Anaphylaxis Australia Inc

1300 728 000

www.allergyfacts.org.au
Anaphylaxis Australia Inc is supported by
funding from the Australian Government.
PUBLISHED BY
Anaphylaxis Australia Inc Copyright 2012
ACKNOWLEDGEMENTS
Anaphylaxis Australia Inc gratefully acknowledges the
support of Sue & Sam Eller, ASCIA, Alphapharm Pty
Ltd, Link Pharmaceuticals, Clayton Utz, Food Allergy &
Anaphylaxis Network.
DISCLAIMER
Anaphylaxis Australia Inc. and its members and associates
make no representation and give no warranty as to
the accuracy of the information contained within this
publication and do not accept any responsibility for any
errors or inaccuracies in or omissions from the information
contained therein (whether negligent or otherwise) and
Anaphylaxis Australia, its members and associates shall
not be held liable for any loss or damage however arising
as a result of any person acting in reliance or refraining from
acting in reliance on any information contained therein. No
reader should rely solely on the information contained in
this publication as it does not purport to be comprehensive
or to render specifc advice. This disclaimer does not
purport to exclude any warranties implied by law which
may not be lawfully excluded.
INSIDE THIS ISSUE:
Presidents Report 2
Whats Happening in WA 3
Adrenaline Autoinjector 4
Hints for Eczema Management 5
Food Allergy Research in 2011 8
AAI Awards 13
Food Recalls 16
Contacts 24
a charity committed to helping keep those with severe allergy safe
NEW
Resource
NEW
Book
Blue Wiggle,
Anthony Field
stands alongside
Anaphylaxis Australia
with son Antonio
See insert
to order
News facts
AUTUMN 2012
AUTUMN 2012
2
And.............the crowd cheered when Anthony Field,
Australias very own blue Wiggle, said yes to helping
Anaphylaxis Australia get our media Back to school and
preschool media message out to all in the community!
It was great to spend some time with Anthony and his little
boy Antonio who has food allergy just like so many of us/
our children. Some eighteen years ago, I took my now 21
year old son, Alex (who has peanut allergy) to a Wiggles
concert in Western Sydney. Anthony shook Alexs hand
and had a chat with him. Alex will kill me for sharing that
he loved wearing his Dorothy the Dinosaur hat and he was
wearing it that day! It is ironic that after this many years,
I was sitting in the Wiggles studio with Anthony and his
son, Antonio, also peanut allergic. Antonio shook hands
with me in my role as president of AAI and played with the
AAI Allerbling bracelet I gave him as a little gift.
The Wiggles have now produced an allergy song which
will be launched on DVD in mid 2012. How special is that?
AAI thanks Anthony, Antonio and indeed The Wiggles for
their support in getting important messages out to those
with allergy and the community more broadly. Education
of little ones at risk of anaphylaxis starts almost at the time
babies start walking, talking and singing. We look forward
to working with The Wiggles to help educate and increase
awareness in the special way they can.
The world of AAI has been frantic since the school/
preschool year resumed in Feb 2012. Our website,
online shop, email and phone support people have been
busy trying to keep up with demands. Many enquiries
surround children, but the scope of the support and the
information we give/share extends to camp facilities,
prisons, hospitals, sporting groups, defence forces,
universities, restaurants, food manufacturers, government
departments, workplaces and more.
Our theme for Food Allergy Awareness Week in May
14-18 2012 is Aussies with Allergies - food allergy does
not discriminate. Whether you are 6 or 60, an atheist or
a Protestant/Catholic/Buddist, English speaking or non-
English speaking, well to do or just your average Aussie,
have a university education or are a high school dropout
- food allergy has woven into the Australian community
with no boundary. We are Aussies with allergies and we
are doing what we can to increase safety for all, so they
can live a normal (well.... very close to normal!) life. Keep
an eye on our website and become our face book friend
so you can keep up to date with progress as we lead up
to May 14th.
Huge thanks to all our members and supporters who
help us keep doing what we do best through awareness,
education, research and support. n
Best wishes,
Maria
Presidents Report
Anthony, Antonio and Maria -
The Wiggles and Anaphylaxis Australia meet up for kids with allergies.
