New Zealand's allergy epidemic

By JAN CORBETT

Like all devoted parents, Brenda Fairhall and Martin King have albums bulging with photographs of their 4-year-old daughter, Chelsea. The difference is that in these pictures Chelsea's normally cherubic face looks as if it has been savagely punched, then splashed with scalding water. Her eyelids are swollen shut, her skin a map of raw, scarlet blotches.

The Fairhalls take these photographs so Chelsea will someday understand what happens to her body when it is ravaged by an allergic reaction.

For Chelsea, that can happen any time she eats one of a list of forbidden foods - dairy products, eggs, peanuts and seafood. It can even result from doing something as simple as breathing the air outside.

Brenda admits she has a family history of allergies that may explain Chelsea's condition. From her mother to herself and now her daughter, the degree of allergic reaction is more severe in each generation.

And she didn't know when she was pregnant about the present theory that mothers with a predisposition to allergies should not eat dairy products, eggs or peanuts while pregnant or breastfeeding.

She also had to have an emergency operation when she was nine weeks pregnant, and she often wonders if this may have been the trigger, too. But whatever it is, Chelsea is one of a growing number of New Zealand children with irritating to severe allergies, a trend mirrored in other developed countries. Of the 124,000 New Zealanders who wear Medic Alert bracelets, half are allergy sufferers, and the greatest proportion of those are children.

According to research by the International Study of Asthma and Allergies in Childhood (ISAAC), chaired by Auckland University Associate Professor Innes Asher, New Zealand joins Britain, Australia and Ireland for having the highest rates of asthma, which is strongly correlated with allergy. According to the Asthma and Respiratory Foundation, that translates to 15.5 per cent of adult New Zealanders suffering from asthma and 21 per cent of children aged up to 14.

But it doesn't stop with children. At the Auckland Allergy Clinic, Barbados-born and London-trained Dr Vincent Crump talks about an allergy epidemic, saying that in the past 10 years the prevalence has increased by 50 per cent.

He is seeing an increasing number of forty-somethings, himself included, who are developing the leading allergy-related ailments - asthma, hayfever or eczema - and often all three.

Five years ago Auckland Hospital introduced an allergy and immunology service for patients over 12 who were too old to be seen by Starship Hospital. Here Dr Rohan Ameratunga says the unit is overwhelmed by the demand. Two years ago it had 40 patients each month. Now it ranges from 150 to 200, stretching the waiting list to eight months.

At the same time prescriptions and over-the-counter traffic in allergy treatments are steadily increasing. According to IMS Health, which measures this trade, the number of antihistamines and nasal preparations sold or prescribed rose by 6.3 per cent between 1999 and 2000, and a further 1.2 per cent for the year to May 2001.

St John Ambulance gets called to deal with a severe allergic reaction or anaphylactic shock at least once a day in the Auckland region. Anaphylactic shock is an allergic reaction spiralling out of control. The blood vessels become so swollen they leak, depriving the body's organs of essential oxygen and nutrients.

With the winter sun streaming through the french doors of their new Te Atatu home - one they would never have carpeted had they known then that their child would suffer from multiple allergies - Brenda Fairhall talks about the moment last year when Chelsea "dropped dead here at home.

"We'd been out the night before to the new WestCity shopping centre and something in the air irritated her. By the time we got to the car she had welts on her face. She'd either inhaled or touched something."

Chelsea needed her inhaler throughout the night. Brenda slept with the child - "It's common for one of us to sleep with her." Normally while the couple are at work, Brenda's sister takes care of Chelsea. Daycare is not an option, although she attends kindergarten in the afternoons. But they were concerned enough about her next morning for Martin to stay home from work. Father and daughter were talking and laughing over breakfast when suddenly Chelsea stopped breathing.

In his panic Martin couldn't find the adrenalin injection (EpiPen) that is always in the backpack she takes to kindergarten. The jab is the standard first response to anaphylactic shock. Martin called the ambulance, making sure he asked for one with a life-support unit, something parents of allergy sufferers know to do. Brenda drove to Starship Hospital still not knowing if her daughter was alive or dead.

Brenda can tell this story now with amazing calmness while Chelsea watches television happily in another room. Although it was probably the most frightening episode they have had with Chelsea, the daily reality of living with a child with severe multiple allergies is unspeakably stressful. There's the chronic sleep deprivation because Chelsea wakes frequently through the night, scratching her eczema-ravaged skin until it bleeds.

