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Ahistoryoffoodallergy

Theevolvingstoryovertwodecades

ByDavidReading

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1976:foodallergyinthepubliceye

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Adefinition

of

allergy

Allergy occurswhen

the

immune

system

reactsadverselytoafoodorsubstancethatis

harmlessformostpeople.

Anaphylaxis isattheextremeend severeandrapidlyoccurring.

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Foodintolerance

Doesnot

generally

involve

the

immune

system.

Requireslargeramountsoffood.

Symptomstakelongertooccur.

Symptomsmayincludeheadache,digestivediscomfort,

sluggishness.

Example:lactoseintolerance.

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My skirt doesnt fit. It

must bean allergy.

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Milestonesin

allergy

research

HughSampson's

work

on

food

challenges

and

predictivevaluesforskinandIgEantibody

assays.

HughSampson'sidentificationofasthmaasthemajorriskfactorforfatalanaphylaxis.

Isleof

Wight

research

showed

ahuge

rise

in

peanutallergyamongchildren.

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Sarahsstory whyIgotinvolved

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Tragedy a

catalyst

for

change

JosephineTurner,

aged

17,

died

1992

after

eatingapretzelcontainingpeanutbutterat

herschool.

MichaelaMortimer,aged16,died1993aftereatingapeanutwaferatherschool.

RachelONeill,aged26,died1993aftereatingpeanutsinaThaimealservedinarestaurant.

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1993

paper

on

anaphylaxis Foodsareamajorcauseofanaphylaxis. Paucityofdataonprevalenceorfrequencyof

deaths.

Deathsmaybewronglyrecorded.

Allergen

avoidance

easier

to

advocate

than

undertake.

Theformationofaselfhelpgroupwouldput

pressure

on

manufacturers.Foodinducedanaphylaxis deathcanandmustbeavoided.(BJCP,1993).DavidHide.

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Thegrowth

of

support

organisations

AsthmaUK:Rootsgobackto1927

CoeliacUK:1968

FAAN(intheUSA):1991

AllergyUK:1991

TheAnaphylaxisCampaign:1994

Othersaroundtheworld

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TheAnaphylaxis

Campaign

Helpsindividuals

with

severe

allergies.

Seekstoensurehighqualityallergenlabelling.

Promotesawareness

in

the

catering

sector.

Runsonlinetrainingforschools.

Variousinformation

tools

magazines,

websiteetc.

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The1990s:amediascarestory

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Amothers

letter,

1994

Mylittle

boy

suffered

avery

severe

allergic

reactiontoasliceofcakeinarestaurantwhile

we

were

on

holiday.

The

cake

contained

walnuts.IamterrifiedIwilllosehim.Weare

livingwithatickingtimebomb.

fromtheAnaphylaxisCampaignfiles

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Thepatients

lifeline

EpiPen developedbasedonCombopenfor

chemicalwarfare

antidote.

1980:EpiPen launchedandregisteredinUSA.

Late1980s:EpiPen availableonnamedpatientbasisinUK.

1996:EpiPen registeredinUK.

2001:Anapen registered

in

UK.

2010:Jext registeredinUK.

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Themid

1990s

NicholasSoames

launched

an

awareness

campaignthroughoutindustry.

Retailersand

manufacturers

began

to

develop

robustpolicies.

Industryorganisations(e.g.BRC,FDF)developedcodesofpractice.

ECdiscussedmandatoryallergenlabelling.

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Actionsby

MAFF

and

the

FSA

Allergyawarepackaimedatcaterers.

Webguidanceforindustryandconsumers.

Consumerattitudesurveys.

Maycontainguidancepublished.

Guidanceforcatererspublished.

PLUStheFSAsmajorallergyresearchprogramme.

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Adviceoneatingpeanuts

1998:GovernmentCommitteeonToxicity

issuedguidance

for

families

on

introduction

of

peanutsintothediet.

Mothers

in

atopic

families

may

wish

to

avoid

peanutswhilepregnantandbreastfeeding.

TranslatedinthemediaasMotherstobetoldto

avoid

peanuts.

(Advicerescinded2009).

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FurtherUK

deaths

1995:Lucie

Crawford

died

after

eating

a

Chinesetakeaway.

1995:

Louise

Westlake

died

during

her

companysChristmasdinner.

1998:LauraThrasherdiedonherfirstnightatCambridgeUniversity.

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Victim:Olympic

athlete

Ross

Baillie

1999: Ross ate a

coronation chickensandwich notknowing itcontained nuts.

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Commonsstatement,

June

1999

EdwardDavey,

MP:

When

afit,

gifted

young

athletediesbecauseofafewbitesofa

chicken

sandwich,

it

is

surely

our

duty

to

ask

whetherhisdeathandotherslikeitcould

havebeenavoided.

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2003:new

legislation

on

allergens

Europeanlegislation

requires

the

mandatory

labellingof11allergens(plussulphites)inpre

packed

food. Thisabolishedthe25percentrule.

