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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!

Link Between Nut Allergy and Asthma View More

If so, which concerns you more – the asthma or the nut allergy? For me, my son’s peanut allergy is my main concern and I’ve tended to focus on the need to control his asthma as a way of trying to reduce his anaphylaxis risk. However, I attended a talk earlier this month which made me appreciate the importance of managing his asthma for its own sake too.

My son’s medical history

When D was around 12 months old, he was poorly every other week, with chest infection after chest infection. He was usually prescribed amoxicillin, sometimes the oral steroid prednisolone, and on one occasion we were issued with a blue reliever inhaler. One afternoon, I received a call from nursery, where his baby room key worker told me “D’s breathing isn’t right”. I remember driving down to nursery with his blue inhaler and to bring him home, with the niggling feeling that “this isn’t normal”. At that stage, we didn’t know for sure that he had asthma, as our GP told us he was too young for them to confirm an asthma diagnosis.

We then went through several months of being regular visitors to both the out of hours GP and A&E, for him to be given steroids or put on the nebuliser. He frequently missed nursery. And I was continuously having to take last minute time off work and then frantically play catch up once he was well. Until the following week, when the coughing would start again.

Despite this history, it was only after he suffered anaphylaxis to peanut at 20 months’ old, that the hospital confirmed he was asthmatic. Once he recovered from the reaction, one of the allergy team’s first priorities was “to get his asthma under control”. He was immediately put on two puffs a day of a brown “preventer” inhaler (Clenil) and, following his second anaphylactic reaction to grass last year, a daily montelukast tablet.

Since having a brown inhaler, he has rarely had a chest infection. He’s gone from being on antibiotics once a fortnight, to needing them once or twice a year. I appreciate there may be other factors at work: for example, he’s older and has built up his immunity over the past two years. However, it’s a marked improvement and I often wonder whether he should have been given a steroid inhaler earlier on. Had his asthma been under control in April 2012, his reaction to peanut might not have been quite as severe.

As a side point, one bee I have in my bonnet is the need for new parents to be more clearly warned about the risks of food allergies. Wouldn’t it be a good idea if GPs warned of the associated (potentially life threatening) peanut allergy risk whenever prescribing eczema creams and asthma inhalers to babies, and advised parents of “higher risk” babies how to go about attempting to introduce peanut during weaning?

Asthma: a life threatening condition

Of my son’s atopic conditions, I’ve always bracketed asthma with his eczema: something for which he needs medication, but in a different league to the looming threat of anaphylaxis.

At the beginning of March, I attended a Manchester Allergy Support Group meeting, where Dr Rob Niven (Consultant Respiratory Physician, Wythenshawe Hospital) gave a talk on “Advances in the Treatment of Asthma”, including, for example, bronchial thermoplasty and the development of new drugs (such as mepolizimab and various other impossible to pronounce names). As well as learning about the potential new treatments, the talk opened my eyes to the potential dangers of asthma. Dr Niven explained that someone dies of asthma every seven hours and that one of the key reasons for this is that person’s asthma is not under control. It made me appreciate that asthma isn’t “just asthma” and that it’s something to manage in it’s own right (as well as managing it, in the hope that doing so would reduce the severity of any allergic reaction).

Some good news is that the odds for outgrowing asthma are more favourable than for outgrowing peanut allergy. Apparently for children with asthma, 1/3 outgrow it, 1/3 grow out of it temporarily (only to see it return in midlife) and 1/3 stay asthmatic throughout.

Further information

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Do you avoid products with precautionary labels (“may contain nuts” or equivalent wording)? We do. A fellow nut mum recently asked me why this was, as her doctors had advised that she could safely ignore such warnings. I thought it would be worth explaining my thinking.

Our doctors’ advice

We were given the same advice when my son, D, was first diagnosed with a peanut allergy. Our allergy doctors told us (1) to check the ingredients list on food labels, to make sure there was no mention of peanuts or any other nuts and (2) that we could disregard advisory or precautionary labelling (“May contain nut traces”, “Produced in a facility that also processes nuts” and so on).

I think the logic behind this advice is that:

  • The risk of a food labelled “may contain” containing enough peanut to trigger an allergic reaction is extremely slim.
  • As a side point, there is a concern that if we cut out “may contain” foods too, D could have a restricted diet.

