Sunday Insight: Upturn in food allergies raises questions

Sarah Smith is generally tolerant and understanding of the needs of others. But when a notice came, out of the blue, from her daughter's kindergarten late last year, Sarah got "really angry." It was a note too far. There was to be a ban on egg cartons for collage. Add to that all dairy products (including butter and cheese), and also soy drinks and eggs.

Sarah and other parents at the Wellington kindergarten her 4-yearold attends had already been asked to accommodate a ban on nuts at the venue, in consideration of a child's allergy to peanuts. Fair enough, she thought. "But then another child turned up and this notice came without warning."

It spoke of an unidentified child with severe allergies. An anaphylactic and potentially life-threatening response was highly likely if she "eats (or residue is absorbed through broken skin) dairy products, nuts, soy or eggs."

Sarah is sympathetic to the needs of children with allergic reactions to food; she is fortunate neither of her two children have any allergies. But she asks: "At what point do they stop? When do we stop bringing baking?"

"Sarah Smith" is not her real name. The stand-off between parents who claim their children have allergies, and those who have to tailor their kid's lunch boxes accordingly, is a sensitive one. Wellington Kindergartens asked that "Sarah" not be identified, lest it embarrass the families of allergy sufferers at her daughter's kindy.

The child with the life-threatening allergies whose condition sparked the new rules attends only a couple of days a week but the ban extends throughout the week.

Herald on Sunday columnist Paul Little lit a fairly large flame with his column arguing that some people's self-diagnosed "allergies" were little more than a way of explaining away their more embarrassing bodily functions. Targeting those who claim gluten intolerance and irritable bowel syndrome especially, he wrote that, in many cases, the elevation of minor reaction to the status of allergy was simply a way for the sufferer to make him or herself "more interesting".

His columns sparked a furious outpouring of protest from legitimate coeliacs and the like. One of the more restrained contributions noted: "Dear Sir. I fear you are a little misguided in your thoughts. I am a diagnosed coeliac and cannot eat any gluten." She said the end result for her, after eating gluten, was vomiting, diarrhoea and going into a state of shock. "Basically poisoned."

Are we going too far in hunting down ingredients allegedly held responsible for allergic reactions? Are we making claims where there's no scientific proof to back them? Or is there a legitimate increase in the number of allergies?

Associate professor Rohan Ameratunga is an Auckland University adult and paediatric immunologist who specialises in food allergies. He says there's a reasonable amount of indirect evidence to show that the number of people with food allergies has risen in the past two decades.

One study he co-wrote, published in the New Zealand Medical Journal in 2008, suggested one in 10 children has a possible food allergy; a community- based food allergy study conducted in Melbourne two years ago identified 10 per cent of all 1-year-olds have some sort of well-defined food allergy to eggs, milk or peanuts.

Those results could have similar application here.

Ameratunga further notes that the spectrum of allergies is increasing. In addition to the standard allergy-causing foods of milks, eggs, peanuts, tree nuts, wheat and soy, henowadds sesame seeds and lupin (used in European breads).

No one really knows, who, or what, is to blame, says Ameratunga. But current theories are:

» A change in food introduction patterns for babies being weaned (they are being exposed to a bigger variety of foods at an earlier age);
» Changes in culture and associated eating habits (Chinese children eating a Western diet, for example);
» Changes in saturated fat consumption.

This year, the results of a large international study by Auckland City Hospital colleagues Professor Innes Asher and Philippa Ellwood noted an increased risk of severe asthma, eczema and rhinitis in adolescents and children who ate fast food three ormore times a week. Three ormore weekly servings were linked to a 39 per cent increase in risk of severe asthma among teenagers and a 27 per cent increase in risk among children, as well as to the severity of rhinitis and eczema overall.

One Wellington mother of three, two of whom have allergies, sees kindergarten as a lifesaver.

Although her 3-year-old daughter is at the severe end of the allergy spectrum - she's allergic to more than 20 foods and even a sip of milk can spark an anaphylactic attack - the local kindy is the one place where she can be a normal child.

"They have tried to be very open with other parents and keep dietary restrictions to an absolute minimum ... I think being open about it has helped"

As a result, her daughter loves her four visits a week. "She absolutely adores it. She gets to play with her friends, and it's a safe environment."

Ameratunga says his practice sees a spectrum of people - from those with severe, life-threatening food allergies, through to those who have a food intolerance. He believes there's an element of truth to both sides of the argument in Little's column. "I wouldn't want to trivialise anyone's symptoms, so go and get them checked through a GP."

Adrienne Kohler was craving a steak sandwich. She soon regretted her decision. It was the two pieces of toast she had wrapped around the steak that did the damage, Kohler says. "Any time I eat a wheat product, I get terrible bloating and cramp. I also get a lump in my throat that feels like I've swallowed a golf ball."

It's the same when she eats chickpeas, a key ingredient of hummus. After such an incident, it can take about three days to fully come right.

Kohler, a 49-year-old business manager, says she was originally a sceptic about food allergies and fads. But by eliminating gluten and chickpeas from her diet, she has rid herself of the resultant side-effects.

Eating out is difficult; cafes are the worst, with little provision of gluten-free foods, she says.

Kohler's condition manifested itself when she was in hermid-40s, but she believes it has worsened with age. She has consulted her doctor about her reaction to wheat-based products and he advised her to be tested for any allergic reaction. She has not done that. "It seems obvious; if Idon't eat wheat, it doesn't happen."

Kohler's sister also experienced the same reaction to the same foods. Her daughter, now 18, developed a dairy intolerance after she returned from visiting the United States. It would be interesting to know why people develop allergies as they get older, she says.

Ameratunga warns those who, like Kohler, self-diagnose a food allergy. "These people need a sufficient amount of care, because they can run a significant health risk by restricting their diet."

Sarah Smith thinks there are other risks to consider. New rules at her daughter's kindergarten include children washing their hands before entering the premises. If they've eaten allergy-causing foods for breakfast, they have to wash their faces, too. Says Sarah: "I'm worried our kids will get dermatitis. They made the playgrounds safe, and now it's affecting our children's ability to learn and read and write and know their safe limits. I'm worried they'll go down the same road with food and we'll have an increase in allergies because the food our kids are eating is not real food."

For its part, the Wellington Kindergartens association is at pains to include all children. General manager Amanda Coulston says that, yes, there has been an increase across kindergartens in children presenting with allergies. "The thing that's really challenging
is each child is different. By the time they've got to school, their condition might have lessened or the child might have got it under control, whereas at kindergarten, children are more vulnerable."

If a child has allergies that could be life-threatening, the kindergarten engages with the family, their medical specialist and the community, says Coulston. (What can be read into that is they seek medical verification of allergy claims.)

"Some parents are really supportive and see the logic. Others feel aggrieved because it might disrupt their family situation."

Sarah is sceptical. How much is too much, she asks? "If I had that child with life-threatening allergies, I would not expect other families to change for me."