AUTUMN 2012
3
THANK YOU
Anaphylaxis Australia would like to thank the many families
who participated in the WA Health focus group sessions
for teens. The information provided by the teens who
participated will be used to develop resources for this age
group to assist them in managing their severe allergies.
Anaphylaxis Australia would like to thank Robyn Willis
and Joanna Elliott for their very useful education session
Teen speak: Talking with your Teenager. This education
session focused on how to effectively communicate with
your teenager and how that can assist with helping them
to manage their medical conditions such as allergies.
WHATS HAPPENING IN WA
Anaphylaxis Australia and WA Health are working together
to increase community awareness of anaphylaxis. A
number of activities have been planned to coincide with
Food Allergy Awareness Week:
SCHOOL COMPETITIONS
School students in WA can enter either a poster
competition (kindy grade 7) or a video competition
(years 7-12). The closing date for entries is Friday
13th April, 2012. More information and entry forms
are available from the Anaphylaxis Australia website
(www.allergyfacts.org.au). Prizes iPad Touch/iPad
COMMUNITY LECTURE
On Monday 14th May 2012, a free community lecture on
managing food allergy will be presented by Ingrid Roche,
Allergy dietitian at Princess Margaret Hospital. Clinical
psychologists Joanna Elliot and Robyn Willis will also
talk about how to manage the anxiety of managing food
allergy. Those attending will also have the opportunity to
ask questions of a panel which includes the presenters,
Richard Loh (clinical immunology and allergy specialist,
PMH), Val Noble (Clinical nurse specialist in allergy, PMH)
and Sandra Vale (Anaphylaxis Australia).
For more information and to register to attend, contact
Jasmine Lamb at WA Health by email
anaphylaxis@health.wa.gov.au
or phone 08 9323 6670.
WA SCHOOLS BE A MATE AWARDS.
In 2012, in collaboration with and support from Western
Australian Department of Health and Child and Adolescent
Health Service, Anaphylaxis Australia will be running this
competition to fnd a primary or high school in Western
Australian that is worthy of this award. The call is now
open to parents and students to nominate a school
they feel has made a signifcant difference in improving
the care and support given to those students at risk of
anaphylaxis. If you would like to nominate a school for
a WA Be a MATE award, visit the Anaphylaxis Australia
website (www.allergyfacts.org.au) to fnd out more
information or download a nomination form. n
Whats Happening in WA

Food Allergy Awareness
Week May 14 18th 2012
Theme: Aussies with allergies
food allergy does not discriminate.
Mark your diaries and get involved
to raise awareness of food allergy.
Your FAAW pack will be sent to
all members in early April.
Visit our dedicated FAAW website
www.foodallergyaware.com.au
which has many activities listed
with more to be added soon!
AUTUMN 2012
4
Adrenaline Autoinjector
and Action Plan CHECK
Currently there are two different brands of adrenaline
autoinjectors (EpiPen

and Anapen

) available in Australia,
with different administration techniques. Only one brand
should be prescribed per individual and their ASCIA
Action Plan for Anaphylaxis must be specifc for the brand
they have been prescribed. The brands of adrenaline
autoinjectors look different and steps to administer the
devices are different.
At present, and until October 1 2012, we have three
different looking adrenaline autoinjectors in the Australian
market place. We have two different shape/coloured end
type of EpiPens and of course the Anapen. (Although the
original look EpiPen is no longer provided in market, the
last of the original EpiPens are due to expire at the end of
September 2012). Anaphylaxis Australia is concerned that
some parents, teachers and childcare staff do not know
what their autoinjector looks like and sometimes even
which of the different devices has been prescribed.
It is critical that the individual and those who care for them
know what device has been prescribed and dispensed
by the pharmacy and that they have an Action Plan for
Anaphylaxis that matches that device. Although EpiPen Jr
and Anapen Jr, and then EpiPen and Anapen contain the
same dose of adrenaline, the method of administration of
EpiPen and Anapen is different. The decision on whether
a person is prescribed an EpiPen or an Anapen is one that
is made after discussion between the parent / patient and
the prescribing doctor.
It is important that the person prescribed an adrenaline
autoinjector has the ASCIA Action Plan for Anaphylaxis that
matches the device they currently have. It could be the
original style EpiPen, the new look EpiPen or the Anapen.