Furthermore, given “may contain” labelling is completely voluntary (and will continue to be so when the new labelling regulations come into force in December 2014), is a product labelled “may contain nuts” any more dangerous than another product where the manufacturer knows there is a cross contamination risk, but chooses not to flag this on the label?

Cross contamination: assessing the risk

In the UK and EU, the ingredients list on prepacked food must be accurate. If even the tiniest amount of peanut (for example) has been intentionally added to the recipe, then “peanut” should be listed in the ingredients.

“May contain” labels are intended to alert consumers to the possibility of accidental cross contamination during the production process. So, for example, if your supposedly nut free breakfast cereal is produced in the same factory as nutty granola, the manufacturer might put “may contain nuts” (or an equivalent warning) on your cereal packet.

A few points worth making about “may contain” labels:

  • They are voluntary. If there is no warning wording, you cannot safely assume there is no cross contamination risk.
  • If the manufacturer chooses to use a “may contain” label, you have no way of knowing whether the risk is genuine or whether the manufacturer is just trying to cover its back.
  • You cannot gauge the level of risk from how the warning is phrased. For example, a product labelled “Not suitable for nut allergy sufferers” is not necessarily more high risk than one labelled “May contain nut traces” (and vice versa).

An opposing view from the Anaphylaxis Campaign, Ireland and the University of Nebraska

In the early months following diagnosis, we followed our doctors’ advice and focused only on the ingredients list. However, as I touched on in my recent post on Oreo, our attitude to “may contains” has evolved. When I started Nutmums.com in January 2013 (and particularly when I joined Twitter), I began reading a lot more about food allergies and allergen labelling law. I realised that many allergic people avoid products with advisory labelling. In fact, it seemed as if we were in the minority for not having sworn off “may contain” products.

I then discovered that the Anaphylaxis Campaign advises people to “heed the warnings every time” and that ignoring the warnings is “risky behaviour”. Two recent studies have further underlined this approach:

  • An Irish study tested 38 food products with peanut or nut “may contain” warnings. Peanut was detected in 5.3% (2 of 38) of the products tested. The study concluded “Although it appears that the majority of food products bearing advisory nut statements are in fact free of peanut contamination, advice to peanut allergy sufferers to avoid said foods should continue”.
  • Similarly a study by the University of Nebraska discovered detectable levels of peanut in 8.6% of foods labelled “may contain peanut” (or similar advisory wording). This study concluded that “Peanut-allergic individuals should be advised to avoid such products regardless of the wording of the advisory statement”.

In the UK, the Food Standards Agency have:

“been working to reduce the unnecessary use of ‘may contain’ labelling and to provide clear advice to the public on why these labelling terms are used and what they mean.”

The FSA hopes to publish the outcome of this work shortly.

Peanuts, murderers and lightning bolts

I read recently in the Metro that “People with a food allergy are more likely to be murdered than to die from their condition”. A comforting statistic? Not really. As to my mind, psychopaths can come after anyone, but my son’s one of those with a target on his back where peanuts are concerned.

Similarly for the adage that you’re more likely to be struck by lightning than die from a food allergy. If you’ve got a peanut allergic child with a prior history of severe anaphylaxis, it kind of feels like your kid is the one with the 50 ft conducting rod pointing at them.

It’s also not just about death (although, it goes without saying, that’s the main overriding worry). I don’t want my son to have ANY kind of allergic reaction, if I can possibly help it. I don’t want him to be on life support again, even if within a week he is back home building Lego and watching CBeebies as if nothing has happened. I don’t even want him to spend one night on the children’s ward for observation after a mild reaction, IF I can help it.

The statistics about murderers and lightning bolts might offer me some perspective on his allergies generally. However, they’re not something that would influence my decision on may contains. Avoiding a food labelled “may contain nuts” is something I can do. It’s an element of this whole food allergy business that I can control. There may only be a slim chance that a food labelled “may contain nuts” actually contains enough peanut to trigger a reaction. It may therefore follow that the chance of a life threatening reaction from a “may contain” product is incredibly small. But it’s not outside the realms of possibility and it’s a risk that’s easy to avoid.

Why we avoid products labelled “may contain nuts”

In summary:

  • If a manufacturer has decided to state that its product “may contain nuts”, I take that statement at face value and avoid the product.
  • Even if the chance of a reaction to a may contain product is extremely unlikely, that chance still exists.
  • We’re only dealing with a nut allergy, so, whilst it may mean more time spent searching for nut free options, I don’t feel D has a restricted diet by avoiding products labelled “may contain nuts”.