Molluscs

and

lupin

added

2006.

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Whylupin?

Sweetlupin

is

grown

for

its

edible

seeds.

Theseedscanbeeatenraworusedtomakeflour.

ReactionsoccurontheContinent andoccasionallyintheUK.

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Reactionsto

lupin

in

the

UK

Aman

with

peanut

allergy

reacted

to

ameat

pie.Thepastry importedfromFrancecontainedlupinflour.

Awoman

reacted

to

an

Asda

apple

flan

and

an

onionring.Bothcontainedlupinflour.

Awoman

reacted

to

bread

bought

at

an

in

storebakery.Thebreadcontainedlupinflour.

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The next one on the list?

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Therise

in

kiwifruit

allergy

Kiwiintroduced

in

the

UK

late

1960s.

The1980s emergingcasesseenmainlyinadults.

The1990s severecasesbecomingcommoninchildrenandinfants.

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Othertriggersinclude...

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Buckwheat one to watch?

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Allergytobuckwheat

AmajorallergeninJapan wherelabelling is

mandatory. Notatruecereal relatedtorhubarb.

Used

in

savoury pancakes,

Japanese

noodles,

Russianblinis.

UKcase: Ayoungwomansufferedanaphylaxisafter

eating

canaps.

Thewomantestedpositivetobuckwheat.

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Therise

in

may

contain

Ihad

always

thought

food

labelling

was

there

tohelpandprotecttheconsumer.ButnowI

wonder

if

it

really

exists

to

protect

the

food

industry.

Motherofanallergicchild

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Ateenagers

view

Foodcompanies

put

nut

warnings

on

everythingtocoverthemselves.Ijustcant

believetheriskisreal.Illeatanythingwitha

warningon

it.

FromthefilesoftheAnaphylaxisCampaign

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Ashoppers

view

"Weignore

all

may

contain

warnings

since

wefoundoneonacabbage.

FromthefilesoftheAnaphylaxisCampaign

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Isthisalittle

extreme?

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Can of milk

with a nutstatement!

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And a packet of chewing gum!

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Food

allergy

alerts TheAnaphylaxisCampaignsendsoutallergy

alertsto

allergic

members.

36alertssentoutin2006.

58in

2007.

65in2008.

46in

2009.

40in2010.

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Productalerts examples

Undeclaredegginspaghettibolognese.Packaging

had

been

printed

using

an

old

artwork

file. Apackagingerrorinvolvingpumpkinandredpepper

soup.Someproductcontainedmushroomand

celeriac soup.

Gheeinabiriyaninotidentifiedascomingfrommilk.

Achocolatecoveredpeanutfoundinapackof

chocolatecoveredraisins.

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Theadvent

of

free

from

Werefed

up

with

you

telling

us

what

we

cant

eat.Willsomebodytelluswhatwecan eat.

acommoncomplaint.

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Thedownsideoffreefrom

Shopperstakeshortcutsandignorethe

ingredientlist.

Thephrasefreefromsuggestsanabsolutevalue.Consumersexpectittomeantotal

absence.

Somefreefromproductshavebeentestedto

revealtraces.

Peoplehavereacted.

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A mistake with free from

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Casehistory

Packsofcarobiceswerelabelled100percent

dairyfree.

Atoddlerreacted.

Testswere

positive

for

milk.

Onecarobsamplecontained1.6percentcasein,theother2.7percent.

Thesuspectbatchwasrecalled.

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Themessage

Food

companies

wishing

to

label

products

freefromXmustbeconfidentthereis

virtuallynochanceofcrosscontact.

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Newrulesonglutenlabelling

NewregulationscomeintoforceJanuary

2012.

Glutenfreestatementwillmeanthe

productcontains

20ppm

or

less

of

gluten.

Verylowglutenwillmeannomorethan

100ppm.

FSAsaystestingwillberequiredtosupporttheseclaims.

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Thequest

for

thresholds

Isthere

adose

beneath

which

people

are

unlikelytoreact?

Can

safe

levels

be

set

that

industry

could

work

to?

Researchismovingclosertofindinganswers.

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Hopeforthefuture

Canwestopchildrenbecomingallergicto

foods? TheEATandLEAPstudieswanttoshowthat

introducingallergenicfoodsearly mayprevent

allergyfrom

developing.

Thischallengesestablishedthinking.

LEAPis

working

with

peanut.

EATwithmilk,peanut,fish,wheat,eggsandsesame.

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Hopeforthefuture

Canallergybecured?

2011:Researchers

at

Addenbrookes achieve

furthersuccessindesensitisingchildrento

peanut.

Oralimmunotherapy(OIT)worksbyintroducingsmallamountsofpeanutintochildrensdietsand

graduallybuilding

up

to

larger

amounts.

USresearchersalsohavingsuccesswithOITandwithsublingualimmunotherapy(SLIT).

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Pleasestayintouch

FoodAllergySupportLtd.

david.reading@foodallergysupport.com

Tel:07904979562

www.foodallergysupport.com