Open the box of your adrenaline autoinjector and look at
the device. Check that you / your childs current ASCIA
Action Plan for Anaphylaxis matches the device that you
have. In an emergency, although people regularly practise
administration using an autoinjector training device people
may need to follow instructions on the Action Plan so it is
important that the instructions (words and pictures) match
the device. n
NOTE:
Training Anapen and EpiPen devices (and DVDs
showing administration) can be purchased through
Anaphylaxis Australia www.allergyfacts.org.au

MEET WITH OTHERS AT RISK OF
ANAPHYLAXIS IN SA
As the representative of Anaphylaxis Australia for SA, I
would like to meet with other allergy sufferers and their
families and see how we can help each other and how as an
organization AAI can improve awareness through education,
research and support. Our frst get together will be a family
picnic.
Where: Bush Magic Playground at the Adelaide Aquatic
Centre, at the corner of Jefcott Road and Fitzroy Terrace
North Adelaide.
When: 12 noon on Sunday 29th April. Hopefully at this get
together we can make arrangements for other projects and
meetings if the group feels they might be benefcial.
Please drop me an email (or give me a call) if you are
interested in attending. I will email you a few days
beforehand to confrm the above details and I look forward to
meeting with you and your families.
Pooja Newman
AAI SA Representative
Email: pooj@thenewmans.net.au
Phone: (08) 83420876
AUTUMN 2012
5
Hints for Eczema Management
Written by Deryn Thompson, Eczema Nurse & Allergy
CN, WCHN., Lecturer University of South Australia
Eczema, also called atopic dermatitis, is a chronic
condition affecting 1 in 4 Australian children and numbers
are still rising
1
. Some will be grow out of it around the time
they start school, but some will have the condition until
teenage years or adulthood. The key to keeping eczema in
remission, is to apply a thick enough moisturiser regularly,
if possible twice daily, and to continue once or twice daily
even when the skin looks better and eczema seems to
have disappeared
1,6
.
Eczema triggers vary greatly from person to person.
Common triggers often overlooked are:
heat/lack of humidity
change of seasons
colds & general infections/illness
teething in infants and smaller children
stress
tiredness (as tired people with eczema scratch)
forgetting to moisturise every day!!
Extra moisturising at these times usually helps. If reddened
fares occur, use the topical cortico-steroid cream
prescribed by your doctor. A helpful resource for those
fearful of using topical cortico-steroids: Steroid phobia
www.eczema.org/Steroid_Phobia_Article.pd
2
Peri-oral contact dermatitis:
Protect your babys mouth with a thick barrier type
preparation, prior to eating, particularly when introducing
new foods. Babies usually get food all over their face and
redness is a very common result (mild peri-oral contact
dermatitis). Protect the area with a thick, barrier type
ointment/cream before eating. Wash food off and re-
moisturise the area. For mild contact reactions, referral for
allergy testing is usually not needed
3
. Parents automatically
blame foods and focus on allergy triggers, but removal of
foods, that are eaten regularly, is not advised unless there
is a defnite, reproducible link or rash on the body. If that
occurs, medical advice should be sought. Research now
shows that unnecessary removal of foods from childrens
diets may actually increase the risk of serious reactions
later on.
Eczema cannot be cured and is caused by both genetic
factors and environmental factors. It is an infammatory
skin condition where impairment to the skin barrier, which
normally protects it from invading germs, irritants and
allergens occurs. The skin also produces fewer oils and
lamellar lipids (fats) needed to keep the skin waterproof,
soft and supple. Skin is dry, red and itchy. Scratching
causes the skin to release more chemicals that keep the
skin feeling itchy. Eczema may affect most of the body
or just patches such as the face, elbows, knees, wrists,
ankles and even the buttocks. Some people may have
eczema that looks like round circles (discoid eczema).
Unfortunately there is no quick fx.
4

It is important to use
non-soap based cleansing products (ones that do not
bubble)
applying thick enough moisturiser regularly and continuing
to moisturise when skin looks better
Think of skin as being like a brick wall in which skin
cells are the bricks and the mortar is the glue that
holds everything together. In the skin the mortar is the
moisturising factors and oils that people with eczema
cannot produce in suffcient quantities. You can begin to
understand why moisturising is so important. Using the
right thickness depending on skin dryness is the key to
more control over eczema.