So, for now, for us, any product with a “may contain” label doesn’t even make it as far as the shopping trolley. If there is no warning wording, I then have to resort to checking the manufacturer’s website or emailing their customer services team.

For me it comes down to this. Would I forgive myself if I knowingly gave my son a product labelled “may contain nuts” and he had an allergic reaction? No. Would it be any comfort whatsoever, if a doctor then told me what had happened was “incredibly rare”? Precisely.

So, until the law on advisory labelling is improved, we will continue to avoid “may contains”.

Sources

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Back in March, I read an article in the New York Times about Dr Kari Nadeau, who is currently carrying out a multiallergy trial, “desensitising” children in respect of more than one food allergen at a time.

The Allergy UK website explains that desensitisation (immunotherapy) “involves the administration of gradually increasing doses of allergen extracts over a period of years”, given either by injection (subcutaneous immunotherapy) or by drops or tablets under the tongue (sublingual immunotherapy). As regards food allergies, the Allergy UK site goes on to state that:

“Early results are promising but this research is still in its infancy and the technique is not widely available”.

Much of the New York Times piece struck a chord with me, but one part which stuck in my mind was the description of the boy who had an anaphylactic reaction when attending hospital for a dose of allergen and had to be given an EpiPen. His mother, the author of the article, initially thought:

“Forget this. My son is not going to be the canary in the coal mine.”

If D were offered the chance to participate in an immunotherapy trial to be desensitised in respect of peanut, would we take it? I’m not sure. Having seen him in intensive care following an anaphylactic reaction to peanut, would we be able to go through with him being given doses of peanut and being knowingly put at risk of life threatening anaphylaxis? But, then, if nobody participates in these trials, a cure will never be found. So hats off to those parents who are brave enough to have their child participate in an immunotherapy trial. Whether or not we would muster the courage to go through with it, I don’t know.

So, on the back of that, when I read the news about the Viaskin peanut patch this week, I was extremely heartened. The stick on patch, which is about the size of a 10p piece, is worn on the arm or the back. It contains tiny amounts of peanut protein, which gradually seep into the skin. The Daily Mail reported that:

“The breakthrough patch, called Viaskin Peanut, does not cause anaphylactic shock because the proteins stay in the skin and do not penetrate as far as the bloodstream.”

Apparently, after 12 months, at least 20 per cent of the children in the trial were able to consume over ten times the amount of peanut protein than they could tolerate previously. After 18 months, this increased to 40%.

In the UK, there are about 200-400,000 peanut allergic people and approximately 1 in 50 children have a peanut allergy. So it looks as if the Viaskin peanut patch is one to watch … and, if the trials are successful, it seems that it could offer a means of desensitisation without the usually associated risk of anaphylaxis during treatment.

Sources

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In my previous post, I talked about the world’s biggest food allergy study (the iFAAM study) and how the professor leading the study, Professor Clare Mills, will be talking at the next Manchester Allergy Support Group meeting on Monday 1 July 2013.

Professor Mills is also involved in the TRACE study, which is being led by Dr Andrew Clark, allergy consultant at Cambridge University Hospitals. Commissioned by the Food Standards Agency, the TRACE study will investigate how much peanut will cause an allergic reaction and whether exercise and stress make people more likely to react. The study results will be published in summer 2016.

UK food allergen labelling laws govern ingredients which have been intentionally added to a food’s recipe. They do not cover accidental cross-contamination, for example where a product is contaminated from peanut residue left on shared manufacturing machinery. Where there is a risk of such cross-contamination, food manufacturers put advisory warnings on the packet such as “May contain peanut” or “Produced in a facility that also processes nuts”. At present, there is no way for the consumer to assess the level of risk behind these warnings.

By discovering what amount of accidental peanut contamination is safe (even after people have exercised or are stressed), the TRACE study should help improve “may contain” labelling, by limiting warnings to foods where the peanut levels are likely to be above the threshold.

Dr Clark, together with experts from Imperial College, London, are looking for peanut allergic men and women, aged 18-45, to participate over a 12 month period. For more information on the TRACE study, including details of how to get involved, see http://www.tracestudy.com/.

Source: Manchester University, Pioneering study to investigate factors affecting how much peanut is safe to eat.