There's the daily ritual of lathering her body in creams, making sure no allergen such as fish oil is still on their hands. There's no prospect of eating out at a restaurant for fear a trace of peanut oil may have sneaked into the food. There are no invitations to children's birthday parties, or even to another child's house to play, because no one wants the responsibility of accidentally exposing her to an allergen and having her die on them.

It means Brenda and Martin, like a lot of the parents you see in supermarkets studying the labels on everything they buy to ensure they are not taking home a poison, have decided not to have any more children.

Five years ago the faces of Natalie Lloyd and her baby son, James, filled the Herald's front page with the astounding story of how James had gone into anaphylactic shock on an Air New Zealand flight from Rarotonga.

Knowing her son was allergic to even a particle of peanut, Lloyd thought she had an agreement from the airline not to serve peanuts in the flight. Somehow the message failed to reach the cabin crew, so when she saw them about to hand out the foil packets she begged them not to, knowing James would react to the peanut dust when hundreds of packets were opened simultaneously. The crew refused, probably doubting it could have such an effect, and probably thinking Lloyd was, well, nuts.

Soon after, Air New Zealand changed its policy, and like a number of other airlines which have had to respond to the increasing number of nut allergies, no longer serves peanuts on its planes.

Lloyd, now a walking encyclopedia on allergies, is president of the nationwide support group Allergy New Zealand (www.allergy.org.nz), formerly known as Allergy Awareness. Here, too, they see the evidence of this being a Western epidemic, even though official figures on allergy sufferers are not kept.

Three years ago the association received around 7500 inquiries annually. Last year that rocketed to 90,000 along with a 60 per cent membership increase. But, says Lloyd, those figures also reflect increased awareness and better diagnosis.

Dr Crump says much of his work is educating GPs about allergies and removing the notion that it is fringe medicine. Training initially as a dermatologist, he found the relationship between skin conditions and allergy was not readily accepted by the experts, something he worked to change.

But according to Dr Ameratunga, not everyone developing allergic-type ailments later in life does so because of allergies, even though they may show an allergic reaction on the skin tests.

Both doctors say we need a nationwide policy on dealing with allergic children, especially in schools and daycare centres. The Ministry of Health is in the early stages of drafting advice for parents and teachers on how to deal with allergic children at school. According to Dr Pat Tuohy, chief adviser on child and youth health, an advice sheet written by the ministry in the mid-1990s "doesn't cover the issues in detail and is not ideal for parents or teachers". He cannot say when the new advice will become available.

According to the New York Times magazine, the allergy epidemic there is forcing schools, daycare centres and summer camps to introduce food policies. Some have banned nuts. Others are segregating children with diet allergies at lunchtime, and banning the traditional childhood ritual of swapping lunches.

In New Zealand, daycare centres are putting the lists of who is allergic to what on the refrigerator. When Bayfield Early Education Centre in Herne Bay opened last year it began by banning peanuts entirely. Although its policy is to accept children with special dietary needs, director Shona Hewitt says parents of severe allergy sufferers can see that daycare is not always a realistic option, because they don't have enough staff to supervise a child who has to be separated from the rest at lunchtime.

Brenda Fairhall was determined Chelsea would go to a kindergarten, believing neither she nor her daughter could live life in a bubble and that it would be a good testing ground for getting the right protocols and emergency plans in place. Because sooner or later she would have to face school.

Next February that time will come, when Chelsea starts at St Francis School in Pt Chevalier.

It took some searching to find a school willing and able to enrol Chelsea. Some would take her, "but were very blase. You need one that will put the structures in place," says Brenda.

"I looked at big and little schools. Children like this need a little school that's an extension of their family."

Finding a suitable one was "such a relief," says Brenda. At kindergarten, where Chelsea is one of two children with a food allergy, she is shadowed by a teacher's aide, trained to give her the adrenalin shot if necessary and to administer CPR.

And now the Fairhalls are applying for funding for a teacher's aide to accompany her to school.

The application will go to people at the Ministry of Education who administer the School High Health Needs Fund, introduced this year to help children with special health needs get through school. Chief verifier Margaret Parkin does not have figures on how many teacher aides are being funded for children with allergies - at $10 to $14 an hour - but says the applications from the parents of allergy sufferers are memorable.

One, which has been reproduced in their brochure, describes a child so allergic that he is unable to breathe independently much of the time and is wheelchair-bound. He is so allergic to latex that the mere presence of a rubber band in a classroom could bring on anaphylactic shock.