AUTUMN 2012
6
See link to brick wall concept: http://www.allergy.org.au/
content/view/173/148/
5
Moisturisers come in three thicknesses:
Runny (usually in a pump pack)
Medium thickness (thick crme in a tub.
Turn tub upside down and it will not come out)
Greasy.
Using a runny one when skin is very dry, means that
the gaps may not be flled up for very long. A thicker
moisturiser will. It will also replace the barrier on the skin
to keep allergens and irritants out.
Common triggers not thought about are:
Teething
Change of seasons
Generalised sickness, eg. colds, viral infection
Tiredness (tired children scratch)
Change of the seasons can trigger peoples eczema.
For some eczema worsens for others it may improve.
There is no test to tell to which group you belong.
Here are some tips:
Swimming: apply moisturiser to the skin before going
into the pool or sea water. This helps stop the chemicals
penetrating the skin, getting down where the mortar should
be. In the sea it can help protect it from stinging. If you or
your child fnds sea water soothing and it helps, you may
be able to get away without using any beforehand. After
swimming wash the skin with a non-soap based product
if possible, then apply more moisturiser.
Sunscreen: People may fnd sunscreen dries out the skin
and it feels itchy (without any rash) when they apply it. If
so, you can moisturise the skin with your usual moisturiser,
wait 5-10 minutes then apply the sunscreen in the amount
you would usually use. A guide to sunscreen can be found:
http://nano.foe.org.au/safesunscreens
7
Sweating: Research is showing that sweating may play
a role in making some peoples eczema worse. Try using
a fan or keeping the environment at the temperature you
fnds works best for you. Shower if you have been very
sweaty, and remoisturise afterwards.
Aero-allergens: For those who notice that seasonal
aero-allergens (grasses, airborne moulds) affect their
eczema, try to minimise exposure to the triggers. Dry
bed linen and even clothes inside, rather than outside
where they will trap pollens/moulds/grain dusts etc. If an
antihistamine helps for hayfever related symptoms, it may
help the eczema itch for some people.
Greasy moisturisers: If using the greasy moisturisers
makes you/your child feel hotter on hot days, you can
use a thick crme consistency one instead, but you will
probably fnd you need to apply it more often and to
remember to do so!
Winter heating: Heating reduces humidity and may
affect eczema. Try to increase the humidity by a) drying
washing on an airer in the room b) using a humidifer. n
REFERENCES:
1
Odhiambo, J., Williams, C., Tadd, C. Robertson. C. Asher, A. and
ISAAC Three Study group, 2009, Global variations in Prevalence of
eczema symptoms in Children from ISAAC Phase Three, Journal of
Allergy and Clinical Immunology, vol.124, pp.1251-1258.
2
National Eczema Society UK 2008, Taibjee, S. & Charman, C.
Steroid Phobia
www.eczema.org/Steroid_Phobia_Article.pd>
3
Childrens Hospital Westmead 2008 Food allergies & Eczema
www.kidshealth.chw.edu.au/fact-sheets/food-allergies-and-eczema
4
Cork, M. & Danby, S. 2009 Skin Barrier Breakdown: a renaissance
in emollient therapy, British Journal of Nursing, vol.18, no.4,
pp.872-877.
5 Australasian Society of Clinical Immunology & Allergy (ASCIA) http://
www.allergy.org.au/content/view/173/148/>
6
National Institute for Health & Clinical Excellence, 2007, Atopic
Eczema in Children: management of atopic eczema in children from
Birth up to the age of 12 years. http://www.nice.org.uk/nicemedia/
pdf/CG057FullGuideline.pdf
7
Friends of the Earth Safe Sunscreen Guide 2011/2012
http://nano.foe.org.au/safesunscreens
Hints for Eczema Management
Z- CARD FOR EPIPEN

USERS
Members will fnd a wallet sized folded ASCIA
Action Plan Z-card included as a loose insert,
with this newsletter. This is for use by individuals
prescribed an EpiPen only. If you do not have an
EpiPen please give the Z-card to someone with an
EpiPen, return it to AAI or discard it.