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On Monday 1 July 2013, Professor Clare Mills (from the Allergy and Respiratory Centre at the University of Manchester) will be attending a Manchester Allergy Support Group meeting. She will be talking to the group about the iFAAM study, which launched in March 2013 and is the world’s biggest ever study of allergies.

What’s the iFAAM study about?

iFAAM, which stands for “Integrated Approaches to Food Allergen and Allergy Risk Management”, is being led by the University of Manchester and will bring together food allergy experts from the UK, Europe, Australia and US. The study is expected to take three years to complete.

Professor Mills (who is heading up the project) said:

“This is a massive research project which will have far reaching consequences for consumers and food producers. The evidence base and tools that result from this will support more transparent precautionary “may contain” labelling of allergens in foods which will make life easier for allergy sufferers as they try to avoid problem foods.”

At present, if a prepacked food or alcoholic drink contains one of the top 14 food allergens (or an ingredient made from one of them), this must be declared on the food label. The 14 allergens include both peanuts and nuts. From December 2014, the Food Information for Consumers Regulation 1169/2011 (EU FIC) will extend the allergen labelling requirement to foods sold non-prepacked and foods prepacked for direct sale. However, both the existing law and EU FIC only regulate those ingredients intentionally added to the food. They do not cover allergens which are added accidentally, for example due to a manufacturer using the same equipment for, say, both plain and nutty biscuits. For more information, see Deciphering UK food allergen labelling law.

The iFAAM study will build new risk models to support allergen management in factories, which, in turn, will minimise the use of “may contain” labelling.

In addition to producing a standardised management process for food manufacturers, the iFAAM study will:

  • Develop tools to measure allergens in food, which will allow the validation and monitoring of manufacturer’s allergen management plans.
  • Develop safe allergen thresholds, which would give the food industry guidelines to work within and should reduce the use of “may contain” labelling.
  • Try to predict which allergy sufferers are likely to suffer a severe reaction.
  • Look at whether early introduction of allergenic foods and other nutritional factors may protect against developing allergies. This would then inform the nutritional advice for pregnant women, babies and allergy sufferers.

For more information on the iFAAM study, see:

(See also my related blog post on the TRACE study).

Manchester Allergy Support Group

As mentioned above, on Monday 1 July, Professor Clare Mills together with Debbie Hughes (Allergy Nurse Specialist, University Hospital of South Manchester) will be attending a meeting of the Anaphylaxis Campaign’s Manchester Allergy Support Group. Professor Mills will be talking to the group about the iFAAM study.

For more information on:

  • The support group meeting on 1 July 2013 with Professor Mills, see the Manchester Allergy Support Group”s July poster.
  • The topics to be discussed at the Manchester Allergy Support Group throughout 2013, see the group’s list of discussion topics.
  • The group generally, with leader Michelle Byrne’s contact details, see the group poster.

Update (September 2013)

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

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I saw an article last week which caught my eye. It reported on 6-year-old Lucas Tomlinson’s extremely severe nut allergy, which was “so strong just the smell of [nuts] could kill him”. The article went on to state that Lucas’s:

“RAST (radioallergosorbent) measure [was] 511. The normal range is 0 to 50. … Anything over 100 means a person is dangerously sensitive to an allergy”

Our son, D, has had skin prick allergy tests but not blood tests. We do not know his “RAST measure”.  However, as he has already had an anaphylactic reaction, it is a given that his peanut allergy is severe. Our allergy doctor’s advice was that actual ingestion would be necessary to trigger anaphylaxis.

I decided to find out:

  • What is a “RAST measure” and whether there was any benefit to us knowing D’s number.
  • At what point doctors can say that a patient’s nut allergy is “airborne”. Continue Reading
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Although my 2 1/2 -year-old son, D, has a life threatening peanut allergy, my daughter C (now 10-months-old) has no known allergies as yet. After D’s anaphylactic reaction to peanuts, the hospital doctors told us that:

  • C would be allergy tested for peanuts and other nuts when she was 3-4 years old.
  • Until she was allergy tested, she too should avoid peanuts and all other nuts.

However, when we attended hospital for D’s skin prick tests in October 2012, the doctor informed us that the policy had changed. C would now NOT be offered allergy testing.

I wasn’t sure what to make of this U-turn, so I decided to look into the likelihood of C also being severely allergic to peanuts. Continue Reading