tag:theconversation.com,2011:/au/topics/food-allergies-8779/articlesFood allergies – The Conversation2024-03-11T21:26:04Ztag:theconversation.com,2011:article/2217202024-03-11T21:26:04Z2024-03-11T21:26:04ZAllergen warning: “Vegan” foods may contain milk and eggs<figure><img src="https://images.theconversation.com/files/570731/original/file-20240112-29-t9z77z.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C989%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When buying pre-packaged foods, consumers with allergies rely on the declarations in the list of ingredients to identify safe foods.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The popularity of vegan diets continues to increase around the world. Indeed, in 2023, the vegan food market grew to <a href="https://www.expertmarketresearch.com/reports/vegan-food-market">more than US$27 billion</a>.</p>
<p>The term “vegan” usually refers to foods that contain no animal ingredients (meat, poultry, eggs, milk, fish, seafood).</p>
<p>While some consumers consider them to be healthier, vegan foods are also an interesting alternative for consumers concerned about the environment, sustainable development, and animal welfare.</p>
<p>But another type of consumer may be turning to these products for a completely different reason: people who are allergic to proteins of animal origin, such as cow’s milk and eggs.</p>
<p>In view of this, <a href="https://parera.ulaval.ca">our research group</a>, a leader in food allergen risk analysis in Canada, decided to explore <a href="https://link.springer.com/article/10.1186/s13223-023-00836-w">the following two questions</a>:</p>
<ul>
<li><p>Do consumers who are allergic to animal proteins consider vegan products to be safe?</p></li>
<li><p>And, if so, are these products truly safe for them?</p></li>
</ul>
<h2>What’s in it for consumers with allergies?</h2>
<p>The answers to these questions are crucial for people with food allergies who risk suffering potentially severe reactions (anaphylaxis) from consuming these products.</p>
<p>Food allergies affect around <a href="https://www.jaci-inpractice.org/article/S2213-2198(19)30912-2/fulltext">six per cent of Canadians</a>, including 0.8 per cent who are allergic to eggs, and 1.1 per cent to milk.</p>
<p>Despite the fact that different forms <a href="https://foodallergycanada.ca/living-with-allergies/allergy-treatments-and-therapies/treatments-and-therapies/">of immunotherapy or allergen desensitization</a> have shown promising results, the most effective strategy for avoiding allergic reactions is still to refrain from eating foods that may contain allergens.</p>
<p>When buying pre-packaged foods, consumers with allergies rely on declarations in the list of ingredients to identify foods that are safe for them. Regulatory authorities who are responsible for the quality and safety of food recognize the importance of accurate ingredients declarations for allergic consumers. Thus, it is <a href="https://www.canada.ca/en/health-canada/services/food-nutrition/food-labelling/allergen-labelling.html">mandatory</a> to list every allergen that has been voluntarily added to a pre-packaged food item.</p>
<p>However, when it comes to ingredients that may be unintentionally present — for example, as due to cross-contact during food processing — there is a regulatory gap. These ingredients are generally identified with the warning “may contain,” which is used (or sometimes <a href="https://www.sciencedirect.com/science/article/abs/pii/S2213219818300102">overused</a>) voluntarily and randomly by food processors.</p>
<p>Furthermore, the term “vegan” is neither standardized nor defined in Canadian regulations. In fact, <a href="https://inspection.canada.ca/food-labels/labelling/industry/composition-and-quality/eng/1625516122300/1625516122800?chap=2">the Canadian Food Inspection Agency</a> notes that, with regard to the use of the term “vegan,”</p>
<blockquote>
<p>…companies can apply additional criteria or standards that take account of other factors in addition to the ingredients of the food.</p>
</blockquote>
<p>However, details or examples of these elements are not provided. This lack of a precise regulatory definition prevents the implementation of compliance requirements.</p>
<p>Yet, most <a href="https://recalls-rappels.canada.ca/en/search/site?search_api_fulltext=vegan">recalls</a> of products marketed as “vegan” are due to the presence of undeclared ingredients of animal origin, in particular milk and eggs.</p>
<h2>What do consumers with food allergies say?</h2>
<p>In this context, and as part of a <a href="https://www.researchsquare.com/article/rs-2583779/v1">survey</a> of consumers with allergies conducted in collaboration with <a href="https://foodallergycanada.ca">Food Allergy Canada</a>, we asked participants who indicated that they were allergic (or were the parents of a child who was allergic) to eggs or milk if they bought products marketed as “vegan.”</p>
<p>Of the 337 respondents, 72 per cent said they sometimes included these products in their purchases, 14 per cent said they always did, and 14 per cent never.</p>
<p>These <a href="https://link.springer.com/article/10.1186/s13223-023-00836-w">results</a> suggest that these consumers do, indeed, consider the claim “vegan” as an indicator of the absence of animal proteins — an absence which, again, is not supported by any regulatory requirement or definition.</p>
<p>Since the absence of these ingredients is not guaranteed, these consumption habits could put people who are allergic to eggs and/or milk at risk.</p>
<p>An education campaign to clarify that the term “vegan” is an indicator of dietary <em>preferences</em> and not <em>risks</em> would therefore be important for this community.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="dark chocolate" src="https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=467&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=467&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569134/original/file-20240112-29-5nq5bg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=467&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some dark chocolate bars marketed as ‘certified vegan’ contain milk proteins.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Do vegan products contain ingredients of animal origin?</h2>
<p>The fact that 86 per cent of survey respondents buy “vegan” products suggests that the incidence of allergic reactions linked to these foods is potentially rare.</p>
<p>We therefore <a href="https://link.springer.com/article/10.1186/s13223-023-00836-w">analyzed</a> the egg and milk protein content of “vegan” and “plant-based” products marketed in Québec.</p>
<p>A total of 124 products were analyzed for the presence of egg (64) and/or milk (87) proteins.</p>
<p>Egg protein was not detected in any samples, but five samples contained milk proteins: these included four dark chocolate bars marketed as “certified vegan” and a supermarket brand chestnut cake.</p>
<p>These five products declared the potential presence of milk with a warning, “may contain milk.”</p>
<p>We used the concentrations of milk proteins quantified in these products, combined with the quantities of the food that would be consumed in a single eating occasion, to calculate an exposure dose, in milligrams of allergen protein. We then estimated the probability of these doses provoking a reaction in the allergic populations concerned by using <a href="https://www.sciencedirect.com/science/article/pii/S0278691520307213">correlation models</a>. Our results show that the calculated doses could trigger reactions in six per cent of milk-allergic consumers, for the chocolate bars, and one per cent, for the cake.</p>
<h2>How can consumers with food allergies protect themselves?</h2>
<p>Although this level of risk may be perceived as low, it is likely to vary without notice. And this will remain the case until regulatory requirements are put in place.</p>
<p>In fact, rather than attributing it to the presence of a “vegan” or “plant-based” claim, this level of risk most likely reflects <a href="https://www.cell.com/heliyon/pdf/S2405-8440(22)02590-7.pdf">good allergen management practices</a>, characteristic of the North American food manufacturing sector.</p>
<p>Thus, even if a statement “may contain milk” seems contradictory in a “vegan” or “plant-based” product, people allergic to milk should interpret it as an indication that this product may pose a risk to their health.</p><img src="https://counter.theconversation.com/content/221720/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel Godefroy's research activities are funded by the Natural Sciences and Engineering Research Council of Canada, the Foreign Agriculture Service of the United States Department of Agriculture, R-Biopharm GmbH and R-Biopharm Canada Inc. He acts as an expert advisor to members of the food and beverage industry, international organizations (the Food and Agriculture Organization of the United Nations, the United Nations Industrial Development Organization and the World Bank), international food regulatory bodies such as the China National Centre for Food Safety Risk Assessment and consumer organizations such as Food Allergy Canada. Godefroy is Chairman of the Board of the Global Food Regulatory Science Society (GFoRSS).</span></em></p><p class="fine-print"><em><span>Jérémie Théolier et Silvia Dominguez ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur poste universitaire.</span></em></p>Vegan foods are considered by most consumers to have no ingredients of animal origin, but they may actually contain milk proteins.Silvia Dominguez, Professionnelle de recherche en sciences des aliments, Université LavalJérémie Théolier, Professionel de recherche en sciences des aliments, Université LavalSamuel Godefroy, Professeur titulaire - Sciences des aliments, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1925702022-12-08T13:32:46Z2022-12-08T13:32:46ZPeople can have food sensitivities without noticeable symptoms – long-term consumption of food allergens may lead to behavior and mood changes<figure><img src="https://images.theconversation.com/files/499637/original/file-20221207-18-b6a7kw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Asymptomatic sensitization may lead people to continue consuming food allergens, causing hidden neurological issues.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-in-striped-shirt-from-back-choosing-royalty-free-image/1357286617">Garetsworkshop/iStock via Getty Images Plus</a></span></figcaption></figure><p>The prevalence of food allergies is increasing worldwide, <a href="https://doi.org/10.1111/j.1399-3038.2011.01145.x">approaching an epidemic level</a> in some regions. In the U.S. alone, <a href="https://www.foodallergy.org/resources/facts-and-statistics">approximately 10% of children and adults</a> suffer from food allergies, with allergies to cow’s milk, eggs, peanuts and tree nuts being the most common. Some patients have mild symptoms that might not need medical attention, leaving these cases unreported. </p>
<p>Food allergies, or food hypersensitivities, result from the overreaction of the immune system to typically harmless proteins in food. They can manifest as a <a href="https://acaai.org/allergies/allergic-conditions/food/">spectrum of symptoms</a>, ranging from itching, redness and swelling for milder reactions, to vomiting, diarrhea, difficulty breathing and other potentially life-threatening symptoms for severe reactions.</p>
<p>Besides self-reporting, food allergies can be <a href="https://acaai.org/allergies/testing-diagnosis/">diagnosed by exposing patients</a> to trace amounts of offending proteins, or allergens, via their mouth or skin and observing their immediate reactions. More commonly, doctors use blood tests to measure the levels of <a href="https://www.aaaai.org/tools-for-the-public/allergy,-asthma-immunology-glossary/immunoglobulin-e-(ige)-defined">immunoglobulin E, or IgE</a>, a specialized antibody that the immune system uses to identify allergens and trigger a response. Although healthy individuals may have low levels of IgE in the blood, patients with food allergies have much higher levels that increase their risk of having severe allergic reactions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Patient undergoing skin-prick allergy test on arm" src="https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Skin-prick allergy tests involve exposing patients to trace amounts of an allergen and observing their reactions.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/immunologist-doing-skin-prick-allergy-test-on-a-royalty-free-image/1288998568">ronstik/iStock via Getty Images</a></span>
</figcaption>
</figure>
<p>But <a href="https://doi.org/10.1159%2F000517824">some people</a> who test positive on skin-prick allergy tests with moderate increases in IgE don’t notice any allergy-related symptoms when they eat the allergen. This condition is sometimes referred to as <a href="https://www.verywellhealth.com/what-is-sensitization-82988">asymptomatic sensitization</a>. In many cases, people with this condition may not even be aware that they have a food hypersensitivity. </p>
<p>Are they truly asymptomatic, though? Or are there effects within their body that they aren’t aware of?</p>
<p>I am a <a href="https://scholar.google.com/citations?user=kXRRwk4AAAAJ&hl=en">neuroscientist</a> studying how the brain is affected by food allergies. I became interested in this topic when I found that some of my family members had a hypersensitivity to cow’s milk. Some totally avoid dairy products because they have experienced severe, life-threatening symptoms. Those who don’t have typical allergic reactions occasionally eat dairy, but appear to develop seemingly unrelated illnesses a day or two later.</p>
<p>What I and other researchers have found is that food allergens can affect your brain and behavior if you’re hypersensitized, even if you don’t have typical food allergy symptoms.</p>
<h2>Food allergies linked to behavioral disorders</h2>
<p>Researchers have suspected food hypersensitivities to be a potential cause for behavioral disorders for decades.</p>
<p>A <a href="https://doi.org/10.1097/00007611-194908000-00017">1949 case report</a> described behavioral and mood disturbances in patients after they ate certain foods, such as milk and eggs. Their symptoms improved after removing the suspected foods from their diet, suggesting that a food hypersensitivity was the likely culprit. However, I was intrigued that the patients had been able to eat the offending foods up until they chose to avoid them. In other words, they were asymptomatically sensitized, or tolerant, to the allergens.</p>
<p>Several recent studies in people have supported the association between food allergies and various neuropsychiatric disorders, including <a href="https://doi.org/10.1111/all.12829">depression, anxiety</a>, <a href="https://doi.org/10.1016/j.aller.2016.03.001">attention-deficit/hyperactivity disorder</a> and <a href="https://doi.org/10.1002/aur.2106">autism</a>. They strengthen the possibility that some reactions to food allergens could involve the nervous system and manifest as behavioral disorders.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/xyQY8a-ng6g?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The food you eat can affect your brain in many ways.</span></figcaption>
</figure>
<p>However, the idea of food hypersensitivity causing neuropsychiatric disorders is still controversial because of inconsistencies across studies. Differences in the types of allergies, ethnic backgrounds, dietary habits and other factors among the study participants can produce conflicting results. More importantly, some studies included those with self-reported food allergies, while others included only those with lab-confirmed food allergies. This limited investigations to only symptomatic individuals.</p>
<h2>Food hypersensitivity, brain and behavior</h2>
<p><a href="https://doi.org/10.1016/j.bbi.2021.03.002">My laboratory tested</a> whether food allergens could manifest as behavioral symptoms, particularly in asymptomatically sensitized individuals. We wanted to find out whether eating offending foods could lead to brain inflammation and behavioral changes after sensitization, even in the absence of other obvious severe reactions.</p>
<p>To minimize the individual differences found in human studies, we decided to work with mice. We sensitized mice of the same age and genetic background to the common milk allergen β-lactoglobulin, or BLG, and fed them the same diet in the same room. We found that while <a href="https://doi.org/10.1016/j.bbi.2021.03.002">BLG-sensitized mice</a> produced moderately but significantly elevated levels of IgE, they did not show immediate allergic reactions. They could even eat food containing the milk allergen for two weeks without showing any obvious symptoms, despite maintaining elevated levels of IgE. This indicated that they were asymptomatically sensitized.</p>
<p>We then observed whether they showed any changes in emotionally driven behavior. Because we could not ask mice how they felt, we deduced their “feelings” by noting changes from their normal, survival-oriented behavior. Mice instinctively explore their environment to search for food and shelter while avoiding potential danger. However, “anxious” mice tend to spend more time hiding to play it safe. We identified “depressed” mice by briefly holding them by the tail. Most mice will keep fighting to get out of the uncomfortable predicament, while depressed mice quickly give up.</p>
<p>Our experiments were designed to simulate situations where asymptomatically sensitized individuals would eat either a large amount of an offending food in one day or small amounts every day for a few weeks. We mimicked these situations by placing a large amount of the milk allergen directly into the stomach of sensitized mice with a feeding tube, or giving them an allergen-containing mouse chow to eat the allergen a little at a time.</p>
<p>Interestingly, BLG-sensitized mice showed <a href="https://doi.org/10.1016/j.bbi.2021.03.002">anxiety-like behavior</a> one day after receiving a large amount of the allergen. Another group of sensitized mice developed <a href="https://doi.org/10.3390/cells11040738">depression-like behavior</a> after eating small amounts of allergen for two weeks. In addition, BLG-sensitized mice showed signs of brain inflammation and neuronal damage, suggesting that changes in the brain may be responsible for their behavioral symptoms.</p>
<p>We also investigated the <a href="https://doi.org/10.3389/falgy.2022.870628">long-term effect</a> of allergen consumption by keeping BLG-sensitized mice on the allergen-containing diet for one month. We found that IgE levels declined in sensitized mice by the end of the month, indicating that continually eating small amounts of the allergen led to decreased immune responses, or “desensitization.” In contrast, signs of brain inflammation remained, suggesting that the harmful effect of allergens persisted in the brain.</p>
<h2>Chronic brain inflammation</h2>
<p>Researchers have yet to study prolonged brain inflammation, or neuroinflammation, in people who are asymptomatically sensitized. In general, though, <a href="https://doi.org/10.1172/JCI90609">chronic neuroinflammation</a> is a known contributor to neurodegenerative diseases, such as multiple sclerosis and Alzheimer’s disease, although the exact causes of these diseases are unknown. A better understanding of the role allergens play in neuroinflammation can help researchers clarify whether food allergens trigger chronic inflammation that can lead to these diseases.</p>
<p>This knowledge could be especially important for patients undergoing <a href="https://www.aaaai.org/Tools-for-the-Public/Allergy,-Asthma-Immunology-Glossary/Oral-Immunotherapy-Defined">oral immunotherapy</a>, an approach to allergy treatment that involves incrementally ingesting small amounts of allergens over time. The goal is to desensitize the immune system and reduce the incidence of anaphylaxis, or life-threatening allergic reactions. In 2020, the U.S. Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treatment-peanut-allergy-children">approved a standardized form of peanut allergens</a> to prevent anaphylaxis in eligible pediatric patients. However, its possible long-term effect on the nervous system is unknown.</p>
<p>Food allergens can affect the brain and behavior of seemingly asymptomatic people, making them not so asymptomatic neurologically. Considering how your brain responds to the food you eat puts a whole new meaning to the phrase “you are what you eat.”</p><img src="https://counter.theconversation.com/content/192570/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kumi Nagamoto-Combs receives funding from the National Institute of Allergy and Infectious Disease and the National Institute on Aging. </span></em></p>Food allergies have been linked to behavioral and mood disorders, including depression, anxiety and ADHD.Kumi Nagamoto-Combs, Assistant Professor of Biomedical Sciences, University of North DakotaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1884862022-08-24T15:21:32Z2022-08-24T15:21:32ZGot allergies? You could be at lower risk of catching COVID<figure><img src="https://images.theconversation.com/files/480780/original/file-20220824-20-sdo0s6.jpg?ixlib=rb-1.1.0&rect=41%2C0%2C4611%2C3071&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/allergy-mosquito-bite-man-scratcing-arm-2006427659">aleks333/Shutterstock</a></span></figcaption></figure><p>To respond effectively to COVID, it’s been important to understand who may be at higher risk of contracting the virus and developing more severe disease.</p>
<p>To this end, scientists and clinicians have established a range of <a href="https://thorax.bmj.com/content/77/9/900">risk factors</a> for serious illness with COVID, including older age, obesity, and several underlying health conditions. High body mass index also appears to be linked with increased odds of catching COVID in the first place. </p>
<p>But what about factors that might make someone less likely to contract COVID? Interestingly, <a href="https://thorax.bmj.com/content/77/9/900">research suggests</a> that <a href="https://www.jacionline.org/article/S0091-6749(22)00752-7/fulltext">having allergies</a> could reduce a person’s risk.</p>
<p>Allergies are very common. At least <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045871/">400 million people</a> around the world are affected by pollen allergies, or hay fever. Some 300 million people suffer from allergic asthma (induced by inhaling allergens), while food allergies affect around 250 million. Many people are also allergic to certain drugs. Allergic reactions can range from mild (perhaps some redness and swelling on the skin) to severe (anaphylactic shock, which can cause death). </p>
<p>Atopic diseases is a name given to a group of conditions triggered by allergens and includes hay fever, eczema and dermatitis. Research has shown that people with atopic diseases have <a href="https://thorax.bmj.com/content/early/2021/11/02/thoraxjnl-2021-217487">25% lower odds</a> of contracting COVID. For people with atopic disease and asthma, the risk is <a href="https://thorax.bmj.com/content/early/2021/11/02/thoraxjnl-2021-217487">38% lower</a> compared to people without these conditions. </p>
<p>A separate study showed that people with food allergies were <a href="https://www.jacionline.org/article/S0091-6749(22)00752-7/fulltext">50% less likely</a> to become infected with COVID.</p>
<h2>Why would people with allergies be at lower risk?</h2>
<p>Initially we thought that people with allergies could be less likely to contract COVID as they may have been more isolated from others. This might be true for asthma because people with this condition were advised <a href="https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19">to shield</a> earlier in the pandemic. </p>
<p>But the same can’t be said for the majority of atopic diseases, such as eczema. And while you might expect people with food allergies to, say, eat out less, research during the pandemic has shown that households with food allergies only had slightly lower levels <a href="https://www.jacionline.org/article/S0091-6749(22)00752-7/fulltext">of exposure</a> in the community compared with other households.</p>
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Read more:
<a href="https://theconversation.com/do-i-have-covid-or-hay-fever-heres-how-to-tell-188030">Do I have COVID or hay fever? Here’s how to tell</a>
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<p>To be able to infect the body, SARS-CoV-2 (the virus that causes COVID-19) attaches to a specific protein called <a href="https://theconversation.com/what-is-the-ace2-receptor-how-is-it-connected-to-coronavirus-and-why-might-it-be-key-to-treating-covid-19-the-experts-explain-136928">the ACE2 receptor</a>. This protein provides the entry point for the virus to infect a wide range of human cells. </p>
<p>Having higher amounts of ACE2 receptors is associated with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1287568/">increased susceptibility</a> to COVID infection. People who smoke, have diabetes or high blood pressure (all of which are associated with a higher likelihood of <a href="https://www.jacionline.org/article/S0091-6749(20)30551-0/fulltext">severe COVID</a>) have more ACE2 receptors.</p>
<p>Meanwhile, it has been shown that type 2 inflammation – a normal immune reaction that can occur in response to infections or parasites, but also occurs prominently in allergic conditions – <a href="https://www.jacionline.org/article/S0091-6749(20)30551-0/fulltext">reduces ACE2 expression</a> in the airways. This decreases susceptibility to infection, and is considered the primary reason people with allergies appear to be at lower risk of catching COVID.</p>
<p>There are also a range of other factors that may contribute to reducing COVID infection risk among those with allergies. For example, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7651838/">people with asthma</a> tend to produce more mucus than others, which is understood to prevent SARS-CoV-2 entering the airways.</p>