Please read the article on page 4. Make sure
your ASCIA Action Plan matches the adrenaline
autoinjector you have been prescribed.
AUTUMN 2012
7
Allergy and the risk of anaphylaxis -
deciding on an adrenaline autoinjector prescription
Written by Dr Brynn Wainstein, Paediatric Immunologist
Anaphylaxis is the most severe form of an allergic reaction.
Anaphylaxis can occur when an allergic individual is
exposed to the substance (allergen) to which they are
allergic. For many individuals this means food allergens
such as nuts, milk, egg, wheat etc but for others it may
mean insect stings or bites. Symptoms seen in anaphylaxis
are:
diffcult/noisy breathing
swelling of tongue
swelling/tightness in throat
diffculty talking and/or hoarse voice
wheeze or persistent cough
persistent dizziness or collapse
pale and foppy (young children)
Any one of these signs or symptoms indicates
anaphylaxis. The immediate treatment of anaphylaxis is
a dose of adrenaline by injection into the muscle of the
outer mid thigh. An individual who has had an anaphylaxis
or is assessed at high risk of anaphylaxis needs to
have an adrenaline autoinjector (EpiPen or Anapen).
Antihistamines are often used to treat milder, non-
anaphylactic allergic reactions such as hives, but are not a
treatment for severe allergic reactions. Also antihistamines
do not prevent reactions progressing to anaphylaxis (if
that is what is going to happen) even if they are given
early, hence the need for individuals to carry an adrenaline
autoinjector.
In Australia, there are two brands of adrenaline
autoinjectors, EpiPen and Anapen. The green labelled
devices are appropriate for children between 10 kg and
20 kg in weight while any child over 20 kg should have the
yellow labelled, higher dose devices.
It is often diffcult to predict the risk of anaphylaxis for
a given food allergic individual, this is especially true if
there is no history of a severe reaction in the past. Allergy
tests, such as skin tests, are often not very useful on their
own (i.e. without the history of an allergic reaction ever
occurring) for predicting the risk that anaphylaxis may
occur. There are many different factors that determine the
potential severity of an individual reaction. These include
for example the individuals age, the food the individual
is allergic to, whether the individual has asthma, the
amount of food ingested, concurrent illness, and exercise
during or after ingesting the food, access to ambulance
services and of course the past history of reactions (mild,
moderate and severe allergic reactions). Therefore the
severity of reactions can differ from one occasion to the
next and as such there is no such thing as an individual
with anaphylaxis to [insert food here], but equally it is
very diffcult to say that a particular individual can never be
at risk of anaphylaxis. It is better to think of the individual
as food allergic and anaphylaxis as a risk rather than a
permanent state of being.
Your doctor (GP, paediatrician or allergy specialist)
will assess these various factors in deciding whether
to prescribe an adrenaline autoinjector. It is perfectly
reasonable and appropriate to prescribe an adrenaline
autoinjector for individuals assessed to have an allergy
and assessed to be in the higher risk group of having an
anaphylaxis. However, there may be circumstances where
your doctor feels that the risk of anaphylaxis is, to the best
of their opinion, low enough not to warrant an adrenaline
autoinjector prescription at that time. That does not mean
that anaphylaxis can never occur, it just means that your
doctor has assessed the risk of anaphylaxis to be low at
that particular time but will continue to review every year or
two or if they have a more signifcant reaction. A common
example of this may be an individual with a positive allergy
skin or blood test to a food they have never eaten or
reacted to in the past. Cont. page 12
AUTUMN 2012
8
Food Allergy
Research in 2011
Scientifc advances in the feld of allergy in 2011 have
enlightened us and continue to give us hope for a cure
for food allergy. In this issue, we highlight the published
research deemed to have the most impact by leaders in
the medical feld.
Epidemiology (Prevalence and Patterns)
The largest study to evaluate the prevalence of food
allergy among children in the U.S., funded by the Food
Allergy Initiative (FAI), made international headlines last
year for both the scope of the study and its fndings that
suggest the impact of food allergy is far more signifcant
than previously thought.
1
Researchers found that 8% of
children, or nearly 6 million children, have food allergies.