At Kohia Terrace School in Epsom, principal Mark Barratt is happy to accept severe allergy sufferers without insisting on a teacher's aide, a demand he says he would not make of parents. Of his 350 pupils, two have life-threatening allergies. All the staff have been trained to administer adrenalin injections if necessary, with three teachers having special responsibility for it.

Barratt is confident the school can cope in an emergency. There has already been one incident where an allergic child succumbed to the temptation of forbidden food and had to be given a jab. Barratt agrees national policies are needed to remove the fear and stereotyping that goes with these cases.

At nearby Epsom Normal Primary, 10 out of 715 have allergies, three that are life-threatening. Principal Marilyn Gwilliam says these cases can be "very scary" for schools and it is a huge responsibility they take seriously. She says that in this increasingly litigious age it is foreseeable that a school or principal might be sued or prosecuted if a child in their care died from an allergic reaction if there had been a slip-up in the monitoring.

Although they would never refuse to enrol a severely allergic child, Gwilliam encouraged one such parent to apply for funding for a teacher aide and was both surprised and relieved when it was granted.

"The parents can relax and the school can relax and get on with teaching," she says.

At Allergy New Zealand, Natalie Lloyd is concerned that the guidelines for administering adrenalin say that teachers should be trained by GPs to give the injections. But, says Lloyd, doctors don't have the time to go into schools to give that training. At present public health nurses are filling that void.

Some schools say if a child went into anaphylactic shock they would take it to the nearest emergency centre. "We're saying no to that," says Lloyd. "Deaths happen because of a delay in administering adrenalin."

While medical literature is talking about "a considerable concern that the prevalence of asthma and allergic diseases is increasing in Western and developing countries," it notes the same trend is absent in the Third World.

The leading theory on why richer countries have a higher rate of wheezing, sneezing and itching is that our clean, concrete-surrounded environments, and low exposure to bacteria, are leaving our immune system sitting around with nothing much to do and then it gets confused. Desperate for action, it takes to interpreting excretions from dust mites or pollens as bacterial invasions and tries violently to expel them. High immunisation rates may therefore also be part of the puzzle.

Western diets - high in dairy products, sugar, fat, animal proteins, salt, meat and alcohol - are also thought to play a role, with evidence that a diet high in grains, starch and vegetables, more common fare in poorer countries, reduces symptoms of allergic diseases.

The dramatic increase in children with peanut allergies is thought to be because children are eating more peanuts, especially peanut butter. A more recent theory is that there is something in the dry roasting of peanuts that triggers an allergen. In China, where peanut allergy is rare, they fry their peanuts.

Other theories are that childhood asthma is increasing because privileged children exercise less; that air pollution is making our sinuses and lungs more susceptible to pollen; and that airtight modern housing and moisture-producing gas heating are providing the ideal warm, damp environment in which dust mites thrive.

While the research continues, Dr Ameratunga fears that access to allergy services are too scarce - people living outside Auckland, Wellington or Christchurch have no public hospital allergy specialists in their area.

In the meantime the rise in allergies is spawning an industry. Flick through the pages of the glossy quarterly magazine Allergy Today, published by Allergy New Zealand, and see vacuum cleaners for those dreaded dust mites with models labelled allergy control plus. See a range of dehumidifiers to combat the same scourge. Washing machines advertised as "providing an allergy solution" because they wash at 55 degrees or above, the temperature at which the mites die. See the special bedding covers that keep the mites contained. See the milk substitutes and the gluten-free breads, latex-free surgical gloves, low-allergy laundry products, low-odour paints and so on.

There is even talk of work being done on breeding cats that won't trigger allergic reactions.

Combating allergies is clearly an expensive undertaking. Dr Ameratunga says most of his patients are middle class. Unless their condition is severe, poor people with allergies simply don't get treated.

Meanwhile, food companies are looking to their labels. Examine, for example, a packet of potato chips such as ETA Ripples and see on the ingredients panel the statement: "May contain peanut traces". Griffins Foods, which makes the chips, says it is its responsibility to keep the at-risk informed, given the worldwide increase in peanut allergies. While peanuts are not an ingredient of ETA Ripples, "they are processed in an area of our factory which is not isolated from the area where we process peanuts. For this reason it is feasible, even if only remotely, that a small particle of peanut could be found in a Ripples packet."

But this cautious approach has its drawback for allergy sufferers, says Dr Ameratunga. It could leave them with nothing to eat.