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<img alt="A bowl of peanuts." src="https://images.theconversation.com/files/480782/original/file-20220824-18-9q4zfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/480782/original/file-20220824-18-9q4zfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/480782/original/file-20220824-18-9q4zfs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/480782/original/file-20220824-18-9q4zfs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/480782/original/file-20220824-18-9q4zfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/480782/original/file-20220824-18-9q4zfs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/480782/original/file-20220824-18-9q4zfs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many millions of people suffer from food allergies.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baked-peanuts-put-cup-placed-on-1500474608">kram-9/Shutterstock</a></span>
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<h2>More good news</h2>
<p>So we see a reduced risk of catching COVID in people with allergies and asthma. But how do these conditions affect the severity of a COVID infection? </p>
<p>At the beginning of the pandemic, it was assumed that people with asthma may be at greater risk of getting very sick from COVID, because viral infections <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820381/">commonly exacerbate asthma</a>. But it’s now well established that asthma that’s <a href="https://thorax.bmj.com/content/early/2022/03/29/thoraxjnl-2021-218629">mild or well controlled</a> doesn’t increase the risk of serious illness with COVID. And the evidence doesn’t indicate more <a href="https://www.aaaai.org/Tools-for-the-Public/Conditions-Library/Asthma/covid-prevent">severe asthma</a> increases the risk either.</p>
<p>Similarly, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820556/">atopic disease</a> is not considered a risk factor for severe COVID.</p>
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Read more:
<a href="https://theconversation.com/how-psychologists-can-help-people-coping-with-life-threatening-food-allergies-127933">How psychologists can help people coping with life threatening food allergies</a>
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<p>If you suffer with other diseases in combination with asthma or allergies, it’s important to be aware that this could <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689956/">increase COVID severity</a>. </p>
<p>Prevention remains key. The best ways to prevent <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">COVID infection</a> continue to include vaccination, wearing appropriately-fitting face coverings, and physical distancing. </p>
<p>Meanwhile, if you have allergies, having an allergy management plan is essential. Make sure your treatment plan is current and that you have medications on hand in case you need them.</p><img src="https://counter.theconversation.com/content/188486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philippe B. Wilson is Chief Scientific Officer of NHS Willows Health. </span></em></p><p class="fine-print"><em><span>Samuel J. White does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Evidence has shown that people with allergies and asthma are at lower risk of contracting COVID-19. Here’s why we think this might be.Samuel J. White, Senior Lecturer in Genetic Immunology, Nottingham Trent UniversityPhilippe B. Wilson, Professor of One Health, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1669492021-09-21T17:07:32Z2021-09-21T17:07:32Z3 ways restaurant staff and customers can communicate to prevent food allergy reactions<figure><img src="https://images.theconversation.com/files/421692/original/file-20210916-25-1fwipbe.jpg?ixlib=rb-1.1.0&rect=0%2C80%2C4893%2C3066&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An effective approach to allergy communications is for servers to ask customers about food allergies.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Public health researchers have called food allergies “<a href="https://doi.org/10.15353/cfs-rcea.v5i3.326">a growing public health epidemic in Canada</a>” affecting around <a href="https://doi.org/10.1016/j.jaip.2014.11.006">one in 13 Canadians</a> and <a href="https://doi.org/10.1080/10807039.2012.722857">one in five Canadian households</a>. Dining out <a href="https://doi.org/10.1111/j.1365-2222.2010.03649.x">can be risky</a> and <a href="https://doi.org/10.1108/00070701011088197">stressful</a> for people with allergies, in part because many restaurant employees <a href="https://doi.org/10.1016/j.foodcont.2012.10.023">lack the training</a>, <a href="https://doi.org/10.1016/j.ijhm.2016.05.004">skills</a> and <a href="https://meridian.allenpress.com/jfp/article/79/9/1588/174884/Food-Allergy-Knowledge-and-Attitudes-of-Restaurant">confidence to manage food allergies</a> safely and effectively. </p>
<p>These are challenges that existed before the COVID-19 pandemic and will surely persist after it. In recent years, news outlets across Canada <a href="https://www.cbc.ca/news/canada/saskatchewan/man-with-nut-allergy-w%20ins-cheesecake-lawsuit-1.1062258">have reported</a> <a href="https://www.cbc.ca/news/canada/montreal/sherbrooke-waiter-arrested-salmon-allergic-customer-1.3707052">several cases</a> of <a href="https://www.cbc.ca/news/canada/british-columbia/near-fatal-allergic-reaction-caused-by-starbucks-dessert-1.863872">people suffering extreme</a>, sometimes <a href="https://globalnews.ca/news/2231400/first-year-canadian-university-student-dies-of-severe-allergic-reaction/">fatal, allergic reactions</a> to restaurant food. Accidents like these are most often due to <a href="https://doi.org/10.1067/mai.2001.119157">miscommunication</a>.</p>
<p>As researchers in the field of industrial-organizational psychology, <a href="https://doi.org/10.1016/j.ijhm.2021.102959">we analyzed how and why information about food allergies gets communicated, and miscommunicated, at restaurants</a>. We approached allergy communication the way we might approach communication among a flight crew or a surgical team: by isolating the make-or-break behaviours in the communication process.</p>
<p>Based on this research, we offer some guidelines to reduce the risk of allergic reactions at restaurants and improve the customer experience.</p>
<h2>Allergy communication</h2>
<figure class="align-center ">
<img alt="A chef handing a food order to a server in a restaurant kitchen." src="https://images.theconversation.com/files/421702/original/file-20210916-21-lvi0k3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/421702/original/file-20210916-21-lvi0k3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/421702/original/file-20210916-21-lvi0k3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/421702/original/file-20210916-21-lvi0k3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/421702/original/file-20210916-21-lvi0k3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/421702/original/file-20210916-21-lvi0k3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/421702/original/file-20210916-21-lvi0k3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Poor communication between servers and kitchen staff can lead to allergen incidents.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Allergy information can be communicated in written and verbal forms. Written communication happens on a restaurant’s website, posters in dining rooms, menus and ingredient lists. It also happens among staff, such as on order forms and point-of-sale (POS) machines. </p>
<p>Still, most food orders involve verbal conversations between customers and servers. In these conversations, customers and servers get a sense of one another and decide together how best to manage the customer’s food order.</p>
<p>We collected examples, or <a href="https://doi.org/10.1037/h0061470">critical incidents</a>, of restaurant staff handling a food order for an allergic customer. We received 107 successful incidents and 61 failed incidents from a variety of restaurants. Failed incidents involved things like an allergic reaction, staff having to remake a meal and/or an upset customer. </p>
<p>For each incident, staff reported who was involved, what went right, what went wrong and how. Based on these, we mapped the process of allergy communication, from customer to server to kitchen staff and back, and pinpointed where mistakes commonly happen, as illustrated in this diagram.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420860/original/file-20210913-21-4urxbu.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram plotting out communication pathways between restaurant staff" src="https://images.theconversation.com/files/420860/original/file-20210913-21-4urxbu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420860/original/file-20210913-21-4urxbu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=289&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420860/original/file-20210913-21-4urxbu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=289&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420860/original/file-20210913-21-4urxbu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=289&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420860/original/file-20210913-21-4urxbu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=363&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420860/original/file-20210913-21-4urxbu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=363&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420860/original/file-20210913-21-4urxbu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=363&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The process of allergy communication, from customer to server to kitchen staff and back, illustrating where mistakes commonly happen.</span>
<span class="attribution"><span class="source">Reprinted from International Journal of Hospitality Management, DOI: 10.1016/j.ijhm.2021.102959, with permission from Elsevier.</span>, <span class="license">Author provided</span></span>
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<p>Aside from these incidents, we also asked 138 people with moderate-to-severe food allergies to describe their own encounters dining at restaurants.</p>
<p>As you can see, communication at restaurants works like a game of telephone, where messages pass from customers to servers to kitchen staff. As in telephone, mistakes can happen at any stage, and given enough time, mistakes are bound to happen. Unlike telephone, though, mistakes can be anticipated, avoided or fixed.</p>
<h2>Recommendation #1: Ask about allergies</h2>
<p>Most miscommunications happen when customers forget or are too shy to disclose their allergy. We suggest that servers ask customers to disclose their allergies when introducing themselves: “Hello, my name is Sam and I’ll be your server. First off, does anyone at the table have food allergies?”</p>
<p>To be clear, we are not suggesting that allergy disclosure is the server’s responsibility. Quite the opposite: most people we asked (staff and customers alike) agreed that disclosing allergies is primarily the customer’s responsibility. </p>
<p>We suggest that servers ask customers about allergies simply because that’s the most effective approach. A typical server deals with far more food orders than a typical customer. So, staff may not only be more apt to develop the habit of starting conversations about food allergies, trained servers have the opportunity to lead the conversation.</p>
<p>In the same interaction, some customers mention their allergy but leave out important information, like how serious the allergy is. According to staff we surveyed, customers should not just state their allergy; they should also describe the severity of the allergy.</p>
<h2>Recommendation #2: Double-check</h2>
<p>Staff and customers can integrate double-checks to catch and reverse miscommunication before it leads to disaster. Double-checking involves repeating information back to the speaker and asking for confirmation. For example, when a customer discloses an allergy, the server can repeat the allergy and accommodations back to the customer, and ask the customer to confirm that this information is correct. In the diagram above, we highlighted four points where double-checking is most helpful.</p>
<p>Of course, it might not be realistic to include double-checks at all of these points. Still, each additional double-check could improve your chances of catching an error and saving a life. </p>
<h2>Recommendation #3: Involve fewer staff</h2>
<p>Again, the allergy communication process works kind of like a game of telephone, and telephone is easier with fewer people playing. In the same way, it can be helpful to reduce the number of people that have to pass along a message. Restaurants that do this well often designate a staff member, manager or chef to directly oversee orders for allergic customers.</p>
<h2>No one likes fakers</h2>
<p>Both allergic customers and staff raised the problem of allergy “fakers” — people who claim a food allergy that is really just a preference. These fakers aren’t just annoying. They muddy the waters of allergy communication, making it more difficult for customers and staff to trust one another. This is one more reason that customers need to be clear about the severity of their allergy, and for staff to treat all allergies seriously, even when in doubt.</p>
<p>Many restaurants already follow some or all of these recommendations, but many don’t. Every restaurant, every staff member and every customer is different, so these recommendations are meant as a suggested starting point. We kept our recommendations simple so that they’re easy to adopt or adapt.</p>
<p>Good habits can reduce allergic reactions, improve customer experience and strengthen staff confidence to manage allergies. What’s more, people with allergies can be <a href="https://doi.org/10.1111/j.1365-2222.2010.03649.x">loyal customers</a> to restaurants they consider safe.</p><img src="https://counter.theconversation.com/content/166949/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Timothy Wingate has received funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Joshua Bourdage receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Samantha Jones receives funding from the Social Sciences and Humanities Research Council. </span></em></p><p class="fine-print"><em><span>Malika Khakhar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dining out can be risky and stressful for people with allergies, in part because many restaurant employees lack the training, skills and confidence to manage food allergies safely and effectively.Timothy Wingate, PhD Candidate, Industrial-Organizational Psychology, University of CalgaryJoshua Bourdage, Associate Professor, Department of Psychology, University of CalgaryMalika Khakhar, PhD Student, Organizational Leadership, University of GuelphSamantha Jones, PhD Candidate, Industrial and Organizational Psychology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1663822021-08-20T15:17:41Z2021-08-20T15:17:41ZFood allergy and intolerance: five common myths explained<figure><img src="https://images.theconversation.com/files/417089/original/file-20210819-17-10d74kr.jpg?ixlib=rb-1.1.0&rect=8%2C4%2C2709%2C1795&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/childs-hand-holding-peanuts-isolated-on-596715836">2YouStockPhoto/Shutterstock</a></span></figcaption></figure><p>Food allergies seem to be on the rise, but misconceptions abound, often getting in the way of a condition being properly diagnosed and treated. According to <a href="https://publications.aston.ac.uk/id/eprint/38791/1/Why_do_people_misdiagnose_themselves.pdf">recent research</a>, up to 35% of people misdiagnose themselves (or their children) with a food intolerance or allergy then try to manage it themselves rather than seek proper medical advice. So it’s time to set the record straight on five of the most popular misconceptions that persist.</p>
<h2>1. I have symptoms after food so it must be an allergy</h2>
<p>Not necessarily. Adverse reactions to food can occur for a variety of reasons, and all fall within the umbrella term “<a href="https://www.bda.uk.com/resourceDetail/printPdf/?resource=food-allergy-food-intolerance">food hypersensitivity</a>”. This includes reactions that involve the immune system, termed <a href="https://www.nhs.uk/conditions/food-allergy/">food allergy</a>, but also a range of others that don’t – often called “<a href="https://www.bda.uk.com/resourceDetail/printPdf/?resource=food-allergy-food-intolerance">food intolerance</a>”. </p>
<p>Allergic reactions that involve the antibody <a href="https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Definition-Immunoglobulin-(IgE)">Immunoglobulin E</a> are often referred to as IgE-mediated (IgE) allergies and are estimated to affect up to <a href="https://www.allergyuk.org/assets/000/001/369/Stats_for_Website_original.pdf?1505209830">10% of the UK population</a>. These cause <a href="https://www.nhsinform.scot/illnesses-and-conditions/nutritional/food-allergy#symptoms-of-a-food-allergy">symptoms</a> that range from mild, such as itchy eyes, to severe, such as anaphylaxis – a serious, swift allergic reaction that can cause severe throat or tongue swelling, difficulty breathing, low blood pressure and ultimately death. These symptoms usually occur rapidly after eating the food in question and when severe, require immediate medical attention. </p>
<p>Other reactions that involve the immune system (called non-IgE mediated allergy) may cause <a href="https://www.nhs.uk/conditions/food-allergy/symptoms/">symptoms</a> that are either immediate or slower onset and more chronic in nature – such as red, itchy skin, heartburn or loose stools. Some of these may be similar to <a href="https://www.nhs.uk/conditions/food-intolerance/">symptoms</a> caused by food intolerances. While totally excluding the trigger food is usually required in IgE allergy, restricting it may be sufficient in other forms of hypersensitivity, but this will depend on the underlying cause.</p>
<h2>2. I can just go online and get an allergy test</h2>
<p>A trip to the chemist or a browse online for a diagnosis is likely to provide you with a bill and a long list of foods that are apparently causing your symptoms. Many of the <a href="https://www.bda.uk.com/resourceDetail/printPdf/?resource=food-allergy-intolerance-testing">tests</a> offered are not evidence-based for food allergy or food intolerance. These can lead to unwarranted self-imposed dietary restrictions that not only increase the risk of nutritional deficiency, but can cause anxiety, have a detrimental effect on your social life by making eating out tricky, and ultimately affect your quality of life.</p>
<p>The only <a href="https://www.bda.uk.com/resourceDetail/printPdf/?resource=food-allergy-intolerance-testing">evidence-based allergy testing</a> currently available is for IgE (immediate reaction) allergy. These are skin-prick tests and specific IgE blood tests. However, even if IgE testing is offered, the results require careful interpretation as a positive test does not necessarily mean allergy. An “oral food challenge”, where precise and increasing doses of the suspect food are given, is considered the best method of diagnosis for food allergy, but these must be performed with medical supervision. </p>
<p>Diagnosis starts with a thorough, allergy-focused history that will point towards appropriate testing if required. This needs to be undertaken by a medical professional with experience in allergy. So if you are concerned about your symptoms, talk to your GP.</p>
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<h2>3. I need to avoid lots of foods to help control my eczema</h2>
<p>This is unlikely. Food does not cause eczema and there are many <a href="https://eczema.org/information-and-advice/triggers-for-eczema/">environmental triggers</a> implicated in flare-ups, making it difficult to ascertain if cutting out specific foods is actually helping. You don’t need to look far to find books and websites that suggest a variety of implicated foods, but for most people, appropriate <a href="https://www.nhsinform.scot/search?q=eczema&locpt=&ds=&tab=inform">medical treatment</a> is the key to controlling the condition.</p>
<p>That said, some people with <a href="https://patient.info/skin-conditions/atopic-eczema">atopic eczema</a> may need to avoid certain foods due to fast onset and potentially severe IgE food allergy. Additionally, excluding specific foods may be beneficial for some and may involve non-IgE food allergy. However, this needs careful assessment so if you feel your current treatment for eczema isn’t keeping it under control, speak to your doctor before making any dietary changes. </p>
<h2>4. ‘May contain’ warnings are there to protect manufacturers</h2>
<p>Allergen food labelling has improved in recent years with the implementation of the <a href="https://www.legislation.gov.uk/eur/2011/1169/contents">2014 EU legislation</a> which continues to be relevant in the UK as <a href="https://www.foodstandards.gov.scot/business-and-industry/safety-and-regulation/labelling">Scotland</a> and the <a href="https://www.food.gov.uk/safety-hygiene/food-allergy-and-intolerance#allergen-information-and-labelling">other nations</a> update and improve it in this post-Brexit era.</p>
<p>However, it has limitations. In fact, “precautionary allergen labelling” (trace warnings) is not specifically regulated under the legislation beyond the requirement that voluntary information must not mislead the consumer, be ambiguous or confusing. The wording of warnings is not standardised and crucially, doesn’t give an indication of the level of risk.</p>
<p>So it’s perhaps unsurprising that this kind of warning is regarded with suspicion by some while being a cause of angst for others, particularly those with potentially severe IgE allergy where even very small amounts of a specific food may cause immediate symptoms. The safest and for some, necessary, approach is to avoid all products with these warnings. In the end how this is managed is down to personal choice; but understanding what is and isn’t required on food labelling is essential to making a fully informed decision about managing what you eat and foods to avoid.</p>
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Read more:
<a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">What are allergies and why are we getting more of them?</a>
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<h2>5. Food allergy: you just need to avoid the trigger food</h2>
<p>Many people following restricted diets would disagree. Not only is there potential nutritional risk, excluding certain foods requires careful planning and constant vigilance. For those with fast onset IgE allergy in particular, where accidental exposure to the trigger food may cause severe symptoms, this can result in considerable anxiety.</p>
<p>In fact, there is evidence that having potentially severe food allergy has a detrimental effect on <a href="https://theconversation.com/how-psychologists-can-help-people-coping-with-life-threatening-food-allergies-127933">quality of life</a> in terms of health. So proper advice and appropriate management is a must.</p>
<p>With an abundance of information available thanks mainly to online sources, it is more important than ever to make sure you use credible, reliable sources and seek proper medical advice and treatment if you are concerned about food-related symptoms.</p><img src="https://counter.theconversation.com/content/166382/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marian Cunningham does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Up to 35% of people misdiagnose themselves (or their children) with a food intolerance or allergy. It’s time to set the record straight.Marian Cunningham, Lecturer in Human Nutrition and Dietetics, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1322642021-03-31T18:59:44Z2021-03-31T18:59:44Z7 ways to make Easter safe and inclusive for children with food allergies<figure><img src="https://images.theconversation.com/files/392042/original/file-20210327-15-1e54nvy.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C1000%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-toddler-kid-wearing-medical-mask-1886438929">Shutterstock</a></span></figcaption></figure><p>Easter can be a challenging and anxious time for children with food allergies and their families. </p>
<p>First, there are the foods we commonly associate with Easter — chocolate and hot cross buns. Then, Easter is a time when families and friends come together. So celebrations at home, at daycare or at school can include a spread of other foods containing common allergens, including dairy, eggs, peanuts and tree nuts.</p>
<p>However, there are many things parents and educators can do to help make Easter safe and inclusive for children with food allergies and their families.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-do-we-get-allergic-to-food-82503">Curious Kids: How do we get allergic to food?</a>
</strong>
</em>
</p>
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<h2>Kids’ food allergies are common, and becoming more so</h2>
<p>The prevalence of food allergies is on the rise globally, particularly among <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.13362">wealthy, westernised nations</a>. </p>
<p>Food allergies and related <a href="https://www.sciencedirect.com/science/article/abs/pii/S0091674915007022">hospital admissions</a> among Australian children have increased significantly since the 1990s. Some 11% of one-year-olds and 4% of pre-schoolers <a href="https://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/food-allergy-australia">have a diagnosed food allergy</a>. One study in the ACT showed <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-1754.2008.01436.x">one in 30 children</a> starting school had a severe nut allergy.</p>
<p>Nine foods cause <a href="https://allergyfacts.org.au/allergy-anaphylaxis/what-is-anaphylaxis">the vast majority</a> of allergic reactions in Australia: cow’s milk, eggs, peanuts, tree nuts (such as cashews and walnuts), soy, sesame, wheat, fish, and shellfish (such as prawns and crab). </p>
<p>Allergic reactions can range from mild, such as watery eyes or itchiness, to anaphylaxis, the most severe form of allergic reaction. Anaphylaxis involves breathing difficulties and can be life-threatening. </p>
<h2>How do allergies affect families?</h2>
<p>A food allergy doesn’t just affect the child; it can have a psychosocial effect on the whole family. </p>
