so, please join us for an Allergy Friendly Play Date!

  • On Saturday 22 March.
  • From 10am until 12 noon.
  • At the Trafford Centre play area.

The play area is located on the ground floor, at the side of the food courts by the ship. See photo – it’s between Nandos and Barburrito.

The play area is for under 10s only. (Apologies to those with older children – once the weather picks up we’re hoping the next meet up can be in a park, so a broader age group can come along – watch this space!).

Alison (from AllergyBakes) and I will be at the play area (with our children!) from 10am – but feel free to bob along when you can!

Be great to see you there!

As at 5 March the play area prices are:

  • Up to half an hour £2.40
  • Up to 45 minutes £3.40
  • Up to 1 hour £4.20
  • Up to 1.5 hours £4.70

Any questions, please post a comment below or drop me a line at louise@nutmums.com.

If you need any further details about the venue, the play area’s telephone number is 0161 746 9000.

22 March 2014 allergy friendly playdate

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Back in May 2013, I began attending the Anaphylaxis Campaign’s Manchester Allergy Support Group.

The group is run by Michelle Byrne and meetings take place:

  • On the first Monday of every month.
  • From 7pm to 8.30pm.
  • At St John’s Church, Irlam Road, Flixton, Manchester, M41 6AP.

The meetings often include a talk by a guest speaker, who might be, for example, a specialist in allergy or immunology, or an expert in asthma, eczema, nutrition or first aid.

For:

I will also post details of forthcoming meetings on the Nutmums events page, with links to the group’s posters giving details of the individual talks, where available.

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Think “Free From”, think gluten free, right? I certainly used to.

When I ventured into the supermarket free from aisle in the early months after my son’s peanut allergy diagnosis, I invariably spotted a bag of almonds or nutty cookies, and moved swiftly on, empty handed and somewhat disheartened. However, it seems that, in giving up and searching elsewhere in the store, I wasn’t being hasty. The supermarket “free from” ranges aren’t aimed at those with nut allergies. The Sainsbury’s Freefrom range, for example, includes gluten, wheat, and dairy-free foods. Whereas all Tesco Free From range products “are Free From Wheat & Gluten. Some are Free From Dairy, Egg or Milk”. Whilst some products may also happen to be nut free, the ranges are not currently geared to those specifically seeking nut free foods.

So “free from = gluten free” was my perception. However, shortly after joining Twitter at the start of this year, I heard about the FreeFrom Food Awards. Founded in 2008 by Michelle Berriedale-Johnson and the team at FreeFrom Foods Matter, the awards:

 “celebrate the innovation and imagination shown by the food industry in creating foods that are free of wheat, gluten, dairy, eggs, nuts, soya or sulphites”.

Yes: nuts too!

The 2013 awards saw the return of the category entitled Foods manufactured in a nut-free environment. Eskal scooped first prize for its FreeNut Butter, having competed against the following shortlisted products:

D&D Mixed Chocolate Fondants
Doves Farm Lemon Zest Cookies
Orgran Kids Mini Outback Animals Chocolate Cookies 8 Fun Packs Multipack
Rizopia Organic Brown Rice Pasta Fusilli
The Nut Free Chocolatier After Dinner Orange Crisps
The Nut Free Chocolatier Mint Delight
Wellfoods GF Pizza Bases”

As well as discovering all of the above nut free products, the very inclusion of this category in the Awards gave me some hope that one day the term “free from” might also encompass “nut free” (or at least signify a range that “includes some nut free options”).

The FreeFrom Food Awards 2014

It’s great news that the 2014 awards again include a Foods manufactured in a nut-free environment category.

Entry to the 2014 awards has now closed and the judging process will commence at the end of January. A shortlist for each category will be published on 12 February 2014 and the awards ceremony will take place in London on 25 March 2014.

Once the winners are published, I will post the link to the FreeFrom Food Awards announcement here.

From a day-to-day perspective, the Awards are an excellent way for us to discover safe new brands. And if the bigger picture is that they are prompting more and more food manufacturers to cater for the allergic consumer, that’s fantastic.

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I’m excited to be attending the Allergy & Free From Show North for the first time this year!

The event is taking place at the BT Convention Centre, Liverpool on the weekend of 26-27 October 2013. For more details, see here. Free tickets are currently available here.

I’m looking forward to learning about some new nut free food brands for D (and I will add any discoveries to my list of nut free foods). I’ll blog after the event about my top finds (both for eating in and eating out) for nut allergy parents. Watch this space!

