Hospital admissions for anaphylaxis have doubled in the past 10 years, says Paediatric Dietitian at Sydney Children’s Hospital Randwick Rachel Lindeback.
This rise in severe food allergies makes it important for both parents and schools to be informed about their symptoms and how to care for children with them.
Ninety per cent of all food allergy reactions are caused by egg, dairy, nuts, seafood, sesame, soy, or wheat, according to the Australasian Society of Clinical Immunology and Allergy.
“The most common food allergies I see in children that present at our clinic are egg, dairy and peanuts,” Ms Lindeback said
“Symptoms which may indicate a food allergy include hives, abdominal pain, vomiting, wheezing and swelling of the face, particularly the tongue, eyes and mouth. If your child displays these symptoms after ingesting certain foods, a GP or paediatrician will refer you to an immunologist.”
Read the full Q&A with Ms Lindeback below.
What are the most common food allergies that you see children present with?
The most common food allergies I see in children that present at our clinic are egg, dairy and peanuts. According to the Australasian Society of Clinical Immunology and Allergy, 90 per cent of food allergy reactions are caused by egg, cow’s milk, peanut, tree nuts, seafood, sesame, soy, fish and wheat.
How are allergies diagnosed?
Allergies are generally diagnosed by a specialist doctor known as an immunologist or allergist. They will first take a detailed history of exposures and subsequent reactions to identify potential triggers of the allergy symptoms. Based on this history, a skin prick test or blood test may be conducted to determine presence of antibodies to specific allergens. The findings of this test, in combination with the history, help to guide which foods to avoid and whether a food challenge is required.
The purpose of a food challenge is to identify whether a suspected allergen does indeed result in an allergic reaction when ingested. If a patient has a sensitivity (i.e. there is a reaction to the skin prick test but no reaction on the food challenge) the food may be able to be eaten safely at certain frequencies/quantities determined by the immunologist.
What are some of the signs that a child may have an undiagnosed allergy?
Some signs/symptoms of an allergy include:
- Wheeze/cough after ingesting foods (i.e. not attributable to exercise induced asthma)
- Swelling of the face, particularly of the tongue, eyes and mouth
- Abdominal pain/vomiting
It is important to note that not all reactions to food are immune mediated, and so may not be picked up by a skin prick test. For this reason it is important to discuss the reaction history with your GP or Paediatrician so that a referral can be made to the appropriate specialist.
Has the number of children in primary and high school with allergies increased, or do you think there is just more awareness now?
It certainly appears that the rates of severe allergy are increasing, with hospital admissions due to anaphylaxis doubling in the past 10 years. There are several theories as to why this seems to be the case, however none of these have been proven. Theories include:
- Changes in the food system- increased food chemicals and changes in production to create more palatable and shelf stable products.
- Late introduction of allergens- Prior to 2008, allergen advice was to avoid introducing allergenic foods until the age of 2, and up to 3 years old for some foods. A large study in Europe known as the LEAP study found that allergy incidence seemed to be lower in those who introduced allergens, specifically peanuts, when other solids were introduced at around 6 months of age.
- Hygiene Hypothesis. It has been suggested that lack of childhood exposure to infections and dirt seems to result in increased rates of allergies.
What should schools, parents, and carers do to support children with allergies?
Long term, the best thing that people caring for children with allergies to do is to equip them with the skills to navigate appropriate food choices. This means teaching them to read labels (when they are able), to ask if there are allergens present in foods offered to them by others, and to avoid any foods that will trigger a reaction.
In the short term, as parents and carers are often preparing meals for children who suffer from allergies, it is important to be careful about avoiding cross contamination. This can best be achieved by preparing allergenic foods with separate equipment and utensils to allergen free foods.
As food has a very social role it is important to make sure that children are not excluded from activities based on their allergies. This can be achieved by:
- Family providing a stock of cupcakes/goody bags that can be frozen or stored at the school for parties
- For those who suffer from severe allergies, creating school policies around what can and can’t be brought in to the school (e.g. nut free policies)
- Regularly preparing allergen free foods for meals eaten as a family (usually dinner)
It is important for schools to ensure that teachers are adequately trained to look after and care for children with allergies. This means having clear action plans and training in case of reactions and regular updates in case of changes to recommendations. It is also vital that any external catering facility is adequately informed of, and equipped to care for, children with allergies (e.g. at school camps).
The following recipe is without major food allergens listed above, and can be enjoyed safely by most.
Oat-y High Fibre Slice
1 cup dates, sliced
1 cup water
½ teaspoon bicarbonate soda
1 tablespoon honey
1 cup carrot, grated
½ cup ground oats
½ cup barley flour
½ cup pumpkin seeds
½ teaspoon cinnamon
½ teaspoon nutmeg
- Preheat oven to 180°C. Grease a medium sized loaf tin and set aside
- Combine dates, water, bicarbonate soda and honey in a medium saucepan and bring to the boil. Turn down heat and simmer for two minutes or until dates have softened. Set saucepan aside to cool
- In a mixing bowl, combine carrot, oats, flour and pumpkin seeds. Add the date mixture, cinnamon and nutmeg and stir to combine
- Place mixture in the tin and cook in the oven until golden
- Allow to cool, then cut into slices and send to school for morning tea!