<p>Fear of a severe allergic reaction may drive parents and caregivers to exclude children from special events and celebrations, such as school camps, excursions, or birthday parties. Some parents also stop sending their child <a href="https://www.sciencedirect.com/science/article/abs/pii/S1081120610609088">to school</a>.</p>
<p>They may be concerned life-saving medication (such as the adrenaline auto-injector EpiPen) may be delayed or not available, or worry their young child <a href="https://journals.sagepub.com/doi/abs/10.1177/183693911604100414">may not be able to resist temptation</a>, particularly when their friends offer food. This might be because children with allergies are afraid of being labelled “different” or they don’t understand the risk. </p>
<p>In the words of one review study, for affected families, <a href="https://www.karger.com/Article/Abstract/375106">social events</a> can “have a different meaning […] giving rise to feelings of exclusion and difference”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392439/original/file-20210330-23-xlqgtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="School children sharing packed lunch" src="https://images.theconversation.com/files/392439/original/file-20210330-23-xlqgtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392439/original/file-20210330-23-xlqgtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=484&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392439/original/file-20210330-23-xlqgtm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=484&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392439/original/file-20210330-23-xlqgtm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=484&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392439/original/file-20210330-23-xlqgtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=608&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392439/original/file-20210330-23-xlqgtm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=608&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392439/original/file-20210330-23-xlqgtm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=608&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Parents worry about their children sharing food or accessing life-saving medication.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/primary-school-pupils-enjoying-packed-lunch-58963948">Shutterstock</a></span>
</figcaption>
</figure>
<h2>It’s important children are included</h2>
<p>Celebrations can help to foster friendships, family relationships, and are vital for children’s socio-emotional development and well-being. So, children should not be left out or excluded from celebrations and events because of their allergy. </p>
<p>Other children also benefit when children with additional needs <a href="https://alana.org.br/wp-content/uploads/2016/12/A_Summary_of_the_evidence_on_inclusive_education.pdf">are included</a>. They can learn to appreciate and develop empathy and tolerance for differences — traits that need to be nurtured in children in the early years.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/empathy-starts-early-5-australian-picture-books-that-celebrate-diversity-153629">Empathy starts early: 5 Australian picture books that celebrate diversity</a>
</strong>
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</p>
<hr>
<h2>Some tips for parents and educators</h2>
<ol>
<li><p>Take the focus off food when celebrating Easter by organising a non-food Easter egg hunt, such as for stuffed bunnies or toys, or other activities like Easter-themed arts, crafts, and dress-ups. However, craft items including eggshells, egg cartons, milk cartons, peanut butter jars and lids may still pose an allergy risk</p></li>
<li><p>consider non-food treats for all children, such as stickers or story books</p></li>
<li><p>if you’ve invited a child with allergies, ask their parents to provide alternative, allergy-safe treats for their child if food treats are to be distributed to other children. Sometimes, parents of the child with a food allergy offer to provide the same treats for everyone so their child is not getting something different (always check with other parents of children with food allergies first) </p></li>
<li><p>if you’re an educator, check parents are happy for you to give food treats to the child with a food allergy, after reading ingredient labels, and after following a strict process developed with the family. Look for hidden ingredients in packaged foods and understand what each label means. For example, whey is a protein in cow’s milk and a child with cow’s milk allergy needs to avoid it. Encourage all children to eat Easter loot at home so parents can check ingredients</p></li>
<li><p>encourage all children to wash their hands before and after eating. Peanut protein, for example, can last on hands <a href="https://pubmed.ncbi.nlm.nih.gov/23608728/">for three hours</a> after eating. Hand washing with soap, not just water, can help reduce the risk of cross-contamination </p></li>
<li><p>make sure children know they must not share food or drink bottles</p></li>
<li><p>if a child shows signs of an allergic reaction, parents and educators should follow instructions in the child’s individual <a href="https://www.allergy.org.au/hp/ascia-plans-action-and-treatment">allergy management plan</a>. So, make sure your child has one, it is up to date, and people know what to do in an emergency. </p></li>
</ol>
<p>With some planning, empathy and a management plan, Easter can be a joyful and safe celebration for children with food allergies and their families.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-think-my-child-has-outgrown-their-food-allergy-how-can-i-be-sure-130455">I think my child has outgrown their food allergy. How can I be sure?</a>
</strong>
</em>
</p>
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<p><em>For more information on allergy and anaphylaxis, contact <a href="http://www.allergyfacts.org.au">Allergy & Anaphylaxis Australia</a>, 1300 728 000; or the <a href="https://www.allergy.org.au/patients">Australasian Society of Clinical Immunology and Allergy</a>.</em></p><img src="https://counter.theconversation.com/content/132264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maria Said, CEO of Allergy & Anaphylaxis Australia, co-authored this article. Prathyusha Sanagavarapu has previously received research funding from Allergy & Anaphylaxis Australia. The authors wish to note that the information provided in this article is general and parents are strongly encouraged to seek specific medical advice on diagnosis and management of food allergies from a GP or immunologist.</span></em></p>There’s no need for children with food allergies to miss out this Easter. Here’s how to include them in your celebrations and help keep them safe.Prathyusha Sanagavarapu, Senior Lecturer, Early Childhood Education, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1380902020-05-27T17:14:29Z2020-05-27T17:14:29ZPeanuts, eggs and your baby: How to introduce food allergens during the coronavirus pandemic<figure><img src="https://images.theconversation.com/files/337093/original/file-20200522-124826-1wdo67v.jpg?ixlib=rb-1.1.0&rect=49%2C0%2C5193%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Recommendations suggest babies be introduced to food allergens around age six months.</span> <span class="attribution"><span class="source">(Pixabay)</span></span></figcaption></figure><p>The best way to prevent food allergies is to introduce the most common allergenic foods to babies early in life, as <a href="https://www.doi.org/10.1001/jama.2016.12623">research evidence for peanut and egg has shown</a>. Even during the current COVID-19 pandemic, the benefits of allergy prevention outweigh the very small risk of a severe reaction.</p>
<p>As clinicians and researchers in the field of allergy and infant nutrition, we are worried that COVID-19 may lead parents to delay the introduction of allergens to their babies. Parents may not feel comfortable taking their baby to an emergency room because of potential exposure to COVID-19, so they don’t want to risk a severe allergic reaction requiring a hospital visit.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&rect=31%2C146%2C3463%2C2551&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=582&fit=crop&dpr=1 754w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=582&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=582&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The most common food allergens are cow’s milk, eggs, peanuts and tree nuts, sesame seeds, fish and shellfish, soy and wheat.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>The <a href="https://doi.org/10.1093/pch/pxy195">most recent Canadian recommendations</a> continue to apply during the COVID-19 pandemic. The recommendations encourage parents to introduce allergenic foods to babies as soon as they start eating solids around six months, but not before four months of age. This applies to lower-risk infants as well, but is especially important for babies who are at higher risk of allergy due to eczema, other food allergies or an immediate family history of an allergic condition. </p>
<h2>Should I delay introduction of allergens?</h2>
<p>Many parents may be wondering if they should hold off on introducing allergens to their baby because of COVID-19. The answer is no. Despite the pandemic and some families trying to avoid the risk of an emergency room visit, introducing allergens to babies <a href="https://www.cps.ca/en/blog-blogue/can-we-continue-to-recommend-early-allergenic-food-introduction-during-a-pandemic">without delay</a> is recommended. The risk of a severe allergic reaction when eating a new food for the first time <a href="http://www.doi.org/10.1056/NEJMoa1414850">is extremely low — well below two per cent</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The risk of a severe allergic reaction to a new food is very low.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>Delaying the introduction might put children at higher risk of allergies. If not introduced in infancy, the risk of an allergic reaction as a child gets older is increased, so it’s better to introduce early and not delay. There is evidence that in higher-risk infants, peanut introduction during infancy <a href="http://www.doi.org/10.1056/NEJMoa1414850">reduces the risk of peanut allergy by up to 80 per cent</a>.</p>
<h2>What if my baby has an anaphylactic reaction?</h2>
<p>It’s very unlikely that infants will react so severely to a new food that they will need an emergency trip to the hospital. To put it further into perspective, <a href="https://doi.org/10.1001/jama.2010.582">food allergies affect around two per cent to 10 per cent</a> of Canadians, so even most older children will not have an allergic reaction to foods. The chance of a severe allergic reaction such as anaphylaxis is much less than two per cent, even in higher risk infants.</p>
<p>In the unlikely event that infants have a severe reaction and need to go to the emergency room, <a href="https://doi.org/10.1016/j.jiph.2020.03.019">the risk of acquiring COVID-19 is also extremely low when proper infection control measures are adhered to</a>. The risk of an infant dying from COVID-19 in the unlikely event that it is acquired while visiting the emergency room is even more remote <a href="http://www.doi.org/10.1097/INF.0000000000002700">since children have milder disease symptoms</a>.</p>
<h2>How should I introduce allergens?</h2>
<p>In Canada, the most common allergens are cow’s milk, eggs, peanuts and tree nuts, sesame seeds, fish and shellfish, soy and wheat. Puréed foods, smooth nut butters diluted with breast milk or formula, or ground nuts mixed in purées are great ways for parents to introduce allergens safely in non-choking form for babies.</p>
<p>It’s important that the allergen be introduced orally, meaning that the infant eats the food. We don’t recommend rubbing it on the skin or lips to test for an allergic reaction as that may cause irritation that could be misinterpreted as allergy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Allergens can be introduced in puréed foods. Smooth peanut butter can be diluted with breast milk or formula.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Parents can introduce these foods one at a time, always in an age-appropriate way for their baby, and without delays between the introduction of new foods. Allergic reactions usually appear very quickly, so parents can gauge reaction within a couple of hours following the meal. </p>
<p><a href="https://foodallergycanada.ca/food-allergy-basics/preventing-and-treating-allergic-reactions/reaction-signs-and-symptoms/">Allergic reactions in infants will usually affect</a> the skin (hives, itchiness, rash), gastrointestinal tract (vomiting, diarrhea) or respiratory system (wheezing). Parents should monitor the signs closely and take pictures of skin reactions as they seek advice from their family doctor. If there is a reaction, the food should be avoided until parents have consulted their health-care team, and decided on the next best steps to take. </p>
<p>Once an allergen has been introduced safely, it is very important to keep offering and serving it to the baby a few times a week to maintain tolerance. Aiming to include these allergens in the regular family diet is a practical way for parents to offer it often to baby. </p>
<p>The benefit of preventing the development of food allergy (which can affect the quality of life of the whole family for many years) is far greater in our professional opinion than the very small risk of experiencing a life-threatening allergic reaction and potentially exposing infants to COVID-19.</p><img src="https://counter.theconversation.com/content/138090/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maude Perreault was a Vanier Scholar and received funding from the Canadian Institutes of Health Research, and the Canadian Child Health Clinician Scientist Program.</span></em></p><p class="fine-print"><em><span>Edmond S. Chan has received research support from DBV Technologies; has been a member of advisory boards for Pfizer, Pediapharm, Leo Pharma, Kaleo, DBV, AllerGenis; is a member of the healthcare advisory board for Food Allergy Canada; was an expert panel and coordinating committee member of the National Institute of Allergy and Infectious Diseases (NIAID)-sponsored Guidelines for Peanut Allergy Prevention; and was co-lead of the CSACI oral immunotherapy guidelines.</span></em></p><p class="fine-print"><em><span>Elissa Abrams is a member of theHealthcare advisory board for Food Allergy Canada. </span></em></p>Introducing food allergens early is the best way to prevent food allergies from developing. Even in a pandemic, the benefits outweigh the very small risk of a severe reaction requiring emergency care.Maude Perreault, Registered dietitian and Research Associate, McMaster UniversityEdmond S. Chan, Pediatric Allergist; Head & Clinical Associate Professor, Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine; Investigator, BC Children's Hospital Research Institute, University of British ColumbiaElissa M. Abrams, Asssistant Professor, Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1304552020-02-24T01:04:00Z2020-02-24T01:04:00ZI think my child has outgrown their food allergy. How can I be sure?<figure><img src="https://images.theconversation.com/files/316106/original/file-20200219-11000-jdyvy.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-little-asian-toddler-boy-holding-1551986915">Shutterstock</a></span></figcaption></figure><p>Some children grow out of their food allergies, but researchers don’t exactly know why.</p>
<p>Here’s how to work with your allergy specialist if you suspect your child isn’t allergic any more.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/four-myths-about-allergies-you-thought-were-true-but-arent-42855">Four myths about allergies you thought were true – but aren't</a>
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<h2>Who’s more likely to grow out of their food allergy?</h2>
<p>Food allergy affects up to <a href="https://www.allergy.org.au/patients/food-allergy/food-allergy">10% of infants and 8% of children</a> in <a href="https://www.ncbi.nlm.nih.gov/pubmed/28260260">Australia and New Zealand</a>. Common food allergies in young children are egg, cow’s milk and peanut. Allergies to tree nuts, fish and seafood tend to be more common in adolescents.</p>
<p>Rates of food allergies <a href="https://www.allergy.org.au/patients/food-allergy/food-allergy">have increased</a> in children and adults in developed countries including Australia. There’s also an <a href="https://www.ncbi.nlm.nih.gov/pubmed/28260260">increase in the number</a> of children up to four years old who’ve been admitted to hospital with food anaphylaxis (a severe, life-threatening reaction).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/introduce-eggs-and-peanuts-early-in-infants-diets-to-reduce-the-risk-of-allergies-65564">Introduce eggs and peanuts early in infants' diets to reduce the risk of allergies</a>
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<hr>
<p>Yet, Australian research <a href="https://www.ncbi.nlm.nih.gov/pubmed/28514997">shows</a> almost all children (more than 80%) with an egg allergy outgrow their allergy by the time they are four years old, as do about 20% of children with a peanut allergy.</p>
<p>However, for others, food allergies are likely to persist. This is <a href="https://www.ncbi.nlm.nih.gov/pubmed/26968958">most likely</a> if they have eczema, hay fever and/or asthma alongside a <a href="https://www.jacionline.org/article/S0091-6749(18)32688-5/abstract">tree nut allergy from a young age</a>, or they have a <a href="https://www.ncbi.nlm.nih.gov/pubmed/26968958">severe allergic reaction to a low dose</a> of their particular food allergen.</p>
<h2>Why do they outgrow their food allergy?</h2>
<p>Researchers don’t know exactly why some children grow out of their food allergies. But their immune response to food allergens seems to change.</p>
<p>For instance, these children have <a href="https://www.ncbi.nlm.nih.gov/pubmed/28739336">lower levels</a> of antibodies you’d normally see as part of an allergic response (lower levels of allergen-specific IgE). They also have higher levels of other immune system components (allergen-specific IgG4, IL-10 and allergen-specific T cells).</p>
<p>Other research has focused on a type of T cell, called the <a href="https://www.ncbi.nlm.nih.gov/pubmed/30736894">regulatory T cell</a>, which regulates how the <a href="https://www.ncbi.nlm.nih.gov/books/NBK21070/">adaptive immune system</a> responds to antigens. </p>
<p>Children who are not allergic or have developed naturally occurring tolerance are more likely to have stable levels of these cells. However, children <a href="https://www.ncbi.nlm.nih.gov/pubmed/26456457">with an allergy</a> may not be able to regenerate these cells once exposed to the food allergen, so have lower levels.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-the-immune-system-19240">Explainer: what is the immune system?</a>
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<p>Children who outgrow their food allergies may also have a <a href="https://www.ncbi.nlm.nih.gov/pubmed/30736894">dampened inflammatory response</a> in a part of their immune system known as the <a href="https://www.ncbi.nlm.nih.gov/books/NBK26846/">innate immune system</a>.</p>
<p>Lastly, changes in the diversity of <a href="https://www.ncbi.nlm.nih.gov/pubmed/27059726">gut microbiota</a> (microorganisms such as bacteria living in the gut) and substances made by these microbes may also be involved.</p>
<p>However, we need more research to verify what’s happening both in the immune system and the gut microbiome to be sure.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-microbes-arent-the-enemy-theyre-a-big-part-of-who-we-are-79116">Essays on health: microbes aren't the enemy, they're a big part of who we are</a>
</strong>
</em>
</p>
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<h2>What signs can parents look out for?</h2>
<p>If you think your child has outgrown their food allergy, it’s important not to test them yourself to see what happens. This is extremely unsafe and they may have a severe allergic reaction.</p>
<p>However, you may have noticed your child has accidentally eaten a food allergen but did not develop an allergic reaction. This may indicate your child has outgrown the food allergy.</p>
<p>That’s when it’s time to consult an allergy specialist – a doctor who specialises in diagnosing and managing patients with allergic diseases – to investigate.</p>
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<a href="https://images.theconversation.com/files/316526/original/file-20200220-92530-1ab8tpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/316526/original/file-20200220-92530-1ab8tpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316526/original/file-20200220-92530-1ab8tpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316526/original/file-20200220-92530-1ab8tpq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316526/original/file-20200220-92530-1ab8tpq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316526/original/file-20200220-92530-1ab8tpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316526/original/file-20200220-92530-1ab8tpq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316526/original/file-20200220-92530-1ab8tpq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An allergy specialist will conduct tests, including a skin prick test, to see whether your child has really outgrown a food allergy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/allergy-skin-prick-tests-175616312">Shutterstock</a></span>
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<h2>Here’s what an allergy specialist will do</h2>
<p>The allergy specialist will conduct a <a href="https://www.allergy.org.au/patients/allergy-testing/allergy-testing">number of tests</a> to monitor your child, either annually or every few years, depending on the allergen. These tests include <a href="https://dermnetnz.org/topics/skin-prick-testing/">skin prick tests</a> and blood tests.</p>
<p>These tests indicate changes in the immune system to give us an idea of whether your child has outgrown an allergy or it persists.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/early-exposure-to-infections-doesnt-protect-against-allergies-but-getting-into-nature-might-126603">Early exposure to infections doesn't protect against allergies, but getting into nature might</a>
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<p>When these tests indicate almost no allergic response, your child will have an <a href="https://www.allergy.org.au/patients/food-allergy/food-allergy-challenges-faqs">oral food challenge</a> under medical supervision. </p>
<p>For example, a child will be given the food allergen in increasing amounts in a medical facility. If the child tolerates the food (known as passing the challenge), the food is regularly reintroduced into the diet.</p>
<p>Food challenge tests are also done to see if a child can tolerate foods in a modified form. For example, a child allergic to eggs or cow’s milk may be able to tolerate baked egg or baked milk.</p>
<p>In general, it’s only with a medically supervised oral food challenge that allergy specialists can say whether your child has really outgrown their food allergy.</p>
<hr>
<p><em>If your child has a food allergy, more information is available from <a href="https://allergyfacts.org.au/">Allergy & Anaphylaxis Australia</a> and the <a href="https://www.allergy.org.au/patients/food-allergy">Australasian Society of Clinical Immunology and Allergy</a>. You can also listen to the <a href="https://www.podcastoneaustralia.com.au/podcasts/allergies">Allergies podcast</a>, by Murdoch Children’s Research Institute’s specialists Professors Katie Allen and Mimi Tang.</em></p><img src="https://counter.theconversation.com/content/130455/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paxton Loke does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If your child has accidentally eaten something you thought they were allergic to, but doesn’t have a response, they may have grown out of their food allergy. Here’s the safest way to check.Paxton Loke, Paediatric Allergist and Immunologist, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1279332020-01-06T15:50:36Z2020-01-06T15:50:36ZHow psychologists can help people coping with life threatening food allergies<figure><img src="https://images.theconversation.com/files/307917/original/file-20191219-11904-1t35in0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smiling-little-boy-talking-cheerful-child-760999168">Shutterstock/photographee.eu</a></span></figcaption></figure><p>Food allergies have a big impact on people’s quality of life. The stress and worry of having a potentially life-threatening reaction can result in the need for some families to seek help from a psychologist. Unfortunately, only a few allergy clinics in the UK have dedicated psychological services to help these people. </p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cea.13488">We looked at</a> two allergy clinics with such psychological services for children and families. We found the services to be in high demand, and clinicians reported rapid improvements in patients’ anxiety as a result. </p>
<p>Food allergies involve a reaction by the immune system to protein in foods. Symptoms can range from mild to life threatening. The <a href="https://allergytraining.food.gov.uk/english/rules-and-legislation/">foods most commonly</a> linked with allergies are peanuts and tree nuts, dairy products, fish, shellfish, wheat and soy. It can be difficult to avoid such foods as many are used as ingredients. Even where they are not ingredients, minute amounts can still crop up due to manufacturing processes. </p>
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<h2>Stress and anxiety</h2>
<p>Research over the last 20 years <a href="http://www.jiaci.org/issues/vol24issue6/2.pdf">has shown</a> that constantly watching what you eat and the unpredictable nature of allergic reactions has an impact on people’s quality of life and mental health. Where it’s a child’s allergy, parents are also affected. Mothers in particular <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1398-9995.2010.02342.x">report high levels</a> of stress and anxiety. </p>