From browsing the exhibitor profiles on the Allergy & Free From Show website, I will be stopping by the following stands:

Food & Drink

  • Allergy Bakes (stand E60) – Allergy Bakes make biscuits, bakes and cakes which are dairy, egg and nut free… and what’s more that includes Christmas cakes and Christmas puddings!
  • Amy’s Kitchen (stand G25) – Their website states that “Amy’s uses no peanuts or peanut-based products as ingredients”, however “every product is produced in a plant that processes foods containing … tree nuts”. I’m looking forward to chatting to Amy’s about this – as it would be great to be able to try out, for example, their pizzas on D.
  • Doves Farm (stand C10) – We buy their pasta regularly and it will be great to see their full range of products.
  • Eskal Foods (stand G45) –  For now, I don’t think we would ever give D a peanut butter substitute (on the basis of “what you’ve never had, you don’t miss”). Saying that, when he’s older, he might decide for himself that he wants to try a nut-free butter. If Eskal have samples of their “FreeNut Butter”, I would be curious to know how close it tastes to the real thing.
  • Free From Awards (stand C35) – The Free From Foods Matter website has some great resources for nut allergy sufferers, including a list of food companies which use dedicated nut-free facilities for all their products, plus product directories for different allergies. The Free From Food Awards 2014 will include a category for “Products manufactured in a nut free environment”.
  • The Frank Food Company Limited (F35) – I’m looking forward to sampling FRANK Bars, which are “gluten, nut and dairy free”. See here for their photos from the London show.
  • Goodness Direct (stand G5) – Goodness Direct are an online health food store. The product descriptions on their site list what each food is “free from”. You can scan the search results for “Nut free” (in brown), or if you enter “nut free” in the search box, then a selection of products come up from brands such as Doves Farm, Free & Easy, Orgran and Plamil (to name but a few).
  • Ilumi – there has certainly been a buzz on Twitter about Ilumi since the Allergy & Free From Show in London back in June. I’m hoping they will be at the Liverpool show too – looks like that is there intention judging from this article on their website!

Sources of help and advice on allergies

As well as the food and drink exhibitors, the following organisations will also have stands:

Especially for children…

I’ve not yet decided whether to go alone or with the children in tow. However, for anyone taking their children along, the Allergy Adventures zone definitely looks worth a visit!

Seminars by allergy experts

There are seminars taking place on both days. However, I’m planning to visit on the Saturday and so will unfortunately miss out on the “Food allergy in infants and young children” and “Anaphylaxis: ask the experts” talks which are taking place on the Sunday.

Any other “nut free” recommendations?

If anyone has any recommendations for other “nut free” exhibitors who will be at the show, please do post a comment below!

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It is the Anaphylaxis Campaign’s second annual orange wig day on Friday 17 May 2013.  The aim is for members to wear an (extremely fetching!) orange wig all day to raise awareness and money for the Campaign’s work.

The Anaphylaxis Campaign is a UK charity which supports people at risk from severe allergic reactions (anaphylaxis). I can vouch that my family has certainly found the information on their website invaluable since my son’s peanut allergy diagnosis. As well as providing help and support to its members, the Campaign also educates sectors such as the food industry, schools and health professionals on the medical aspects of allergies, food labelling, risk reduction and allergen management.

So far, we’re planning to wear our wigs to playgroup, the park (weather permitting!) and the supermarket…

So, if you are in the Macclesfield area and see a lady with bright orange hair, with a toddler and a baby who’ve clearly inherited the same beautiful locks, then do say hello (or give us a wave!) and make a donation at http://www.anaphylaxis.org.uk/get-involved/ways-to-donate.

Photos to follow on Friday!

* * *

Friday 17 May 2013

And here they are! Thanks to everyone at playgroup for your donations … and quote of the day goes to the lady who kept a straight face whilst saying “Dear, can I just ask … who does your hair?”.

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I mentioned back in February that, following my toddler’s anaphylactic reaction to peanuts, I was keen to meet other people in the same boat, for example by joining an allergy support group, or a playgroup for children with food allergies.

On Monday 6 May, I did just that. I attended a meeting of the Manchester Allergy Support Group, which is run by Michelle Byrne and supported and endorsed by the Anaphylaxis Campaign.

The Manchester Allergy Support Group meets on the first Monday of the month. As the May meeting fell on Bank Holiday Monday, it took the form of an informal group discussion. I found this really useful and am definitely planning to be a regular attendee.

The group often has guest speakers, including, for example, allergy specialists from hospitals in and around Manchester and the National Eczema Society. The next meeting, on Monday 3 June, will be a first aid session led by Laura Grewer of St John Ambulance.

For more information (and Michelle’s contact details), see:

For details of allergy support groups across the country, see the Anaphylaxis Campaign website.

Update (September 2013)

Please see the Events page for details of the Manchester Allergy Support Group’s forthcoming meetings.

Update (December 2013)

For more details of the speakers for 2014, see Manchester Allergy Support Group 2014.