<p>Anxiety in parents can increase when children grow older and take on more responsibility for their health. Teenagers say that their food allergy becomes <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1398-9995.2008.01862.x">more of a burden</a> as they get older and want to go out with their friends and have a more independent social life. Older children and adolescents also feel a need to be <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1398-9995.2008.01862.x">more like their friends</a> and not be labelled by their allergy.</p>
<p>Despite the impact food allergies can have, very little research has been published on interventions to reduce anxiety and improve quality of life. Two studies have shown that <a href="https://www.mdpi.com/2227-9032/3/4/1194">cognitive behavioural therapy</a>, or CBT, can be effective for parents of children with food allergies, particularly those with <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/cea.12981">high anxiety</a>. CBT is a talking therapy that focuses on present difficulties, including symptoms, emotions, behaviour and negative thoughts. It is very effective for reducing anxiety and depression. To date, there is no published research on such interventions for children or adolescents with food allergies, so this should be a priority. </p>
<h2>Managing stress</h2>
<p>The Paediatric Psychology Network (PPN-UK) provides evidence-based guidelines for <a href="https://www.bps.org.uk/sites/www.bps.org.uk/files/Member%20Networks/Divisions/DCP/Evidence%20Based%20Guidelines%20for%20the%20Management%20of%20Invasive%20and%20or%20Distressing%20Procedures%20with%20Children.pdf">the management of</a> invasive and/or distressing procedures. It has good examples of how psychological knowledge and skills could be used for the benefit of children in managing their allergy, such as when undergoing skin prick testing or learning how to use an adrenaline auto-injector. Unfortunately, access to psychological services for families in paediatric allergy is limited. </p>
<p>The two allergy clinics we looked at that have funding for dedicated clinical psychology services are based at Southampton General Hospital and the Evelina London Children’s Hospital. In Southampton, 40 referrals were made in the first 14 months of the service. In London, just over 300 children and families have been referred since the service began two and a half years ago. </p>
<p>The most common reasons for referrals include: food anxiety and eating outside the home, food challenges to see if a child still reacts to food or has grown out of it, using an adrenaline auto-injector, sleep difficulties, low mood or self-esteem and parental anxiety. </p>
<p>From the allergist’s perspective the addition of psychologists with skills in the management of allergic disease is an important part of the solution. There is little time in a typical consultation for an allergist or allergy nurse to identify and address issues related to anxiety or quality of life.</p>
<h2>Providing hope</h2>
<p>So in clinical practice, having access to a psychologist is invaluable. Reassuringly, clinicians often see patients and their families rapidly respond to psychological interventions, sometimes even after a single consultation. Therapy sessions can often be provided to groups, which is cost-effective. But given the number of families asking for this support and the lack of allergy psychologists, very few deserving patients currently have access to such care. </p>
<p>An increase in public awareness of the potential <a href="https://www.theguardian.com/society/2018/sep/29/pret-allergy-death-parents-demand-label-laws">life-threatening nature</a> of food allergies and the impact this can have on people’s lives does seem to be slowly making a difference. More psychological services are being offered in London and other parts of the UK, such as Leeds.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/B6Ls7Iknece","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>This provides hope for the many families who need them. The challenge now is for allergy services to work with hospital paediatric psychology services to further develop, integrate and deliver these services for all children with food allergies and their families. </p>
<p>In the meantime, for families and patients who do not have access to a psychologist and who need support, the <a href="https://www.anaphylaxis.org.uk/">Anaphylaxis Campaign</a> and <a href="https://www.allergyuk.org/">Allergy UK</a> are there to help. They run helplines, have local support groups and provide useful information to patients and families managing food allergies.</p>
<p>The uptake of psychological services by patients and families demonstrates the real need to expand these services across the UK. Evaluating how effective these services are and developing ways they can be provided in primary as well as secondary care, via GPs as well as through dedicated clinics, will help reach more families and reduce the burden associated with being allergic to a food.</p><img src="https://counter.theconversation.com/content/127933/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Knibb has received funding from Allergy UK. She also acts as a consultant for AImmune. </span></em></p>New research confirms the benefits, but few hospitals in the UK provide these services at present.Rebecca Knibb, Associate Professor in Psychology, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1273792019-12-04T11:27:46Z2019-12-04T11:27:46ZMisleading allergy labelling puts lives at risk<figure><img src="https://images.theconversation.com/files/304700/original/file-20191202-66994-1nmphz9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-reading-nutrition-label-on-1031952505?src=1e2a16dc-b7c7-4c40-98e8-1ad920dfbd6f-1-23">Shutterstock/Goksi</a></span></figcaption></figure><p>Failing to declare allergens on food labels is a breach of regulations and can put lives at risk. The law relating to allergen labels was changed recently to reduce the risks to consumers. But recent cases of flawed and misleading food labelling, sometimes involving major supermarkets, have called into question the effectiveness of allergen labelling laws. </p>
<p>For example, in November, Morrisons was found to be <a href="https://twitter.com/HealthJourno/status/1194638794210914304">selling Shirley biscuits</a> in packaging that failed to emphasise the allergens on the ingredients label. Alex Gazzola, a journalist from Allergy Insight, alerted Morrisons to the problem on Twitter but it took the supermarket a whole month to finally respond and withdraw the biscuits from sale.</p>
<p>Unfortunately this is not an isolated case. There a similar cases of inadequate allergy labelling on foods every month. In fact, the Food Standards Agency publishes details of <a href="https://www.food.gov.uk/news-alerts/search/alerts">allergy alerts</a> where food retailers and manufacturers have recalled products found to have misleading allergy labels. In November there were nine such alerts. </p>
<p>These included: Waitrose <a href="https://www.food.gov.uk/news-alerts/alert/fsa-aa-97-2019">recalling its Carrot and Coriander Soup</a> as it did not declare the fact that it contains barley and celery, Aldi <a href="https://www.food.gov.uk/news-alerts/alert/fsa-aa-99-2019">recalling Breaded Chicken Steaks</a> due to undeclared milk and, perhaps most worrying, Mondelez recalling Cadbury Dairy Milk Little Robins because <a href="https://www.food.gov.uk/news-alerts/alert/fsa-aa-95-2019">some products contained almonds</a> which were not mentioned on the label.</p>
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<p>The law relating to allergy labelling is clear. Under the <a href="https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX%3A32011R1169">European Food Information to Consumers Regulation</a>, where there are pre-packed foods which contain one or more of the <a href="https://allergytraining.food.gov.uk/english/rules-and-legislation/">allergens defined by law</a>, the name of the allergen must be emphasised on the label. This is commonly done by highlighting the name in bold type. But there are exceptions to this rule. For example, where the product or food doesn’t have any packaging or it does not require an ingredients list at all (alcoholic drinks with a strength of 1.2% ABV or more or dairy products with no added ingredients).</p>
<h2>Enforcement issues</h2>
<p>As with other areas of food law, the rules are evident, but my own research has found that <a href="https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0201178">the weak link is enforcement</a>. In the case of Shirley biscuits, Gazzola reported the problem to Morrisons twice and then to West Yorkshire Trading Standards, the local authority where Morrisons’ head office is based. It still took a whole month for any action to be taken. This is unsurprising. Local authority trading standards departments bore the brunt of the <a href="https://www.theguardian.com/money/2016/aug/07/trading-standards-institute-consumers-are-no-longer-protected">cuts during the austerity years</a> that followed from the financial crisis in 2008 and they are still to recover. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-people-are-experiencing-severe-food-allergies-than-ever-before-108124">More people are experiencing severe food allergies than ever before</a>
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<p>In any event, Morrisons took the decision to <a href="https://twitter.com/Morrisons/status/1196347006911963136">withdraw the biscuits from sale</a> without intervention from enforcers and they may have been motivated by the risk to consumers and sensitive to the risk of bad publicity. But it is disappointing to see that in spite of this incident, there is still no allergy alert on the FSA website.</p>
<p>Of course, there are too many laws and too many products for enforcers to closely monitor but where a company is told about a problem, in the light of <a href="https://www.gov.uk/government/news/natashas-legacy-becomes-law">the potential dire consequences</a>, it’s reasonable to expect a quick and joined-up response. Instead, the case highlights the fragmented nature of enforcement.</p>
<p>Children are more likely than adults to suffer from an allergy – and the number of hospital admissions of children with anaphylactic shock has, according to the Natasha Allergy Research Foundation, <a href="https://www.narf.org.uk/blog/2019/11/15/new-nhs-digital-figures-reveal-huge-rise-in-children-hospitalised-with-severe-allergic-reactions">increased by 72%</a> over the past six years.</p>
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<p>Natasha Ednan-Laperouse <a href="https://www.bbc.co.uk/news/uk-england-london-45623831">died in 2016 aged 15</a> when she suffered from an allergic reaction after eating a baguette purchased from Pret A Manger which contained sesame that was not declared on the label. As a result of the concerted campaign by Natasha’s parents the law relating to allergen labelling <a href="https://www.gov.uk/government/news/natashas-legacy-becomes-law">was changed</a> to implement tighter rules for pre-packed foods for direct sale. From 2021, food that is made and packed where it is sold will be required to have a full ingredients list that emphasise those ingredients that are known allergens.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/may-contain-nuts-isnt-good-enough-we-need-a-new-approach-to-food-allergy-testing-58451">'May contain nuts' isn't good enough: we need a new approach to food allergy testing</a>
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<p>Where foods are not pre-packed and is made onsite at a restaurant, takeaway or sandwich shop, there’s more flexibility in relation to how allergen information is provided. The food business must still provide information about the allergens but there is no requirement on businesses to provide full details of ingredients on each item. A food business can provide the information by a label on the shelf or a notice that directs consumers to make an enquiry to staff. </p>
<p>So in some cases the information can be provided orally. For example, a notice may say: “If you’re worried about allergies, speak to a member of staff”. But the use of this method means there’s no label on each individual item and – crucially – it puts the onus on the consumer to find out.</p>
<p>The family of Owen Carey, who died in 2017 <a href="https://www.theguardian.com/uk-news/2019/sep/13/allergic-teenager-who-died-was-misled-about-byron-burger-coroner-rules">while celebrating his 18th birthday</a>, has called for <a href="https://www.leighday.co.uk/News/2019/September-2019/Family-call-for-Owens-Law-following-inquest-con">a change in the law</a> so that the discretion afforded to restaurants to provide allergen information orally is removed. Owen suffered from a dairy allergy and the chicken breast he had eaten had been marinated in buttermilk. This was in spite of the fact that Owen had told staff at Byron Burger about his allergy. </p>
<p>There are clearly still some very serious issues around food labelling that must be addressed. But whatever action is taken, it should not lead to retailers labelling their food with more <a href="https://theconversation.com/may-contain-nuts-isnt-good-enough-we-need-a-new-approach-to-food-allergy-testing-58451">blanket warnings</a> just to avoid claims, such as the commonly used “may contain nuts”. It is not helpful for allergy sufferers to restrict their choices and they end up not being able to eat foods that are safe.</p><img src="https://counter.theconversation.com/content/127379/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ajay Patel does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are still some serious issues around food labelling that must be addressed and enforcement is one of them.Ajay Patel, Senior Lecturer in Food Law, Manchester Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1157422019-05-01T11:36:49Z2019-05-01T11:36:49ZChildren with eczema: the link to food allergies is not clear cut<figure><img src="https://images.theconversation.com/files/270902/original/file-20190425-121224-d7dvpx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/food-allergy-can-cause-baby-toddler-704891131?src=jfDSGwcMqt3eSe6DdRG12A-1-18">TassaneeT via Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/eczema">one in five children</a> have eczema – and even mild cases can have a big impact on both the child and their family. For many, symptoms will come and go before they start primary school, but for others it can indicate the beginning of a genetic tendency to develop allergic conditions such as hay fever or asthma (or both).</p>
<p>We also know that children with eczema are <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cea.12406">more likely to develop food allergies</a>, especially if the condition starts in the first few months of life and is severe. Often parents will make the allergy diagnosis themselves – at the sudden onset of vomiting, diarrhoea or rash after eating scrambled egg, for example. </p>
<p>This can be frightening, but doctors can usually easily confirm the cause of these immediate reactions by talking to the parents and offering a confirmatory allergy blood or skin prick test.</p>
<p>In the absence of such obvious physical reactions however, a different question sometimes arises for parents: “Is a food allergy contributing to my child’s eczema and would an allergy test help to find out?” </p>
<p>GPs diagnose and treat most children with eczema – and parents often ask this question, worried that something in the child’s diet (or the diet of a breast-feeding mother) is contributing to their dry, itchy and inflamed skin. But it can be difficult to link any given food to a worsening of eczema, as symptoms may not appear for hours or even days after eating it.</p>
<p>On top of this, the value of allergy tests in these circumstances is uncertain since we don’t really know how commonly food allergy worsens eczema symptoms. Although eczema and food allergy often occur together, food allergy is not thought to be the main cause of eczema. In fact, many experts believe that it is <a href="https://www.nih.gov/news-events/news-releases/scientists-identify-unique-subtype-eczema-linked-food-allergy">eczema which leads</a> to the development of allergy to foods. </p>
<p>A second uncertainty about the value of allergy tests in children with eczema is that a child with a positive test may be “sensitised” rather than “allergic” to any given food. This means they can actually eat that food without any apparent ill effect. So testing could potentially lead to unnecessary and unhelpful dietary restriction.</p>
<p>For children with early onset, difficult to treat eczema, guidelines steer GPs in the UK towards referral for food allergy tests or special diets in case exposure to food allergens might be worsening the eczema. However, for older children or those with milder forms of eczema, it’s not so straightforward. </p>
<p>Sometimes parents don’t raise their concerns at all, or if they do, they may feel their concerns are being dismissed. Even when parents and doctors agree that further investigation is needed, access to specialist advice on the NHS is not guaranteed. Most allergy services in the UK have waiting lists of several months and don’t have the capacity to see every child with eczema.</p>
<p>So, what happens? As we confirmed in a <a href="https://www.ncbi.nlm.nih.gov/pubmed/30834551">recent online survey</a>, many parents of children with eczema take matters into their own hands. They may exclude foods such as dairy, wheat or eggs without any professional advice. This is not without its own risks as a restricted diet may lead to malnutrition. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Testing times.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-doctor-gives-patient-allergy-test-1215710590?src=xYMovTyE1N1K3pSYYiIgmg-1-85">Shutterstock</a></span>
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<p>Although eczema is most commonly linked with allergy to eggs or peanuts, parents often restrict dairy or wheat because these are eaten more regularly. Some doctors advise allergy testing to look for food allergies which might be worsening the eczema. Others think that allergy tests are more likely to cause harm through unnecessary dietary restrictions than to help the eczema.</p>
<h2>Seeking solutions</h2>
<p>To try to unpick the problem a bit more, we’ve just finished recruiting children with eczema <a href="http://www.bristol.ac.uk/primaryhealthcare/researchthemes/test-study/">to a trial</a> exploring the role of routine allergy history and skin prick testing in the dietary management of eczema. </p>
<p>Funded by the <a href="https://www.spcr.nihr.ac.uk">NIHR School for Primary Care Research</a>, 84 children in the English city of Bristol, have been randomised to receive either usual care or an intervention of “test-guided dietary advice”. At the end of the study we expect to have a better understanding of both the feasibility of doing future bigger studies and also the issues from the perspective of both parents and GPs. </p>
<p>In addition, the NIHR recently funded an <a href="https://www.spcr.nihr.ac.uk/themes-SPCR">allergy working group</a> to try to improve the capacity for primary care research in the important but neglected area of allergies more generally.</p>
<p>So what should parents and clinicians do until more research is available to guide them over whether certain foods may be making children’s eczema worse? </p>
<p>At the moment there is no cure for eczema. So the best advice is to use two simple treatments (emollients and topical corticosteroids) to control the disease. However, if there are any immediate reactions to food or, despite good skin care, the child’s skin is causing misery, parents should persist in seeking further help from their family doctor.</p><img src="https://counter.theconversation.com/content/115742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Ridd is funded by an NIHR Post-Doctoral Research Fellowship (PDF-2014-07-013)</span></em></p><p class="fine-print"><em><span>Robert Boyle has received consultancy payment from Dairy Goat Co-Operative (NZ) Ltd. for designing a clinical trial of an infant formula, and for advisory board membership from ALK-Abello (who market tests and treatments for allergy), DBV Technologies (who market treatments for food allergy), and Prota Therapeutics (who develop treatments for food allergy). He also undertakes consultancy work for Cochrane as Senior Editor for the Children and Families Network and has acted as an expert witness in court cases relating to severe allergic reactions or to infant feeding.</span></em></p>Avoiding certain foods risks malnutrition.Matthew Ridd, GP and Senior Lecturer in Primary Healthcare, University of BristolRobert Boyle, Reader in Paediatric Allergy, Imperial College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1136252019-03-15T16:30:03Z2019-03-15T16:30:03ZFood allergies: what you need to know about the role your skin plays<figure><img src="https://images.theconversation.com/files/264150/original/file-20190315-28471-aqzaau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/davidjlee/9336083592/">David Lee/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Food allergies are on the increase worldwide, ranging from minor inconvenience to possible sudden death, and leading to warnings of an “<a href="https://www.jaci-inpractice.org/article/S2213-2198(18)30036-9/fulltext">allergy epidemic</a>”. The most severe form of allergic reaction – <a href="https://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis">anaphylaxis</a> – can occur repeatedly or without warning. The reasons for the rise in allergies are complex, but the skin is now recognised to play an important role as a gatekeeper for the body’s immune system.</p>
<p>Human skin is a protective barrier that provides a dynamic covering, ensuring essential fluids (including water, proteins and minerals) remain inside while damaging substances remain outside. The skin barrier is structural – like a brick wall – but it is also living and active, constantly sensing and responding to the external environment. This barrier is made up of multiple layers of interconnected human cells, plus a multitude of <a href="https://www.ncbi.nlm.nih.gov/books/NBK279387/">microbes</a>, the tiny organisms that live on the surface of healthy skin.</p>
<p>Skin forms a continuous lining on the outer surface of the body which joins seamlessly with the lining of the mouth and gut. Human cells are normally introduced to foodstuffs through the mouth, but the body can also be exposed to food on the skin surface. </p>
<p>The <a href="https://www.stanfordchildrens.org/en/topic/default?id=all-about-the-immune-system-90-P01665">immune system</a> – cells and tissues that work together to defend the body against potentially harmful viruses, bacteria and foreign substances – may react very differently when food is first encountered through skin instead of through the mouth. This is because “leaky” skin may confuse the immune system’s capacity to recognise a harmless substance. </p>
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<h2>Of mice and humans</h2>
<p>Mice exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587010/">egg white</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347216/">peanut</a> through skin have been shown to develop allergic reactions or anaphylaxis to these foods when they are then eaten. Human food allergy may develop in the same way.</p>
<p>When food is consumed we normally develop <a href="https://www.niaid.nih.gov/research/immune-tolerance">tolerance</a>, meaning no immune reaction occurs. But when skin is leaky because of <a href="https://www.nhs.uk/news/genetics-and-stem-cells/new-genetic-clue-to-peanut-allergy/">faulty genes</a> or when skin is damaged by a condition such as <a href="https://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/eczema-food-allergy">eczema</a>, food allergens may pass through. This stimulates immune cells in the skin, which release chemical signals of attack. Then the next time that specific food is encountered the cells are primed to produce an allergic reaction.</p>
<hr>
<p><em><strong>Read more: <a href="https://theconversation.com/more-people-are-experiencing-severe-food-allergies-than-ever-before-108124">More people are experiencing severe food allergies than ever before</a></strong></em> </p>
<hr>
<p>The “leakiness” of baby skin soon after birth (measured by how much water evaporates from the surface) can <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Skin+barrier+impairment+at+birth+predicts+food+allergy+at+2+years+of+age.+Irvine">predict their risk</a> of food allergy at the age of two. And <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=The+nonlesional+skin+surface+distinguishes+atopic+dermatitis+with+food+allergy+as+a+unique+endotype">recent research</a> has shown that people with a food allergy have molecular evidence that their skin is leaky and primed to react, even if the skin looks to be normal. </p>
<h2>Treatment and prevention</h2>
<p>In an emergency situation, a food allergy is treated with drugs that counteract the <a href="https://www.nhs.uk/conditions/anaphylaxis/treatment/">most dangerous features</a> of an anaphylactic response: low blood pressure and airway obstruction. <a href="https://www.wisegeek.com/what-is-adrenaline.htm">Adrenaline</a> (administered outside of hospitals by auto-injector “pen”) causes blood vessels to squeeze tight – to maintain the blood pressure – while <a href="https://www.nhs.uk/conditions/bronchodilators/">bronchodilator drugs</a> cause the airways to open. Steroid treatment can dampen down the harmful effects of an overactive immune response. So <a href="https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/corticosteroids">corticosteroids</a> are also used to limit the production of inflammatory signals in the blood and throughout the body. </p>
<p>Parents and carers often ask what they can do to help prevent the development of food allergy, especially if there is a history of allergies in the family. The Enquiring About Tolerance, or “EAT”, <a href="https://www.nejm.org/do/10.1056/NEJMdo005063/full/?requestType=popUp&relatedArticle=10.1056%2FNEJMoa1514210">study</a>, showed that introduction of peanut and egg into the diet of babies from three months of age could reduce the likelihood of developing an allergy to these foods. The protective effect was less clear with other common foods such as milk, fish, wheat and sesame. This may be because smaller amounts of these foods were consumed.</p>
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<img alt="" src="https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Skin conditions like eczema that break the surface of the skin are often associated with food allergies.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/580580401?size=medium_jpg&src=lb-59856941&sort=newestFirst&offset=3">Shutterstock</a></span>
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<p>Another <a href="https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2031-3">ongoing study</a> aims to determine whether the use of moisturisers (known as emollients) on babies can improve the skin barrier to help prevent eczema and food allergies. The results are eagerly awaited, but further research will still be needed to clarify if – and how – food allergy can be prevented.</p>
<p>In the meantime, UK government guidance continues to advise that babies should be <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/">exclusively breastfed</a> until six months of age. Although it is <a href="https://www.ncbi.nlm.nih.gov/pubmed/26192405">not known</a> whether breastfeeding protects against food allergy, it is clear that breast milk can provide many health benefits for the baby and mother.</p>
<p>Some people grow out of their food allergies, but for others it becomes a life-long burden of carefully avoiding the offending foodstuff. Attempts to prevent any accidental exposure may fail with disastrous consequences such as in <a href="https://www.bbc.co.uk/news/uk-45679320">the case</a> of teenager Natasha Ednan-Laperouse who had a sesame allergy and died of cardiac arrest after she ate a baguette which she did not know contained sesame seeds.</p>
<p>While accidental exposure to food can be very dangerous, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284278/">immunotherapy</a> – the deliberate application of food substances to the surface of healthy skin – is being tested in clinical trials for the treatment of peanut and milk allergy. </p>
<p>A greater understanding of the causes of allergy will offer the opportunity to develop new treatments – and our own skin may provide a route to prevention as well as treatment for life-threatening reactions.</p><img src="https://counter.theconversation.com/content/113625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara J Brown receives research funding from the Wellcome Trust, the Tayside Dermatological Research Charity and the British Skin Foundation and is a medical adviser for Eczema Outreach Support.</span></em></p>With food allergies on the rise, it’s important to understand the role the skin plays in protecting or exposing us to reactions.Sara Brown, Professor of Molecular and Genetic Dermatology, Wellcome Trust Senior Research Fellow, University of DundeeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1100932019-01-22T11:50:35Z2019-01-22T11:50:35ZAre microbes causing your milk allergy?<figure><img src="https://images.theconversation.com/files/254554/original/file-20190118-100279-bc50hj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Millions of Americans suffer from food allergies.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lactose-intolerance-dairy-intolerant-man-refuses-373904563">Albina Glisic/Shutterstock.com</a></span></figcaption></figure><p>In the past 30 years, <a href="http://doi.org/10.1542/peds.2017-0194">food allergies</a> <a href="http://doi.org/10.1007/s11882-016-0616-7">have become increasingly common</a> in the United States. Changes to human genetics can’t explain the sudden rise. That is because it takes many generations for changes to spread that widely within a population. Perhaps the explanation lies in changes to our environment, particularly our internal environment. Shifting lifestyle practices over the last half-century – increasing antibiotic and antimicrobial use, surface sterilization, air filtration and changes to diet – have changed our internal environment and wiped out important bacteria with beneficial health effects. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/254547/original/file-20190118-100264-fb2qxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/254547/original/file-20190118-100264-fb2qxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/254547/original/file-20190118-100264-fb2qxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=748&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254547/original/file-20190118-100264-fb2qxt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=748&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254547/original/file-20190118-100264-fb2qxt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=748&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254547/original/file-20190118-100264-fb2qxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=940&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254547/original/file-20190118-100264-fb2qxt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=940&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254547/original/file-20190118-100264-fb2qxt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=940&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Bacteria (red) reside among the epithelial cells (blue) and the mucus (green) of a mouse small intestine.</span>
<span class="attribution"><span class="source">UChicago, cnagler@bsd.uchicago.edu</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>For many years, <a href="https://naglerlab.uchicago.edu">my research group</a> at the University of Chicago has been exploring the role that intestinal bacteria play in preventing allergic responses to food. Bacteria, together with viruses, fungi and other small organisms living in and on our bodies, collectively make up the microbiome and play a critical supporting role in health. </p>
<p>The microbiome is our internal environment. Humans and microbes have “grown up” together: As humans evolved, so did their microbes. We tend to think of health practices as changing slowly, but from the perspective of the bacteria in our guts, changes in their composition and function have happened more quickly – and the results are dramatic. </p>
<h2>Intestinal bacteria and allergies</h2>
<p>Several years ago, my research group, together with a collaborator in Italy, <a href="https://www.researchgate.net/profile/Roberto_Berni_Canani">Roberto Berni Canani</a>, was comparing the bacteria present in infants with a diagnosed cow’s milk allergy to those without. We found <a href="https://doi.org/10.1038/ismej.2015.151">some remarkable differences</a> between the two groups. This led us to wonder whether the different bacteria present in each of the two groups are sufficient to protect against allergy. And if so, could we figure out why?</p>
<p>To test this idea, we transplanted the entire microbiome of the two different groups – the healthy infants and those allergic to cow’s milk – into special laboratory mice that were bred in a completely sterile environment, with no bacteria of their own. The idea was simple: If we transplant the different groups of bacteria into mice, will the mouse become allergic to cow’s milk or not? </p>
<p>When we did this, we were stunned by the results: The bacteria from a healthy infant could protect the mouse from developing an anaphylactic response to a cow’s milk protein, while the bacteria from a cow’s milk allergic infant did not.</p>
<h2>A new diagnostic?</h2>
<p>When we cataloged bacteria present in the mice colonized with healthy bacteria and those present in the mice colonized with the cow’s milk allergic bacteria, we were able to calculate a ratio of protective to nonprotective groups. This ratio could <a href="https://doi.org/10.1038/s41591-018-0324-z">accurately predict</a> whether or not the infants had an allergy. We also learned that the two different groups of bacteria activate different genes in the mouse gut. </p>
<p>These genes influence a variety of processes in the intestine, such as metabolism and permeability. We identified one bacterial species in particular, <em>Anaerostipes caccae</em>, as the key. When we put only this species into a germ-free mouse, the mouse was protected from food allergy.</p>
<p>These studies show a health-promoting role for the microbiome in food allergy. It’s clear that the internal environment of the intestine is very different in infants with and without food allergy, and that this internal environment changes the biochemistry of the intestine.</p>
<p>Our study also suggests a way forward to harness these protective bacteria, and the molecules that they produce, as therapies to prevent and to treat food allergy. They could also work well as a diagnostic tool for predicting allergies and allergy risk. Therapies based on this idea remain 5 to 10 years away, but I am excited for their prospects. Such therapies may provide relief for children, parents, caregivers and patients living with food allergy.</p><img src="https://counter.theconversation.com/content/110093/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cathryn Nagler is the President and Co-Founder of ClostraBio, Inc.</span></em></p>There has been a dramatic rise in life-threatening food allergies in the last few decades. Antibiotics, poor diet and C-sections have all been implicated. Now new evidence points to gut microbes.Cathryn Nagler, Bunning Food Allergy Professor, University of ChicagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1081242018-12-05T16:44:37Z2018-12-05T16:44:37ZMore people are experiencing severe food allergies than ever before<figure><img src="https://images.theconversation.com/files/249002/original/file-20181205-186085-1s3kp54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/peanut-butter-sandwiches-toasts-on-wooden-576773974">Shutterstock</a></span></figcaption></figure><p>The <a href="https://www.bbc.co.uk/news/uk-45679320">recent inquest</a> into the death of Natasha Ednan-Laperouse from anaphylaxis after eating a Pret A Manger baguette she was unaware contained sesame, could lead to a change in <a href="https://www.theguardian.com/society/2018/oct/23/pret-allergy-death-parents-to-meet-gove-over-food-labelling">labelling legislation</a>. Indeed, a <a href="https://www.bbc.co.uk/news/uk-england-46345097">recent investigation</a> found that undeclared allergens were present in a quarter of foods sampled. But a more fundamental issue needs to be addressed: why are more people experiencing severe food allergies than ever before?</p>
<p>As I explain in <a href="https://cup.columbia.edu/book/another-persons-poison/9780231164856">Another Person’s Poison: A History of Food Allergy</a>, strange reactions to food have long been known. The Ancient Greek physician <a href="https://www.britannica.com/biography/Hippocrates">Hippocrates</a> (c.460-370BC) described such reactions to various foods, including cheese. Strawberries caused Richard III to break out into hives. It is said he once sneakily consumed “a messe of strauberies”, and then blamed his reaction on witchcraft orchestrated by one of his opponents, who was summarily beheaded. By the time Austrian physician <a href="https://www.ncbi.nlm.nih.gov/pubmed/27794078">Clemens von Pirquet</a> coined <a href="https://www.ncbi.nlm.nih.gov/pubmed/17136331">the term</a> “allergy” in 1906, many believed that food could trigger skin problems, asthma, gastrointestinal distress and even mental disorders.</p>
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<p>In the 1930s, food allergy emerged as a distinctive sub-category of allergy. But it was also highly controversial. Although it was easy to identify the food at fault in anaphylactic reactions, such as the one that killed Ednan-Laperouse, these sudden reactions were rare. Food allergists tended to focus instead on patients whose reactions were delayed, occurring up to 48 hours after eating the suspected food and, so, much more difficult to diagnose. These reactions were typified by symptoms such as eczema, diarrhoea, asthma, migraine and psychiatric problems, including depression and hyperactivity.</p>
<p>Many doctors, however, doubted the claims of food allergists that food allergy was responsible for much undiagnosed chronic illness. In fact, some were so unconvinced that they would refer patients complaining of chronic food allergy to psychiatrists, believing that their symptoms were <a href="https://www.psychologytoday.com/gb/blog/happiness-in-world/201003/psychosomatic-symptoms">psychosomatic</a>. The heated debates that would emerge during the post-war period about the prevalence of food allergy distracted researchers from investigating the root causes of the condition.</p>
<h2>Enter the peanut</h2>
<p>In the early 1980s, food allergy became a marginalised topic within medicine. Then, a new phenomenon emerged that forced doctors to take it seriously: <a href="https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/36-types-of-food-allergy?gclid=EAIaIQobChMIq-SThsiG3wIVlOJ3Ch1TQQEsEAAYASAAEgI-sfD_BwE#download_access">peanut allergy</a>. In 1988, an article in the Canadian Medical Association Journal described the case of a 24-year-old woman who died after eating a biscuit that contained peanut oil. Although one or two similar stories had been reported previously in newspapers, this was the first report made in a medical journal. It would not be the last.</p>
<p>By the 1990s, peanut allergy fatalities were commonplace. According to US charity <a href="https://www.charities.org/charities/food-allergy-research-education-inc-fare">Food Allergy Research and Education</a> (FARE), rates of peanut and tree nut allergy <a href="https://www.foodallergy.org/life-with-food-allergies/food-allergy-101/facts-and-statistics">tripled</a> between 1997 and 2008 among American children. As a result, food allergy became associated with these severe, potentially fatal, allergies, rather than the chronic food allergies on which food allergists had previously concentrated.</p>
<p>FARE and other allergy charities successfully lobbied for better labelling, more peanut-free spaces (in schools for instance) and the availability of life-saving <a href="https://obamawhitehouse.archives.gov/blog/2013/11/13/president-obama-signs-new-epipen-law-protect-children-asthma-and-severe-allergies-an">epipens</a> which administer a dose of epinephrine (a chemical that narrows blood vessels and opens airways in the lungs) to anyone suffering an anaphylactic reaction.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249003/original/file-20181205-186085-fj8fl3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249003/original/file-20181205-186085-fj8fl3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249003/original/file-20181205-186085-fj8fl3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249003/original/file-20181205-186085-fj8fl3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249003/original/file-20181205-186085-fj8fl3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249003/original/file-20181205-186085-fj8fl3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249003/original/file-20181205-186085-fj8fl3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The increasing use of soy, which is related to the peanut, is said to contribute to allergy problems.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tractor-spraying-soybean-crops-pesticides-herbicides-289460621">Shutterstock</a></span>
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<p>But they failed to convince scientists to conduct detailed investigations into why such allergies were increasing so rapidly. On the one hand, this reluctance was understandable. There was a pressing need to provide new treatments and support to the increasing number of people suffering from severe food allergies. On the other, scientists were hesitant to investigate a condition that had long been considered a <a href="https://www.bmj.com/content/337/bmj.a2880">fad</a> – a suspicious and divisive diagnosis that was too reliant on patient accounts for its justification.</p>
<p>While research continues to explore <a href="https://www.nhs.uk/news/medical-practice/peanut-allergy-therapy-shows-promise/">potential cures</a> and treatments, not enough effort has been spent on exploring root causes. Into the vacuum has emerged a number of controversial explanations, many of which have not been based on much scientific research.</p>
<h2>Possible explanations</h2>
<p>One suggestion is the <a href="http://www.bbc.com/future/story/20151118-can-you-be-too-clean">hygiene hypothesis</a>, which argues that children grow up in excessively clean environments, meaning that their bodies struggle to distinguish between harmful pathogens and harmless proteins, such as those found in peanuts. <a href="https://www.ncbi.nlm.nih.gov/pubmed/11398088">Others point to cooking techniques</a>, indicating that peanut allergy is more common in countries where peanuts are roasted, rather than boiled.</p>
<hr>
<p><em><strong>Read more: <a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">What are allergies and why are we getting more of them?</a></strong></em> </p>
<hr>
<p><a href="https://www.nhs.uk/news/pregnancy-and-child/some-babies-should-be-given-peanuts-early-say-new-us-guidelines/">Infant feeding is also implicated</a>, the most recent advice being that mothers with a family history of allergy should introduce peanuts early on. <a href="https://www.ncbi.nlm.nih.gov/pubmed/12637607">Increased use of soya</a> (a relative of the peanut) in food production has also been suggested. But none of these explanations have proved completely convincing, leading to the emergence of <a href="https://www.skyhorsepublishing.com/9781510726314/the-peanut-allergy-epidemic-third-edition/">even more controversial</a> hypotheses.</p>
<p>The truth is that we simply don’t yet know what is triggering the peanut allergy epidemic or increasing rates of food allergy. A chief reason for this is a lack of open-minded research into the causes of allergy. The explanations that emerge from such research might not be easy for people to accept if they indicate that food allergy is a byproduct of modern lifestyles, new diets or changes in how people interact with their environment. Investigating the causes of food allergy will not be easy, but if medicine is to prevent more tragedies such as the teenager Ednan-Laperouse, it will be essential.</p><img src="https://counter.theconversation.com/content/108124/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Smith received funding from the Wellcome Trust for this project. </span></em></p>A worrying lack of open-minded research means we do not know exactly why food allergy is on the rise.Matthew Smith, Professor in Health History, University of Strathclyde Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1048812018-10-16T15:06:20Z2018-10-16T15:06:20ZCurious Kids: if you have lots of the thing you’re allergic to, does your body get used to it?<figure><img src="https://images.theconversation.com/files/240814/original/file-20181016-165918-1fshi24.jpg?ixlib=rb-1.1.0&rect=95%2C27%2C4432%2C2966&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-asian-boy-has-allergies-flower-397846021?src=1EuFgJwIEmV76yzFhQ55Bg-1-8">Shutterstock.</a></span></figcaption></figure><p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children of all ages. The Conversation is asking young people to send in questions they’d like an expert to answer. All questions are welcome: find out how to enter at the bottom.</em> </p>
<hr>
<blockquote>
<p><strong>If you have lots of the thing you’re allergic to, does your body eventually get used to it? – Karen and Dawn, age 14 and nine, Manchester, UK</strong></p>
</blockquote>
<p>Thanks for your brilliant question, Karen and Dawn! As usual with science, there is not a simple answer. But the first thing to say is that if you know you are allergic to something, you must not purposefully go near it or eat it to try and make your allergy better. It won’t work and might make you very unwell. </p>
<p>Some people are allergic to things in the air, such as pollen, dust and animal hair. Other people are allergic to certain foods, or things that we touch. </p>
<p>When you are allergic to something, your body mistakenly thinks that the thing you are allergic to is going to cause you harm. </p>
<p>This triggers your immune system (which normally fights infections) to start fighting whatever you’re allergic to. Then you get symptoms, which are the signs that something is wrong in your body. </p>
<p><a href="https://www.nhs.uk/conditions/allergies/symptoms/">The symptoms</a> could be anything from an itchy nose and sneezing to breathing problems or a skin rash. In the case of serious allergies, people may get a swollen tongue or throat, which can be very dangerous. </p>
<p>There are some very serious allergies that you must always be very careful with, because they can lead to a very serious medical problem called anaphylaxis. </p>
<p>The most common foods that cause anaphylaxis are nuts and eggs. People who have these allergies must carry a special injection with them all the time, in case they accidentally eat these things, and they always need to be extra careful around food. </p>
<p>Some less serious allergies, such as hay fever, might get better if you were stuck on an island for a long period of time with no medication. This is because our bodies can get used to the pollen that causes this allergy. </p>
<p>There are <a href="https://www.nhs.uk/conditions/allergies/treatment/">medical ways</a> of testing this, which experts call “desensitisation therapy” or “immunotherapy”. This means that you are given a certain amount of the thing you are allergic to every day, until you become less sensitive to it. This should always be done with the help of a doctor, and it doesn’t work for all allergies. </p>
<p>There are some things that you might be intolerant to, but not allergic to. This means that when you eat it, you might get some tummy trouble, but it would not cause you any serious harm.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/240816/original/file-20181016-165909-1je462h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/240816/original/file-20181016-165909-1je462h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240816/original/file-20181016-165909-1je462h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240816/original/file-20181016-165909-1je462h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240816/original/file-20181016-165909-1je462h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240816/original/file-20181016-165909-1je462h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240816/original/file-20181016-165909-1je462h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Milk can give some people a sore tummy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-little-girl-drinking-milk-countryside-674878165?src=rSXm8E-p4NcNjfGpNy3D3g-1-4">Shutterstock.</a></span>
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<p>Milk is a really good example of this. There is a type of sugar in milk called lactose. To digest lactose, humans need a special chemical called an enzyme, which is made in our intestines. </p>
<p>When we are babies, we all produce lots of this enzyme because we only have milk. Some people stop making the enzyme altogether when they are adults and some people might just make a bit less of it. And some people will produce more or less of it depending on how much milk they drink. </p>
<p>That means that sometimes, if you haven’t had much milk for a while, then you have a lot, you might have a sore tummy. But you might also find that the more milk you have, the more of the enzyme your gut produces and the more milk you can enjoy without a tummy ache. </p>
<p>Only milk from animals (including humans) has the sugar lactose in it, anything that is made from plants like coconut milk, soya milk and almond milk does not contain any lactose. </p>
<p>But whether you’ve got an allergy or an intolerance, it’s very important to always follow your doctor’s instructions.</p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. You can:</em></p>
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<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age and which town or city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question, but we will do our best.</em></p>
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<p><em>More <a href="https://theconversation.com/topics/curious-kids-36782?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=CuriousKidsUK">Curious Kids</a> articles, written by academic experts:</em></p>
<ul>
<li><p><em><a href="https://theconversation.com/curious-kids-why-do-hens-still-lay-eggs-when-they-dont-have-a-mate-104077?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=CuriousKidsUK">Why do hens still lay eggs when they don’t have a mate? – Finley, age ten; Evie, age eight; and Jonah, age five, Cambridgeshire, UK</a></em></p></li>
<li><p><em><a href="https://theconversation.com/curious-kids-whats-the-history-of-aircraft-squawk-codes-and-how-do-they-work-103102?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=CuriousKidsUK">What’s the history of aircraft squawk codes and how do they work? – Daniel, age 12, Perth, Australia</a></em></p></li>
<li><p><em><a href="https://theconversation.com/curious-kids-how-can-chickens-run-around-after-their-heads-have-been-chopped-off-103701?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=CuriousKidsUK">How can chickens run around after their heads have been chopped off? – Gaelle, age four, Bristol, UK</a></em></p></li>
</ul><img src="https://counter.theconversation.com/content/104881/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie Medlin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Don’t try this at home, kids.Sophie Medlin, Lecturer in Nutrition and Dietetics, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/976502018-06-12T10:37:17Z2018-06-12T10:37:17ZStress is bad for your body, but how? Studying piglets may shed light<figure><img src="https://images.theconversation.com/files/222639/original/file-20180611-191965-1g834yf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pigs and humans have a lot in common, particularly their digestive tracts. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/small-piglet-sleep-farm-group-pig-639942640?src=KuRK9LIlIySn2C9uAFfCjA-1-7">Krumanop/Shutterstock.com</a></span></figcaption></figure><p><a href="https://www.medicalnewstoday.com/articles/145855.php">Stress</a> affects most of us to one degree or another, and that even includes animals. My lab studies early-life stress in pigs and how it impacts their health later in life, specifically in the gastrointestinal (GI) tract. Pigs, whose GI tracts are extremely similar to those of humans, may be one of the clearest windows we have into researching stress, disease, and new therapies and preventatives – both in livestock and people.</p>
<p>In my study of how stress makes humans and pigs vulnerable to disease, I have seen the profound impact that stress-related chemical substances, such as hormones and <a href="https://www.britannica.com/story/what-is-the-difference-between-a-peptide-and-a-protein">peptides</a>, can have on a body’s tissues. I’m hopeful that our research in piglets could eventually lead to treatments for both people and animals designed to mitigate the adverse effects of stress on the GI health. </p>
<h2>How stress can save your life</h2>
<p>Not all stress is bad. When we perceive a threat, our hypothalamus – one of our most basic parts of the brain – kicks in to protect us by triggering what many recognize as the <a href="https://www-ncbi-nlm-nih-gov.proxy2.cl.msu.edu/pubmed/19488073">“fight or flight”</a> response. It is a primal evolutionary response programmed in our brains to help us first survive and then restore us to a normal set point, or what feels like stability.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/222633/original/file-20180611-191947-80dbur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222633/original/file-20180611-191947-80dbur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222633/original/file-20180611-191947-80dbur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222633/original/file-20180611-191947-80dbur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222633/original/file-20180611-191947-80dbur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222633/original/file-20180611-191947-80dbur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222633/original/file-20180611-191947-80dbur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The stress response is essential to helping escape a dangerous situation, such as an attacking dog.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thief-running-away-dog-118767052?src=P9qrPEPnPnh0--VL52_4Pg-1-3">Dmitri Ma/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>What actually is happening has to do with something called the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860380/">hypothalamic-pituitary-adrenal (HPA) axis</a>, which is at the core of the stress response. During stress, the <a href="https://www.britannica.com/science/hypothalamus">hypothalamus</a>, a region in the brain, makes and sends out a chemical called <a href="https://www.ncbi.nlm.nih.gov/pubmed/19811447">corticotrophin-releasing factor</a>, which signals for the pituitary gland to release another chemical, <a href="http://www.yourhormones.info/hormones/adrenocorticotropic-hormone/">adrenocorticotrophic hormone</a>. </p>
<p>This stimulates the adrenal gland to release <a href="https://dictionary.cambridge.org/us/dictionary/english/adrenalin">adrenalin</a> and <a href="http://www.yourhormones.info/hormones/cortisol/">cortisol</a>. Adrenalin and cortisol, two of the most well-known stress hormones, power our bodies to react during the fight or flight response. They can heighten our response time in a fight. They can pump blood to our extremities when we flee. They can boost our immune system to protect against pathogens. That stress response gives us what we need to resolve the situation.</p>
<h2>How stress can harm your life</h2>
<p>Fortunately for many of us, we don’t have to deal with life-threatening situations on a regular basis. However, we still experience stress. This stress can be chronic, due to a specific situation or overall lifestyle. </p>
<p>But, our stress response is meant for short-term resolvable conflict. So, in a way, the stress response is misplaced in today’s world of enduring stressors. Danger comes when we experience repeated elevations of these stress hormones, or when we are exposed to too much of these stress hormones at a young age. Instead of physical threats, many of us experience psychosocial stress, which triggers a similar stress response but is often not resolvable. </p>
<p>For example, stress in the workplace, such as feeling overworked or undervalued, could be perceived as a threat and in turn activate the stress response. However, in these situations, the survival aspects of the stress response, such as increased heart rate and immune activation, is not effective in resolving this threat. </p>
<p>This results in continued production and higher levels of these stress chemicals in the body. They bind to <a href="https://www.hormone.org/hormones-and-health/hormones/cortisol">target receptors</a> in many organs, which can have profound effects on physiology and function. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/222634/original/file-20180611-191965-ekbrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222634/original/file-20180611-191965-ekbrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222634/original/file-20180611-191965-ekbrpl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222634/original/file-20180611-191965-ekbrpl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222634/original/file-20180611-191965-ekbrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222634/original/file-20180611-191965-ekbrpl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222634/original/file-20180611-191965-ekbrpl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Stress is particularly damaging to the developing brain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adorable-baby-girl-sitting-on-play-543251734?src=1LFWrpjyagGeFUivQGNiUg-1-43">Mcimage/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>High levels of stress are also especially harmful when they occur at a young age, when many of the body’s important stress regulatory systems – for example, the brain and nervous systems – are still developing. Exposure to stress in early life can alter the normal development and physiology of many organ systems, resulting in increased sensitivity to stress and lifelong health risks in offspring. </p>
<p>Also, a mother’s stress during pregnancy can be “transmitted” to the fetus, resulting in permanent changes to the stress response system and health in offspring. </p>
<p>This early-life stress can fuel a constant stress response inside the body. This can include inflammation, or increased activity of the immune system, or immune suppression as its new “normal.” </p>
<p>Inflammation and immune suppression are unpredictable and can manifest in many parts of our body, with different consequences. For example, stress and inflammation near blood vessels can cause blood vessels to constrict. This causes <a href="https://www.ncbi.nlm.nih.gov/pubmed/28415916">elevated blood pressure</a>, which can lead to a slew of other conditions like coronary artery disease and heart attack. </p>
<p>Immune suppression can reduce the body’s ability to heal wounds and make it more susceptible to other pathogens. Inflammation and immune suppression can affect anything, including our mental health. Chronic stress can traffic immune cells into the brain, where they can cause <a href="https://www.ncbi.nlm.nih.gov/pubmed/26404713">neuroinflammation</a>, which can affect our mood and fuel diseases like depression and anxiety.</p>
<h2>Your GI tract and you</h2>
<p>The GI tract is our largest interface with the outside world. If you think about it, your GI system is “outside” your body; it experiences many of the pathogens and other foreign entities with which we come into contact. If you unfolded your entire GI system, it would cover a tennis court. The GI system also contains just as many neurons as your spinal cord and houses the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515351/">largest collection of immune cells</a> in the body. A system of that size is as powerful as it is susceptible.</p>
<p>Chronic stress that affects your GI tract can manifest as abdominal pain, diarrhea or constipation and can lead to common diseases such as <a href="https://www.webmd.com/ibs/guide/stress-anxiety-ibs#1">irritable bowel syndrome</a> or <a href="https://www.medscape.com/viewarticle/715811">inflammatory bowel disease</a>. </p>
<p>Early-life stress is especially concerning; scientists only now are beginning to understand the long-term consequences. My research demonstrates the impacts of early-life stress on animal health and productivity, as well as human health. In pigs, this stress can result from early weaning and other management practices. In humans, it could be from physical or emotional trauma like abuse or neglect. </p>
<h2>What we can learn from piglets</h2>
<p>Pigs and humans have similar digestive tracts, making pigs an excellent model for human GI disease. My research team has demonstrated early stress in piglets results in GI symptoms (e.g. diarrhea, GI infections) that are remarkably similar to stress-related GI disorders in people: Irritable bowel syndrome, inflammatory bowel disease and food allergies are examples.</p>
<p>Through my lab’s research of piglets and early-life stress, we have been able to significantly lower the stress and GI disease that they experience through their life by eliminating individual early-life stressors. </p>
<p>Much of their stress is caused through early weaning, social change due to maternal separation and mixing with unfamiliar pigs. These pigs then experience a higher rate of gastrointestinal and respiratory diseases, as well as <a href="https://www-ncbi-nlm-nih-gov.proxy2.cl.msu.edu/pubmed/29767141">reduced growth performance</a> and feed efficiency into adulthood.</p>
<p>We also learned that a particular type of immune cell, called the mast cell, becomes highly activated during stress, which in turn causes much of the <a href="https://www.nbcnews.com/think/opinion/too-much-stress-can-make-you-physically-ill-researchers-now-ncna839371">stress-associated GI disease</a>. By focusing on animal welfare and implementing new management practices to eliminate individual stressors or intervene therapeutically with mast cell blockers, we can lower the overall threshold of stress that the piglets experience. </p>
<p>This basic research could result in future breakthroughs regarding how we combat stress in humans. Maybe with more fundamental research in animal models, we can develop a therapy to help lessen the impact of bad stress on our bodies.</p>
<p>In the meantime, those of us experiencing stress can take action. If you experience a lot of stress on a daily basis, focus on what you can and cannot control, and then apply your energy to the things within your control while taking care of your body by eating properly, getting enough sleep, and maintaining some level of physical activity. Then, learn to cope with the things you cannot control through therapy, meditation and other stress management practices.</p><img src="https://counter.theconversation.com/content/97650/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Moeser receives funding from The National Institutes of Health and United State Department of Agriculture. </span></em></p>Stress makes people tired and irritable, but its dangers to the body do not stop there. Chemicals that were meant to work under an immediate threat harm organs in the body and can elevate blood pressure.Adam Moeser, Matilda R. Wilson Endowed Chair, Associate Professor of Large Animal Clinical Sciences, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/932252018-03-14T22:51:35Z2018-03-14T22:51:35ZYoung Canadians lead the charge to a meatless Canada<figure><img src="https://images.theconversation.com/files/210375/original/file-20180314-113472-lx6s1x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Younger Canadians are going meatless, but Canada still has a love affair with meat, according to a Dalhousie University study. This 2015 photo shows rib eye steak with gochujang butter and nori.</span> <span class="attribution"><span class="source">(AP Photo/Matthew Mead)</span></span></figcaption></figure><p><a href="http://www.agr.gc.ca/eng/industry-markets-and-trade/market-information-by-sector/red-meat-and-livestock/red-meat-and-livestock-market-information/protein-disappearance-and-demand-by-species/?id=1415860000022">Canadians love meat.</a> Many of us have been dedicated to our favourite protein source for years. But other sources of protein are emerging as potent alternatives to animal protein. </p>
<p>Demand is up for vegetable proteins like pulses, as well as <a href="http://www.agr.gc.ca/eng/industry-markets-and-trade/value-chain-roundtables/seafood/?id=1385755866700">for fish and seafood.</a> </p>
<p>Loblaw has even <a href="https://www.thestar.com/business/2018/03/06/loblaw-adds-cricket-powder-to-presidents-choice-line.html">started selling cricket flour</a>, apparently trying to take insect consumption mainstream. </p>
<p>As a result, some believe vegetarianism and veganism may be on the rise in Canada. Not so much, it seems. </p>
<p>According to <a href="https://barrie.ctvnews.ca/most-canadian-vegans-and-vegetarians-are-under-35-poll-1.3841396">our recent poll at Dalhousie University,</a> it appears that the number of vegetarians and vegans have remained the same over the last decade or so, but the number of Canadians who follow specific dietary practices is clearly on the rise over the last few years. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/209928/original/file-20180312-30961-q76mdx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209928/original/file-20180312-30961-q76mdx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209928/original/file-20180312-30961-q76mdx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209928/original/file-20180312-30961-q76mdx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209928/original/file-20180312-30961-q76mdx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209928/original/file-20180312-30961-q76mdx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209928/original/file-20180312-30961-q76mdx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>Results suggest that 7.1 per cent of Canadians consider themselves vegetarians, and 2.3 per cent vegans. <a href="http://www.vancouverhumanesociety.bc.ca/almost-12-million-canadians-now-vegetarian-or-trying-to-eat-less-meat/">These numbers are fairly consistent</a> with <a href="https://www.statista.com/topics/3262/vegan-vegetarian-diets-in-canada/">several other polls</a> conducted over the last decade or so.</p>
<p>Vegetarians maintain a meat-free diet, while vegans also abstain from any animal or animal-derived products, including dairy, eggs and even honey. We should note that there are several variations of vegetarianism and veganism.
But even if these percentages are not shockingly high, there is some indication that things may get more complicated in the future.</p>
<p>Results show that 32 per cent of Canadians do observe some sort of committed dietary regime. This number is one of the highest we’ve seen in recent years.</p>
<h2>More women than men eschewing meat</h2>
<p>Women are 1.6 times more likely to consider themselves vegetarian or vegan than men. </p>
<p>Level of education also seems to be a significant determinant. People with a university degree are three times more likely to consider themselves vegetarians or vegans than those with a high school diploma. </p>
<p>Consumers living in British Columbia are three times more likely to identify as vegetarians or vegans than consumers living in the Prairies or the Atlantic Region. </p>
<p>Wealthier people also seem to commit more to specific diets. Consumers who earn more than $150,000 per year are twice as likely to consider themselves vegetarians or vegans than consumers earning less than $80,000.</p>
<p>Nothing very surprising here, but younger people are really making things interesting. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/210394/original/file-20180314-113469-kofaz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/210394/original/file-20180314-113469-kofaz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=816&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210394/original/file-20180314-113469-kofaz0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=816&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210394/original/file-20180314-113469-kofaz0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=816&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210394/original/file-20180314-113469-kofaz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1026&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210394/original/file-20180314-113469-kofaz0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1026&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210394/original/file-20180314-113469-kofaz0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1026&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People under 35 are three times more likely than older Canadians to be vegetarian or vegan, suggesting a big change in Canada’s dietary habits is on the horizon.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Those under 35 are three times more likely to consider themselves vegetarians or vegans than those 49 or older. That’s a significant number.</p>
<h2>A rise in food allergies</h2>
<p>Experts argue that the rise of speciality diets is due to consumers associating vegetarianism and veganism not just with animal welfare, as they did in the past, but also with healthier and cleaner products. </p>
<p>Others are simply rejecting the model of industrialized agriculture altogether. And health appears increasingly to be a factor.</p>
<p>In fact, the poll suggests that more than 12 per cent of Canadians are diabetic. Consumers aged 49 and up are twice as likely to adopt a diabetic diet over time than those under the age of 35, and many diabetics choose meat as a lean protein in their carbohydrate-reduced diets. As our population gets older, it is difficult to see how that number could drop anytime soon.</p>
<p>Questions concerning food allergies also garnered interesting results.</p>
<p>Almost 12 per cent of Canadians mentioned having allergies, and more than 20 per cent of households with more than two children said they had to constantly be on the lookout for allergens. These are alarming results. </p>
<p>For many years now, allergens have been a nightmare for food companies and the Canadian Food Inspection Agency alike. So far, in 2018, of the <a href="http://www.inspection.gc.ca/about-the-cfia/newsroom/food-recall-warnings/complete-listing/eng/1351519587174/1351519588221?ay=2018&fr=0&fc=0&fd=15&ft=2">25 food recalls</a> issued by federal regulators, almost a third were due to the presence of ingredients undeclared on the label.</p>
<p>Oddly though, consumers in the Prairies are twice as likely to suffer from food allergies than those in Quebec. </p>
<h2>Religion can drive food choices</h2>
<p>Religious beliefs are also enticing Canadians to choose specialty products like halal or kosher foods, but results show these categories remain somewhat marginal. </p>
<p>A total 2.3 per cent of Canadians mentioned eating halal foods regularly while less than one per cent choose kosher products. Supply remains an issue across the country, as halal and kosher foods are not always readily available. But with <a href="http://www.cbc.ca/news/politics/immigration-canada-2018-1.4371146">Canada’s immigration ambitions</a>, this could change.</p>
<p>Obviously, this is just one survey that polled only 1,049 Canadians. As with any survey, results must be taken with a grain of salt, no pun intended. </p>
<p>Still, these results point to a much more heterogeneous food demand than we have seen in recent years. </p>
<p>No wonder Air Canada now offers several <a href="https://www.aircanada.com/ca/en/aco/home/plan/special-assistance/special-meals.html">different special meal options</a> for its international flights. Catering companies and restaurants also know very well that serving patrons is an art that is slowly becoming more about customizing servings than delivering a standardized meal.</p>
<p>So if you’re one of those who have no specific dietary needs of any sort, you are still in the majority. But with a younger generation seeking more dietary nuances, expect to see major changes in food offerings over the next decade or so.</p><img src="https://counter.theconversation.com/content/93225/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sylvain Charlebois does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Canadians still love their meat, but consumers under 35 are three times more likely to consider themselves vegetarians or vegans than consumers who are 49 or older.Sylvain Charlebois, Professor in Food Distribution and Policy, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/903892018-01-23T19:10:17Z2018-01-23T19:10:17ZPackaged products may contain more than the label states, including allergens<figure><img src="https://images.theconversation.com/files/202759/original/file-20180122-110084-1tousfb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'May contain traces of nuts' labels aren't always present in foods that could be cross contaminated.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Our new study has found packaged foods can contain allergens even when there is no listed ingredient or even warning on the label (such as “may contain traces of nuts”). </p>
<p>Paediatricians, allergy/immunology specialists, nurses and dietitians from the Australasian Society of Clinical Immunology and Allergy <a href="http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-1754">reported</a> there were 14 cases of anaphylaxis (severe allergic reaction causing skin rash, vomiting, difficulty breathing or even death) to packaged foods over a nine-month period. Of those reactions, 50% were reported from foods that didn’t have a warning statement. </p>
<p>The reports of anaphylactic episodes to products both with and without a warning is of concern, as it suggests there is no reliable labelling system that can inform people with allergies if their food choice is a safe one.</p>
<hr>
<p><em><strong>Read more: <a href="https://theconversation.com/can-i-prevent-food-allergies-in-my-kids-88873">Can I prevent food allergies in my kids?</a></strong></em></p>
<hr>
<h2>Modern manufacturing processes</h2>
<p>Modern manufacturing processes often share facilities and equipment for the processing of different foods, meaning there’s a risk of cross-contamination.</p>
<p>At the point of consumption, food products may have become cross-contaminated with residues of allergens due to shared farming practices, harvesting equipment, storage facilities, transportation vehicles, processing facilities and processing equipment.</p>
<p>This cross-contamination can leave an allergic patient vulnerable to any of the symptoms that can occur in a patient exposed to hidden allergens, ranging from hives to life-threatening anaphylaxis. </p>
<p>Consumers with food allergy are often advised to avoid products with precautionary statements, even though the exact risks are unknown.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/202761/original/file-20180122-110103-y6ccep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/202761/original/file-20180122-110103-y6ccep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/202761/original/file-20180122-110103-y6ccep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/202761/original/file-20180122-110103-y6ccep.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/202761/original/file-20180122-110103-y6ccep.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/202761/original/file-20180122-110103-y6ccep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/202761/original/file-20180122-110103-y6ccep.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/202761/original/file-20180122-110103-y6ccep.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Allergens can contaminate other foods where manufacturing processes are shared, but it’s not always on the label.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<hr>
<p><em><strong>Read more: <a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">What are allergies and why are we getting more of them?</a></strong></em></p>
<hr>
<h2>Advice to parents</h2>
<p>A more scientific approach to cross-contamination of foods has been developed in Australia, where manufacturers undergo a more intensive investigation into the possible presence of allergens in foods prior to their release to consumers. </p>
<p>Foods, and the environments they’re manufactured in, are tested for possible sources of allergen such as egg and peanut. If the level of cross-contamination is equal to or above a certain level that’s considered unsafe, a statement of “may be present” is used. If it’s below this level, no precautionary labelling is required.</p>
<p>Some international manufacturers have now implemented the use of this risk assessment tool. But a major limitation of this process is there’s nothing on the package to say these tests have been done. </p>
<hr>
<p><em><strong>Read more: <a href="https://theconversation.com/introduce-eggs-and-peanuts-early-in-infants-diets-to-reduce-the-risk-of-allergies-65564">Introduce eggs and peanuts early in infants’ diets to reduce the risk of allergies</a></strong></em></p>
<hr>
<p>This means allergic people have no way of telling which packaged foods are truly safe to eat.</p>
<p>Our results add significant concern to this dilemma. Those foods without a label may be safe because they have been risk assessed or they may be very unsafe because they have not been risk assessed at all.</p>
<p>Governments and regulatory bodies need to intervene to help resolve this dilemma. Food allergic consumers deserve to feel safe about eating packaged foods and they need to have clear guidelines. Manufacturers should clearly state not just which foods should be avoided, but which have been tested and which are safe to eat.</p><img src="https://counter.theconversation.com/content/90389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Allen receives funding from the National Health and Medical Research Council.
I am a Liberal Candidate for Prahran but believe this is unrelated to this article. I have recently completed the University of Melbourne School of Government Pathways to Politics Program for women.</span></em></p>A new study has found some foods may contain allergens even if there’s no warning.Katie Allen, Paediatric Allergist and Gastroenterologist, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/888732018-01-09T19:36:04Z2018-01-09T19:36:04ZCan I prevent food allergies in my kids?<figure><img src="https://images.theconversation.com/files/199171/original/file-20171214-27555-jq68k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's still a lot we don't know about why more children have food allergies today. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>With the rise in food allergies over the last ten to 20 years, parents are understandably concerned about what – if anything – can be done to reduce the chances of their child developing a food allergy. Expectant mums often ask whether there’s anything they should eat, or avoid eating, to reduce the risk of food allergy in their child. </p>
<p>In the past, some guidelines recommended mums avoid eating “allergenic” foods (foods that commonly cause reactions in individuals with food allergy) during pregnancy and breastfeeding. This advice has now been removed because it hasn’t prevented food allergies in the child. So what do we know (and not know) about the link between foods eaten during pregnancy and food allergies in children?</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-do-we-get-allergic-to-food-82503">Curious Kids: How do we get allergic to food?</a>
</strong>
</em>
</p>
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<h2>What is a food allergy?</h2>
<p>There are many different types of reactions to foods. Those involving the immune system are classified as allergies. </p>
<p>The type of allergy most studied is called “IgE-mediated” food allergy (IgE refers to immunoglobulin - the antibodies produced by our immune system). In IgE-mediated food allergy, the immune system responds to a particular food or foods in the same way it would respond to something dangerous. It causes symptoms that we call an allergic reaction. Food allergy can occur to a wide range of foods, but common culprits are peanut, tree nuts, egg, milk, soy, wheat, fish and shellfish. </p>
<p>For people with this type of food allergy, reactions generally occur rapidly, sometimes within minutes of ingesting the food. Common symptoms include hives (raised wheals that resemble mosquito bites), vomiting, and swelling of the lips, eyes, or face. Less commonly, reactions can involve the airways or circulation, resulting in potentially life-threatening symptoms like difficulty breathing, wheezing or collapse.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/199173/original/file-20171214-27597-1qua1fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/199173/original/file-20171214-27597-1qua1fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/199173/original/file-20171214-27597-1qua1fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/199173/original/file-20171214-27597-1qua1fh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/199173/original/file-20171214-27597-1qua1fh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/199173/original/file-20171214-27597-1qua1fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/199173/original/file-20171214-27597-1qua1fh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/199173/original/file-20171214-27597-1qua1fh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Peanuts should be introduced before one year of age.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<p>In Australia, IgE-mediated food allergy now affects around <a href="http://www.jacionline.org/article/S0091-6749(11)00135-7/abstract">one in every ten babies</a>, and around <a href="http://www.jacionline.org/article/S0091-6749(17)31017-5/abstract">one in 20 older children</a>. It usually develops in infancy or early childhood, and can be lifelong. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/food-allergies-linked-to-overactive-immune-system-at-birth-53100">Food allergies linked to overactive immune system at birth</a>
</strong>
</em>
</p>
<hr>
<h2>Can we prevent children from developing food allergy?</h2>
<p>The normal response to eating a food is “tolerance”. In other words, the immune system sees the food as harmless and does not mount a response. Interventions to prevent food allergy aim to promote the development of tolerance.</p>
<p>Ten years ago, no one knew how this could be achieved. Since then, there have been major advances. Perhaps the most important is the recent discovery by researchers in the UK that peanut allergy can be prevented in some children who are at high risk of developing it. </p>
<p>In a <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#t=article">study</a> in which 600 children with eczema or egg allergy were randomly assigned to either eat or avoid peanut, those who started eating peanut earlier (before they were one year old) were less likely to have peanut allergy at age five than those who avoided peanut. Studies have also shown eating egg earlier may protect against egg allergy, although this protective effect does not appear to be as strong as for peanuts. </p>
<p>As a result of this study, <a href="https://theconversation.com/introduce-eggs-and-peanuts-early-in-infants-diets-to-reduce-the-risk-of-allergies-65564">parents are now advised</a> to introduce foods like peanut and egg to infants before one year of age.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/introduce-eggs-and-peanuts-early-in-infants-diets-to-reduce-the-risk-of-allergies-65564">Introduce eggs and peanuts early in infants' diets to reduce the risk of allergies</a>
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<p>Although this is an important advance in knowledge, the research also showed this isn’t effective for everyone. Some children develop food allergy very early in life, too early to benefit from being given foods like peanut before one year. </p>
<p>It’s also clear infant diet isn’t the only factor that determines whether a child develops a food allergy, since most children do not develop food allergy regardless of the age when foods like peanut and egg are first given. And some children develop food allergy even with an optimal diet. </p>
<h2>Maternal diet and food allergy</h2>
<p>Immune responses to foods like egg and peanut can be detected in some infants in the first few months of life, before these foods are introduced into the infant diet. This means food allergy prevention might need to start earlier than previously thought. </p>
<p>A <a href="https://cosmosmagazine.com/biology/peanut-antigens-in-breast-milk-may-protect-kids-from-allergy">recent study in mice</a> reported that milk from mothers exposed to egg protein protected offspring from developing allergic reactions to egg. This protection was strongest when the mothers were exposed to egg proteins during both pregnancy and breastfeeding. At the moment it’s not known whether this is also the case in people.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">What are allergies and why are we getting more of them?</a>
</strong>
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<p>The Australasian Society of Clinical Immunology and Allergy <a href="https://www.allergy.org.au/patients/allergy-prevention/ascia-guidelines-for-infant-feeding-and-allergy-prevention">does not recommend excluding</a> allergenic foods during pregnancy or breastfeeding.</p>
<p>We don’t know yet whether eating more of foods like peanuts or eggs in pregnancy can reduce the risk of the child developing a food allergy. But answers should be available soon. A <a href="https://www.nhmrc.gov.au/media/releases/2017/33-million-wa-researchers-promises-healthier-future">study led by researchers</a> at the University of Western Australia is about to look in detail at how the amount of egg and peanut eaten by mums relates to their child’s risk of having an egg or peanut allergy.</p>
<p>This is a large study which will take several years to complete, but hopefully we will be able to provide evidence-based advice for maternal diet, the same way we can for infant diet, very soon.</p><img src="https://counter.theconversation.com/content/88873/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Koplin receives funding from the National Health and Medical Research Council of Australia. </span></em></p>Parents are now advised to introduce foods like peanut and egg to infants before one year of age.Jennifer Koplin, Research Fellow, Population Health, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/825032017-09-27T00:02:26Z2017-09-27T00:02:26ZCurious Kids: How do we get allergic to food?<figure><img src="https://images.theconversation.com/files/182045/original/file-20170815-27094-goqd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Allergies may be in the genes that are passed down from parents to children.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/usdagov/15031804271/in/photolist-oUiVHa-bBmd4y-6KfTaw-Ge34DY-8q6knQ-Pu1et-6ufawu-bxDJtC-4LnJex-28eWU-fJAN8D-fJUhu7-ejyQxV-bPBF4v-HdPY1-mNsyWB-5ctXoY-9H636F-mNup2y-mNsWVM-q5EEgr-amro9L-mNsRcn-7Ja7F9-mNtscz-9y4R3F-mNv4uA-coXzoG-mNuiT7-djXwKq-mNtaoz-6aexb2-mNtDf4-mNv9mj-mCaTGZ-fBBTMn-syoW1-b9JCAV-9EGjzb-dTYLiQ-zCsUKb-8GwN7a-8rSDqt-S9cZSj-anuKGE-dSPKAt-oRYgSd-PNoBz-2cKmcb-BSnfS">Flickr/U.S. Department of Agriculture</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children. The Conversation is asking kids to send in questions they’d like an expert to answer. All questions are welcome – serious, weird or wacky!</em> </p>
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<blockquote>
<p><strong>How do we get allergic to food? – Younus, age 9, Perth</strong></p>
</blockquote>
<hr>
<p>That’s a really interesting question, and one that many scientists and doctors are also trying to understand better.</p>
<p>It all starts with the immune system. Every person has one - a group of cells, tissues and organs in the body that helps you fight infections.</p>
<p>It does this by fighting off bugs that might make you sick when they enter your body. This is very important both in keeping you well, as well as helping you recover when you do get sick with an infection.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-can-a-tiny-seed-actually-grow-into-a-huge-tree-77873">Curious Kids: how can a tiny seed actually grow into a huge tree?</a>
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<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/183670/original/file-20170829-14211-1s8sa4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183670/original/file-20170829-14211-1s8sa4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/183670/original/file-20170829-14211-1s8sa4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183670/original/file-20170829-14211-1s8sa4j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183670/original/file-20170829-14211-1s8sa4j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183670/original/file-20170829-14211-1s8sa4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183670/original/file-20170829-14211-1s8sa4j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183670/original/file-20170829-14211-1s8sa4j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your immune system helps fight off colds and flus.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/williambrawley/4195919691/in/photolist-7oMbJX-33i8HE-fbDEBz-5TvJ6s-6pypTD-5NHghz-2KKfrg-jJdFvE-GRd7i-9R4TFp-axMv2U-4ZiEHx-uc1vc-q6XfhV-eV25Hf-5ue7CY-7D337E-62rJCG-fcLSgd-82Yb5r-3fG1uY-8BHWhG-5aBP8X-5hC9nc-8wacSd-eU6QVF-8sbfoo-4ZnTP7-6yYciH-xe5A-4r4XJv-jXHrXR-anZgkL-8C1tgU-jwiam3-buK2aw-4UvVFM-5sGMXV-7NZDG3-rtFACo-4SgboA-9VRmbi-7CuRwu-Am1si-4b1M9R-5cTqVH-zbD4h-rcqsaW-7ZQd3o-55B3T5">Flickr/William Brawley</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Allergies happen when the immune system starts overreacting to other things which would not usually make you sick. These can include dust, pollens, pets, and as you mentioned, foods. </p>
<p>For example, in someone who is not allergic to cow’s milk, the immune system doesn’t react when they drink the milk. </p>
<p>But if you <em>are</em> allergic to cow’s milk, when you drink it your immune system overreacts and can cause you to have a rash, swelling or trouble breathing. </p>
<h2>Passing down allergies</h2>
<p>If there are people in your family with allergies, such as asthma, eczema, hay fever or food allergies, then you are more likely to have allergies too. </p>
<p>This means that allergies may be in the genes that are passed down from parents to children, just like there are genes that pass down the colour of your eyes and hair.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">What are allergies and why are we getting more of them?</a>
</strong>
</em>
</p>
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<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/183672/original/file-20170829-1572-1jn6lhw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183672/original/file-20170829-1572-1jn6lhw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/183672/original/file-20170829-1572-1jn6lhw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=606&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183672/original/file-20170829-1572-1jn6lhw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=606&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183672/original/file-20170829-1572-1jn6lhw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=606&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183672/original/file-20170829-1572-1jn6lhw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=762&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183672/original/file-20170829-1572-1jn6lhw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=762&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183672/original/file-20170829-1572-1jn6lhw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=762&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some foods commonly cause allergies, such as cow’s milk, egg, wheat, nuts and shellfish.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/v1ctor/19722659241/in/photolist-w3PMsZ-sGpyws-F3m9Ve-6KudRn-WgCp7G-2KKpHV-7Zz5ui-Sic5tP-UV3f2f-85Bpga-9YVW1y-gc2tQe-r5UoC-adePPh-nPBBYz-dqFKUM-UYza9Z-UovE7q-ULUQ9x-otqDMH-UJf4S5-8CzceE-9Ax1Rr-TK83qz-UJeZT3-obW2bT-d4J7o3-UovEoh-pTo6Dg-7Y17oE-q3APVB-bpdP2C-5SGJ9r-TK84qa-f39D6Q-4AVHip-o7JBbo-VutsA1-9Fnvvt-8j1sxi-6yBiqg-5SEG7m-5SNggT-5SJnWV-f7PJD-oXoKV4-bTLdkX-5SBpq8-dt4NHx-UJf3v7">Flickr/Victor</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Some foods commonly cause allergies, such as cow’s milk, egg, wheat, nuts and shellfish. </p>
<p>It may be that the age when you first try these foods can affect whether you go on to become allergic to that food, and a lot of research is happening to figure out if that is true. </p>
<p>Over the next few years, I think we will understand this question better, and hopefully be able to make food allergies less common. </p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. You can:</em></p>
<p><em>* Email your question to curiouskids@theconversation.edu.au
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* Tell us on <a href="https://twitter.com/ConversationEDU">Twitter</a> by tagging <a href="https://twitter.com/ConversationEDU">@ConversationEDU</a> with the hashtag #curiouskids, or
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* Tell us on <a href="http://www.facebook.com/conversationEDU">Facebook</a></em></p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age and which city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/82503/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucinda Berglund has previously received a government-funded NHMRC scholarship.
She is affiliated with the University of Sydney.</span></em></p>Younus, age 9, wants to know how people become allergic to food.Lucinda Berglund, Clinical Senior Lecturer University of Sydney, Immunologist and Immunopathologist Westmead Hospital and NSW Health Pathology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/584512016-05-04T09:51:52Z2016-05-04T09:51:52Z‘May contain nuts’ isn’t good enough: we need a new approach to food allergy testing<figure><img src="https://images.theconversation.com/files/121034/original/image-20160503-19874-v8nygz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some foods may be easy enough to avoid but when products have a long list of ingredients it starts being tricky.</span> <span class="attribution"><span class="source">Africa Studio/Shutterstock</span></span></figcaption></figure><p>Anybody suffering from a food allergy will know what a huge cause of anxiety it can be. From forensically examining information on food packaging to having to repeatedly ask restaurant staff detailed questions about their ingredients, it can take up a lot of time and energy. And, even then, there are still uncertainties to deal with. </p>
<p>Labels such as “may contain traces of” or “made in the same factory as” don’t actually quantify the risk to individuals. Less obvious risks than just the ingredients used directly in making a product – such as contamination during transport or storage – also pose a threat. In our recent study we therefore call for a whole new approach to allergen measurement that we hope could protect allergy sufferers by boosting the accuracy of allergen testing.</p>
<p>Food allergy is a rapidly growing problem in the developed world, affecting up to <a href="http://www.ncbi.nlm.nih.gov/pubmed/26022862">10% of children and 2-3% of adults</a>. Exactly why the problem is getting worse is <a href="https://www.allergyuk.org/why-is-allergy-increasing/why-is-allergy-increasing">subject to a lot of debate</a>, but it follows a similar rise observed in allergies in general. Common trigger foods include milk, eggs, shellfish, nuts, fish and even some citrus fruits. Reactions can range from a mild runny nose or sneezing attack to severe skin reactions, throat swelling, vomiting and diarrhoea. On rare occasions these reactions can result in <a href="http://www.anaphylaxis.org.uk/">anaphylaxis</a> and prove fatal. </p>
<p>The impact on quality of life for people living with food allergies can be significant and usually requires lifelong avoidance of certain foods. There are also burdens on healthcare, the food industry and regulators. </p>
<p>As well as the threat of contamination, fraud is also a major problem. Fraudsters will put cheaper, illicit substitutes in their ingredients and fail to declare these on the packaging. In these cases, detecting and documenting the presence of allergens proves difficult. Much of the tests are carried out using <a href="http://www.elisa-antibody.com/ELISA-applications/food-industry">enzyme-linked immunosorbent assays (ELISA)</a>, which uses antibodies and colour changes to identify allergens in products. However, other ingredients in the food that may themselves be safe can interfere with the results of the test, provoking false positive results.</p>
<p>Keeping equipment clean and keeping finished products segregated from contaminants are also crucial to avoid contaminants. But this often isn’t followed carefully enough and is the reason why producers often resort to the “may contain” labelling. This is far from ideal – every allergen that gets through the system undetected poses a significant risk to consumer health and the reputation of the food industry.</p>
<h2>The need for a gold standard</h2>
<p>The key to unlock this problem may be by identifying the lowest concentrations of an allergen that will produce an allergic response in a defined, small proportion of the allergic population. </p>
<p>A substantial amount of work is being done to determine safe thresholds for allergens, but without a standard way of measuring allergens accurately and reliably this work may well be in vain. This also needs support from better regulation to prevent foods being contaminated during transport and storage.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/120342/original/image-20160427-30990-rpiqkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/120342/original/image-20160427-30990-rpiqkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120342/original/image-20160427-30990-rpiqkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120342/original/image-20160427-30990-rpiqkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120342/original/image-20160427-30990-rpiqkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120342/original/image-20160427-30990-rpiqkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120342/original/image-20160427-30990-rpiqkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Ronnachai Palas/Shutterstock</span></span>
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<p>These represent major gaps in the system, and it is only by closing them that we can secure a food chain that is reliable, resistant to fraud and ultimately safe for consumers. My colleagues and I have <a href="http://pubs.rsc.org/en/content/articlelanding/2016/an/c5an01457c#!divAbstract">called on</a> the EU’s food safety body, <a href="http://ec.europa.eu/dgs/health_food-safety/index_en.htm">DG Santé</a>, to lead the way in addressing the deficiencies in the current system.</p>
<p>We outline a grand vision to address the challenges in allergen measurement and analysis and call for action in three main areas. One is to use computer models to predict what allergens are present in foods and what quantities of these allergens will adversely affect the health of an allergy sufferer. This would make labelling much easier to follow, with information such as “suitable for a sufferer” of a particular food allergy or “not suitable” rather than the current “may contain”.</p>
<p>Another is to develop reference methods which will provide a gold standard for the detection and measurement of allergens in food. Similarly, we also need to create reference materials which can support threshold decisions – samples of foods with known, controlled amounts of allergens present, to allow for checks on the accuracy of allergen testing methods.</p>
<p>Significant international effort and an interdisciplinary approach will be required to achieve these aims and protect allergy suffers. But the reality is, if we fail to manage the risks associated with food allergens through a lack of ability to measure them properly, we will have failed a significant societal challenge.</p><img src="https://counter.theconversation.com/content/58451/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Elliott does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Why it’s so difficult to detect allergens in food – and what to do about it.Chris Elliott, Professor of Molecular Biosciences, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/531002016-01-14T22:58:42Z2016-01-14T22:58:42ZFood allergies linked to overactive immune system at birth<figure><img src="https://images.theconversation.com/files/108116/original/image-20160114-2343-2jg19e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Babies more likely to have allergies later were born with hyperactive immunity.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/stevendepolo/3013714061/">Steven Depolo/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><a href="http://www.ncbi.nlm.nih.gov/pubmed/21377036">One in every ten babies</a> in Melbourne develops a food allergy during their first year of life. <a href="http://stm.sciencemag.org/content/8/321/321ra8">New research</a> has found children who are born with overly active immune cells are more likely to develop allergies to milk, eggs, peanuts, wheat and other common foods. This finding could lead to future treatments for babies to prevent childhood food allergies.</p>
<p>We discovered changes in immune cells at birth that were associated with an increased risk of babies developing food allergies in the first year of age. In essence, these babies have immune systems that are “primed” for allergic disease by the time they are born.</p>
<h2>Immune snapshot</h2>
<p>The research was based on umbilical cord blood samples from the <a href="barwoninfantstudy.org.au">Barwon Infants Study</a>, which followed mothers during pregnancy and their infants from birth to look at the environmental and genetic factors that influence immunity and allergy.</p>
<p>The blood from the umbilical cord showed us a snapshot of the baby’s immune system at the time of birth. In babies who developed food allergies we found immune cells called monocytes were more activated. This must have occurred either before or during birth.</p>
<p>Monocytes are less specialised cells of the immune system; let’s call them the “foot-soldiers” at the front line of defence against infections. As part of the study, we showed the hyperactive monocytes changed the “landscape” of the immune response by more specialised immune cells called T cells, driving the T cells to adopt characteristics we know are responsible for allergic reactions. </p>
<p>In babies in our study, these immune cell changes were associated with development of allergy to foods such as milk and egg, and later peanuts, wheat and other foods.</p>
<h2>Allergy and immune disease increasing</h2>
<p>In Australia, there has been a <a href="http://www.ncbi.nlm.nih.gov/pubmed/19117599">three-fold increase</a> in hospital presentations due to food allergy over the last two decades and most of this increase has been among children under five years of age. Immune-related diseases more generally have also increased, including other allergies such as eczema and asthma, and type 1 diabetes, multiple sclerosis and inflammatory bowel disease.</p>
<p>Abnormal immune development during early life is likely to be relevant to each of these conditions. Food allergy is an ideal candidate to study as it is common, has an early onset and can be clearly defined.</p>
<p>The next step is to identify <em>why</em> these babies have hyperactive immune cells at birth. Are the immune cells activated because of the baby’s genes or are they activated at the time of birth or earlier in pregnancy, and how? While underlying genetic susceptibility to allergy may be a factor, the rising incidence of food allergy points to the environment as the major culprit.</p>
<p>We didn’t find any relationship to the mode of delivery (vagina versus elective or non-elective Caesarian), but there was a correlation with the duration of labour. However, duration of labour was not correlated with food allergy itself, emphasising that other factors post-birth must be at play.</p>
<p>A range of lifestyle and environmental factors (diet, nutrition, vitamins, exposure to infection, antibiotics and so on) that may modify immune cells in the body are under scrutiny. Many of these influence the mother’s microbiome, the collection of bacteria and other micoorganisms we all carry.</p>
<p>Establishment of colonies in the baby by the mother’s microorganisms at birth is critical in the development of the baby’s immune system. If we can understand what’s driving the activation of monocytes in the baby, we might be able to design lifestyle and environment modification strategies to lower the chances of babies being born with an increased risk of developing food allergy.</p>
<p>This study and its findings show how important it is to look at pregnancy and early life to understand why immune disorders such as allergies have increased in childhood and later.</p><img src="https://counter.theconversation.com/content/53100/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research was funded by the Australian National Health and Medical Research Council, Walter and Eliza Hall Institute Catalyst Fund, the Victorian State Government Operational Infrastructure Support Program and the Australian Food Allergy Foundation.</span></em></p><p class="fine-print"><em><span>Peter Vuillermin and Yuxia Zhang do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research has found children who are born with overly active immune cells are more likely to develop allergies to milk, eggs, peanuts, wheat and other common foods.Leonard C Harrison, Laboratory Head, Walter and Eliza Hall InstitutePeter Vuillermin, Associate Professor, Paediatrics, Deakin UniversityYuxia Zhang, Researcher, Walter and Eliza Hall InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/403182015-10-07T19:24:44Z2015-10-07T19:24:44ZWhat are allergies and why are we getting more of them?<figure><img src="https://images.theconversation.com/files/95161/original/image-20150917-7521-3ppdou.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Allergies are becoming more frequent in the western world. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/al-stan/3475946574/">Al Fed/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Allergies are reactions caused by the immune system as it responds to environmental substances that are usually harmless to most people. They may occur in response to a range of different material (called allergens), such as food, pollen, dust mites, animals, insect stings, or medicines.</p>
<p>An allergy can <a href="http://www.allergy.org.au">affect different parts of the body</a>. Allergic rhinitis, or hay fever, for instance, affects the nose and eyes, while eczema affects the skin. Food allergies affect the gut, skin, airways, lungs, and sometimes the entire body through the blood vessels. </p>
<p>Other conditions such as asthma, which affects the lungs, and eosinophilic oesophagitis, which affects the tube from the throat to the stomach, are closely related to allergy. But they have slightly different underlying causes. </p>
<h2>A range of reactions</h2>
<p>While most reactions are only mild to moderate in severity (and can be treated with antihistamines), some can be life-threatening and require emergency medical treatment. The most severe, systemic allergic reactions are known as anaphylaxis. People with known severe allergies should have an <a href="http://www.allergy.org.au">emergency management plan</a> that includes an adrenaline auto-injector for emergency use. </p>
<p>We can confirm whether someone has an allergy by doing a skin-prick testing or a blood test that checks whether their immune system has produced antibodies to an allergen. If the immune system has developed antibodies, it will remember the allergen as a potential threat and is likely to mount a strong immune response on subsequent exposure. </p>
<p>The likelihood of someone having an allergic reaction from future exposures to the allergen is determined by taking their clinical history and these test results into account. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=265&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=265&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=265&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=333&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=333&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=333&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Allergic rhinitis, or hay fever, affects the nose and eyes.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/14353437@N06/4515249683/">parrchristy/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>In the case of food allergy, if the probability of an allergic reaction is low, people are given a food challenge. This is when increasing amounts of the offending food are administered while the person is closely observed for any signs of an allergic reaction. Of course, it can result in a reaction.</p>
<p>Allergies are becoming more frequent in Australia and the rest of the western world. <a href="http://www.allergy.org.au/">One in three people in Australia</a> will develop allergies at some time in their life. One in 20 will develop a food allergy and one in 100 will have a life-threatening allergic reaction known as anaphylaxis .</p>
<p>Hospital admissions for anaphylaxis <a href="http://www.ncbi.nlm.nih.gov/pubmed/26187235">doubled in the ten years</a> from 1994 to 2004, and were five times higher in children under five years old over the same period. This suggests the development of allergy in early life is increasing at a faster rate than in adults.</p>
<p>Children are <a href="http://www.abc.net.au/news/2015-07-15/number-of-children-hospitalised-with-food-allergies-on-the-rise/6619752">more likely to develop allergies</a> to eggs, dairy products or peanuts, while adults are more likely to develop an allergy to seafood. </p>
<h2>Possible reasons why</h2>
<p>The reasons for the rising number of allergies are not fully understood, but here are six theories.</p>
<p>1) Decreased exposure to infections or microbes – or both – in early life could lead to an increased risk of allergy. This is commonly referred to as the hygiene hypothesis, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838109/">first suggested in 1989</a>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21060319">Research showing</a> children who have close contact with pets or livestock and those who come from larger families are less likely to develop allergies have indirectly supported the hygiene hypothesis.</p>
<p>2) Delayed introduction of allergenic foods, such as eggs and nuts, until later in childhood could also have an impact. This is one of the most recent theories resulting from the <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1414850">LEAP study</a>, published in 2015. This randomised trial for early life peanut consumption in a population at increased risk of developing peanut allergies demonstrated that exposure to the nut early in life is protective against developing the allergy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A child with a nut allergy only has a 20% chance of the allergy resolving by the time she reaches adulthood.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/aoifemac/8424630783/">Aoife Mac/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>3) Different methods of preparing foods can <a href="http://www.ncbi.nlm.nih.gov/pubmed/19000582">impact the degree</a> to which they invoke an allergic response; roasting peanuts, for instance, greatly increases allergenicity while boiling reduces it. This may in part explain difference in incidence of in peanut allergy between certain countries.</p>
<p>4) Vitamin D deficiency may increase the risk to develop allergies. Several studies show that the further away you live from the equator (hence your lower level of sunlight exposure, which is needed to make Vitamin D) – or <a href="http://www.abc.net.au/health/features/stories/2013/03/07/3710140.htm">low vitamin D blood levels increase your risk</a> of developing allergies. But the value of vitamin D treatment for preventing allergies has yet to be demonstrated. </p>
<p>5) Allergies may develop after exposure to allergens, such as dairy products or nut oils in skin moisturisers, particularly on inflamed sites, such as eczema.</p>
<p>6) Altered gut bacterial species due to low-fibre diets and widespread antibiotic usage may alter the body’s immune function and create an allergy.</p>
<p>Whether your allergy improves over time often depends on the type of allergy you have. A child with eczema, for instance, will often find her eczema improves by the time she’s a teenager. But some people will have eczema even into their adult years. In contrast, a child with peanut allergy only has a 20% chance of the allergy resolving by the time she reaches adulthood.</p>
<p>While we have treatments for the symptoms of allergy, we do not yet have a cure or the ability to prevent them from developing in the first place. We also don’t have a good test for predicting food allergy, unless we feed the person the suspected food allergen. For now, the best you can do is to manage your allergy.</p><img src="https://counter.theconversation.com/content/40318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Collison receives funding from the NHMRC, Hunter Children's Research Foundation and the Thrasher Research Fund. He is an inventor on a provisional patent that describes a marker for peanut allergy.</span></em></p><p class="fine-print"><em><span>Joerg Mattes receives/received funding from the National Health&Medical Research Council, the Hunter Medical Research Institute, the Hunter Children's Research Foundation, Asthma Australia, Rebecca L. Cooper Medical Research Foundation. He is a listed inventor on a patent describing a peanut anaphylaxis blood biomarker.</span></em></p><p class="fine-print"><em><span>Rani Bhatia receives funding from the Hunter Children's Research Foundation. She is an inventor on a provisional patent that describes a marker for peanut allergy.</span></em></p><p class="fine-print"><em><span>Elizabeth Percival does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Allergies are reactions caused by the immune system as it responds to environmental substances that are usually harmless. But we don’t yet have a cure or the ability to prevent them from developing.Adam Collison, Post Doctoral researcher - Experimental and Translational Respiratory Medicine Research Group, University of NewcastleElizabeth Percival, Staff Specialist General Paediatrician at John Hunter Children's Hospital, Newcastle, Australia. Conjoint Lecturer & PhD student, University of NewcastleJoerg Mattes, Professor&Chair of Paediatrics | HMRI, University of Newcastle, Australia | Senior Staff Specialist Paediatric Respiratory&Sleep Medicine | John Hunter Children's Hospital, Australia, University of NewcastleRani Bhatia, Senior Staff Specialist in Paediatric Allergy and Immunology at John Hunter Children's Hospital Newcastle NSW Conjoint Lecturer in Paediatrics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/480782015-09-28T08:43:31Z2015-09-28T08:43:31ZAntibiotic overuse might be why so many people have allergies<p>Scientists have warned for decades that the overuse of antibiotics leads to the development of drug-resistant bacteria, making it harder to fight infectious disease. The Centers for Disease Control and Prevention <a href="http://www.cdc.gov/drugresistance/">estimates</a> that drug resistant bacteria cause 23,000 deaths and two million illnesses each year.</p>
<p>But when we think of antibiotic overuse, we don’t generally think of allergies. Research is beginning to suggest that maybe we should.</p>
<h2>Allergies are getting more and more common</h2>
<p>In the last <a href="http://www.jacionline.org/article/S0091-6749%2815%2900584-9/fulltext">two to three decades</a>, immunologists and allergists have noted a dramatic increase in the prevalence of allergies. The American Academy of Asthma, Allergy and Immunology reports that some <a href="http://www.aaaai.org/about-the-aaaai/newsroom/allergy-statistics.aspx">40%-50%</a> of schoolchildren worldwide are sensitized to one or more allergens. The most common of these are skin allergies such as eczema (10%-17%), respiratory allergies such as asthma and rhinitis (~10%), and food allergies such as those to peanuts (~8%). </p>
<p>This isn’t just happening in the US. Other industrialized countries have seen <a href="http://www.eaaci.org/outreach/public-declarations/2648-food-allergy-anaphylaxis-2012.html">increases as well</a>. </p>
<p>This rise has mirrored the increased use of antibiotics, particularly in children for common viral infections such as colds and sore throats. Recent <a href="http://www.sciencedirect.com/science/article/pii/S0091674909012536">studies</a> <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595077/">show</a> that they may be <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874145/">connected</a>.</p>
<h2>Antibiotics can disrupt the gut microbiome</h2>
<p>Why would antibiotics, which we use to fight harmful bacteria, wind up making someone more susceptible to an allergy? While antibiotics fight infections, they also reduce the normal bacteria in our gastrointestinal system, the so-called gut microbiome. </p>
<p>Because of the interplay between gut bacteria and the normal equilibrium of cells of the immune system, the gut microbiome plays an important role in the maturation of the <a href="https://theconversation.com/what-do-the-bacteria-living-in-your-gut-have-to-do-with-your-immune-system-36732">immune response</a>. When this interaction between bacteria and immune cells does not happen, the immune system responds inappropriately to innocuous substances such as food or components of dust. This can result in the development of potentially fatal allergies. </p>
<p>Exposure to the microbes at an early age is important for full maturation of our immune systems. Reducing those microbes may make us feel cleaner, but our immune systems may suffer.</p>
<h2>Do more microbes means fewer allergies?</h2>
<p>Research done in Europe has shown that children who grow up on farms have a wider diversity of microbes in their gut, and have up to 70% reduced prevalence of allergies and asthma compared to children <a href="http://dx.doi.org/10.1056/NEJMoa1007302">who did not grow up on farms</a>. This is because exposure to such a wide range of microbes allows our immune systems to undergo balanced maturation, thus providing protection against inappropriate immune responses. </p>
<p>In our attempts to prevent infections, we may be setting the stage for our children to developing life-threatening allergies and asthma. </p>
<p>For instance, a study from 2005 found that infants exposed to antibiotics in the first 4-6 months have a 1.3- to 5-fold <a href="http://dx.doi.org/10.1016/j.jaci.2005.04.020">higher risk</a> of developing allergy. And infants with reduced bacterial diversity, which can occur with antibiotic use, have <a href="http://dx.doi.org/10.1016/j.jaci.2011.10.025">increased risk</a> of developing eczema. </p>
<p>And it’s not the just the antibiotics kids take that can make a difference. It’s also the antibiotics their mothers take. The <a href="http://www.copsac.com/">Copenhagen Prospective Study on Asthma in Childhood Cohort</a>, a major longitudinal study of infants born to asthmatic mothers in Denmark, reported that children whose mothers took antibiotics during pregnancy were <a href="http://dx.doi.org/http://dx.doi.org/10.1016/j.jpeds.2012.09.049">almost twice as likely</a> to develop asthma compared to children whose mothers did not take antibiotics during pregnancy. </p>
<p>Finally, in mice studies, offspring of mice treated with antibiotics were shown to have <a href="http://embor.embopress.org/content/13/5/440.long">an increased likelihood</a> of developing allergies and asthma. </p>
<h2>Why are antibiotics overused?</h2>
<p>Physicians and patients know that overusing antibiotics can cause big problems. It seems that a relatively small number of physicians are driving overprescription of antibiotics. A recent study of physician prescribing practices reported that 10% of physicians prescribed antibiotics <a href="http://dx.doi.org/10.7326/M14-1933">to 95% of their patients</a> with upper respiratory tract infections. </p>
<p>Health care professionals should not only be concerned about the development of antibiotic resistance, but also the fact that we may be creating another health problem in our patients, and possibly in their children too. </p>
<p>Parents should think carefully about asking physicians for antibiotics in an attempt to treat their children’s common colds and sore throats (or their own), which are often caused by viral infections that don’t respond to them anyway. And doctors should think twice about prescribing antibiotics to treat these illnesses, too.</p>
<h2>As we develop new antibiotics, we need to address overuse</h2>
<p>As resistant bacteria become a greater problem, we desperately need to develop new antibiotics. The development process for a new antibiotic takes a considerable amount of time (up to 10 years), and drug companies have previously neglected this area of drug development. </p>
<p>Congress has recognized that antibiotic overuse is a major problem and recently passed the <a href="https://www.congress.gov/bill/114th-congress/house-bill/6">21st Century Cures bill</a>. This bill includes provisions that would create payment incentives from Medicare for hospitals that use new antibiotics. </p>
<p>But this approach would have the perverse effect of <em>increasing</em> the use of any new antibiotics in our arsenal without regard for whether bacterial resistance has developed. This would not only exacerbate the problem of resistance, but potentially lead to more people developing allergies.</p>
<p>Congress should consider more than just supporting increased development of new antibiotics, but also address the core problem of overuse. </p>
<p>This may stave off the further development of antibiotic resistant bacteria and reduce the trend of increasing development of allergies.</p><img src="https://counter.theconversation.com/content/48078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Avery August receives funding from National Institutes of Health. </span></em></p>When we think of antibiotic overuse, we don’t generally think of allergies. Research is beginning to suggest that maybe we should.Avery August, Professor of Immunology and Chair of the Department of Microbiology and Immunology, Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/369012015-02-18T03:32:22Z2015-02-18T03:32:22ZPeanut allergy treatment is on the horizon – but don’t drop the EpiPen yet<figure><img src="https://images.theconversation.com/files/71919/original/image-20150213-13206-vlgpy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Avoiding peanuts is currently the only way to prevent allergic reactions.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/sharynmorrow/3052699217/in/photolist-5DKT88-53Sm9N-oNomHQ-oNoo2w-93xAGy-62u7wG-bWEvKe-dVMqvf-2nqmq8-9rPN4e-79pjrS-ayw5N5-4E6e8S-niRBmL-4U4cfX-8gHzoq-7vRdJJ-ovW44e-oNonnL-5ihiFa-6AFQ19-niRAHm-7nhGAz-6YVE6n-9nn7Ax-8sQHCK-piZE4i-9VU913-5a4478-5V4V9Z-8JXJrn-NBgcU-5Ubhzm-4wcgcQ-6UC8Tv-4nx5uY-dUtSCJ-bGhKLH-PvRcS-eb9ZMt-b9fM8r-ecj1x-6p5Sor-biKrZ4-6oMbCY-7ADVx8-7mg64d-93uuMp-dYA1YH-AyLw7">sharyn morrow/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Rates of food allergies have increased over recent decades and are at an all-time high. While we don’t know the full extent of the allergy epidemic, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/19217654">rate of hospitalisation</a> for food allergies has quadrupled since the mid-90s.</p>
<p>Peanuts are one of the most common causes of food allergies. The <a href="https://www.mcri.edu.au/research/projects/healthnuts">HealthNuts study</a> tested almost 3,000 Melbourne children born between 2006 and 2009 and found 3% of infants had a confirmed peanut allergy. Only one in five children had grown out of the allergy by four years of age. </p>
<p>Researchers have made some promising steps forward in developing a treatment for peanut allergies, but there is currently no cure. Avoiding the food is the only way to prevent allergic reactions.</p>
<h2>What is a peanut allergy?</h2>
<p>Peanut allergies occur when the body’s immune system develops antibodies – called immunoglobulin (Ig) E molecules – against parts of the “harmless” peanut protein. This is known as sensitisation.</p>
<p>Sensitisation can be easily detected by measuring peanut-specific immunoglobulin E either in the child’s blood or by means of a skin prick test.</p>
<p>Allergy as a disease is seen when IgE antibodies activate the immune system. This may lead to face, lip, eye swelling, welts and hives, breathing difficulties, vomiting, and even collapse of the body’s blood circulation. </p>
<p>The most severe form of reaction, anaphylaxis, can cause swelling of the tongue and throat. This is a potentially life-threatening condition that requires emergency treatment with adrenalin autoinjectors (also known by the brand name, EpiPen).</p>
<p>But not everybody who has IgE antibodies to “peanut” will experience an allergic reaction. </p>
<p>Sometimes peanut sensitisation is found in a child who has never been exposed to peanuts. This is more common in children with eczema or children who have other food allergies. </p>
<p>In other cases, the symptoms cannot be unequivocally attributed to allergy and/or exposure to peanut. In these situations, the question has to be resolved: is it “only” peanut sensitisation or is it a peanut allergy?</p>
<h2>Causes</h2>
<p>The causes of sensitisation are unknown but <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa013536">research suggests</a> it could occur through the skin in children with eczema. </p>
<p>Other factors affecting this meteoric rise <a href="http://fooddrugallergy.ucla.edu/body.cfm?id=40">could be</a> cleaner and more hygienic environments and the delayed introduction of allergenic foods.</p>
<h2>Diagnosis</h2>
<p>If a patient presents with symptoms of allergic reaction after eating peanuts, a positive skin prick test to peanuts or detecting the presence of specific IgE to peanuts by a blood test, will confirm the peanut allergy.</p>
<p>However, if the history is ambiguous or sensitisation is seen in the absence of a known exposure to peanut, the patient may need to undergo a food challenge to confirm the peanut allergy. As this could lead to an allergic reaction, food challenges need to be performed in a clinical setting, where treatment is readily available. </p>
<p>Our <a href="http://onlinelibrary.wiley.com/doi/10.1111/cea.12258/abstract">Newcastle Peanut Anaphylaxis Predictors study</a> showed that the combination of an antibody test and a breathing test that measures a molecule called nitric oxide in exhaled air can avoid the need for a food challenge test in half of the children suspected to have peanut allergy. </p>
<p>Building on this approach, we have developed a blood test to predict anaphylaxis, which is currently being validated in a large population of children with suspected peanut allergy. </p>
<h2>Treatment</h2>
<p>Most children with peanut allergy need to carry an adrenaline autoinjector because it provides immediate relief from severe allergic reactions. </p>
<p>The uncertainty of when a severe reaction will occur places immense psychological and social burdens on patients and families. As a consequence, a number of children with peanut allergy <a href="http://onlinelibrary.wiley.com/store/10.1111/j.1398-9995.2010.02342.x/asset/j.1398-9995.2010.02342.x.pdf;jsessionid=640A3E4F5E182E01F3BDCB58DAAF21A7.f02t04?v=1&t=i636xo7b&s=b60f3b06bed2c02a7304baf21005e2ac22f32ece">suffer from</a> anxiety-based disorders. </p>
<p>Encouragingly, researchers have recently made progress in optimising immunotherapy, also called peanut “desensitisation”. In this process small amounts of peanut protein is administered regularly to build up “tolerance” to the food.</p>
<p>British scientists Leonard Noon and John Freeman were the first to show in 1911 that desensitisation to pollen could be an effective treatment for hay fever. </p>
<p>A century later, a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060783/">study</a> with 28 children in Durham, North Carolina, showed that oral immunotherapy could reduce allergic reactions to peanut. </p>
<p>This study was subsequently confirmed by the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962301-6/abstract">STOP II trial</a> in Cambridge, UK where 62% of children with peanut allergy were able to eat five to ten peanuts without allergy symptoms six months after the initiation of treatment. </p>
<p>Recently, Professor Mimi Tang and co-workers from the Murdoch Childrens Research Institute, Melbourne, <a href="http://www.theatlantic.com/health/archive/2015/01/a-possible-treatment-for-peanut-allergies/385045/">studied</a> an oral probiotic peanut combination immunotherapy in 62 allergic children without previous anaphylaxis. Children enrolled in this study were regularly given small amounts of a peanut and probiotic combination so as to develop tolerance to peanut.</p>
<p>This treatment resulted in 82% of children being “tolerant” to peanuts, meaning they were able to eat roughly 20 to 40 peanuts without allergy symptoms, two to five weeks after the treatment stopped. This suggests that there may be a treatment in the future, which has a sustained effect. </p>
<p>However, treatment side-effects with oral peanut (and probiotic combination) immunotherapy are very common, with 45% to 93% of children affected. That’s why oral peanut immunotherapy can only be provided within high-level specialist care and at present is advisable to do only within research settings.</p>
<p>In future, we hope to be able to use bio-markers to predict whether children who come into contact with peanuts will have anaphylaxis and whether they’ll respond to different treatments.</p><img src="https://counter.theconversation.com/content/36901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rani Bhatia has received funding from Hunter Children's Research Foundation. She is an inventor on a provisional patent that describes a marker for peanut allergy </span></em></p><p class="fine-print"><em><span>Adam Collison receives funding from Hunter Children's Research Foundation and the Thrasher Research Fund. He is an inventor on a provisional patent that describes a marker for peanut allergy.</span></em></p><p class="fine-print"><em><span>Joerg Mattes receives/has received funding from the NHMRC, Hunter Medical Research Institute, Asthma Australia and the CRC for Asthma. He is an inventor on a provisional patent that describes a marker for peanut allergy.</span></em></p>Rates of food allergies have increased over recent decades and are at an all-time high. While we don’t know the full extent of the allergy epidemic, the rate of hospitalisation for food allergies has quadrupled…Rani Bhatia, Senior Staff Specialist in Paediatric Allergy and Immunology at John Hunter Children's Hospital Newcastle NSW Conjoint Lecturer in Paediatrics, University of NewcastleAdam Collison, Post Doctoral researcher - Experimental and Translational Respiratory Medicine Research Group, University of NewcastleJoerg Mattes, Professor&Chair of Paediatrics | HMRI, University of Newcastle, Australia | Senior Staff Specialist Paediatric Respiratory&Sleep Medicine | John Hunter Children's Hospital, Australia, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.