We also learned that nearly 40% of children have a history
of severe reactions and 30% have multiple food allergies.
The prevalence of common allergens among children
was determined as follows: 2% for peanut, 1.7% for milk,
1.4% for shellfsh, 1.0% for tree nuts, 0.8% for egg, 0.5%
for fn fsh, 0.4% for strawberries, 0.4% for wheat, and
0.4% for soy.
I do believe that the increase in prevalence is real, Ruchi
S. Gupta, M.D., the lead author of the study told MSNBC.
The question is, what has changed in our environment
and our lifestyles that is causing this?
Ruchi plans on looking into this question in future studies.
Another study bolstering what we already know that
food allergy is a serious medical condition looked into
the number of emergency department visits related to
food allergy reactions. Using data from two emergency
department-based studies and the National Hospital
Ambulatory Medical Care Survey, researchers estimated
there are approximately 203,000 emergency department
visits for food allergy reactions annually.
2
The study
concluded that on average, there is an emergency
department visit for a food allergy reaction somewhere in
the U.S. every three minutes. A food-related anaphylaxis
case is brought to the emergency department every
six minutes. Recent concerns about the increasing
prevalence of food allergy support further research on
time trends in emergency department use for food-related
acute allergic reactions, the studys authors wrote. Well
designed surveillance programs are needed to improve
our understanding of the incidence and prevalence of
food-related allergic reactions. Together, such work will
improve public awareness about food allergy and assist
efforts to ensure that appropriate resources are allocated
for this potentially life-threatening condition.
This study was also funded by FAI. Another study looking
into food allergy in the U.S. evaluated the economic burden
of treating food allergy reactions. This FAAN-funded study,
the frst of its kind, concluded that the cost of treating
food allergic reactions is between $340 and $510 million
per year.
3
Using federal databases and reviewing medical
records from 2006 and 2007, researchers estimated the
average cost of illness per patient, looking at emergency
visits, offce-based physician visits, and outpatient visits
for food-induced allergic reactions. This healthcare use
resulted in medical costs of $225 million to $307 million
and lost productivity valued at $115 million to $203 million.
This study made an important advance in setting the foor
for costs associated with food-allergic reactions. The data
confrms that there is a signifcant fnancial consequence
associated with food allergy, not only to individual families
but to the healthcare system as well, said FAAN CEO
Maria Acebal.
Given the practical diffculty in tracking food allergic
reactions, the increase in the prevalence of food allergy
since 2007, and the additional direct out-of-pocket costs
to families and to other key sectors such as schools and
the food industry in managing the condition, the total
economic burden of food allergies, as opposed to just
food-allergic reactions, is higher than estimated in this
study.
2012, The Food & Anaphylaxis Network. Used with permission.
AUTUMN 2012
9
Food Allergy
Research in 2011
A landmark study in the area of epidemiology was
conducted in Melbourne, Australia, where researchers
sought to determine the prevalence of select IgE-
mediated food allergies using a population-based sample
of 1-year-old infants, using oral food challenges to obtain
more accurate results.
The study concluded that more than 10% of these infants
had IgE-mediated food allergy as diagnosed by oral
food challenges, a higher than expected result.
4
Out of
nearly 3,000 infants, 8.9% were sensitized to peanut (a
determination made through skin prick testing), 16.5% to
raw egg white, 2.5% to sesame, 5.6% to cows milk, and
0.9% to shellfsh. Once these infants underwent oral food
challenges, 3% were allergic to peanut, 8.9% to raw egg,
and 0.8% to sesame. Oral food challenges to cows milk
and shellfsh were not performed.
Etiology (Cause)
Scientists have continually searched for the cause of food
allergy, an integral piece of the puzzle that would help us
understand why some people have food allergies and
others do not. Several studies in 2011 delved into factors
that have been investigated for their role in food allergy,
such as vitamin D and the timing of introducing foods.
One of these studies, using records from the National
Health and Nutrition Examination Survey, looked into the
association between IgE sensitization levels in children
and adults and vitamin D defciency.
5
Researchers found
that children with vitamin D defciency were more likely
to have allergic sensitization to food and environmental
allergies, while adults were not. Allergic sensitization was
determined by a questionnaire and IgE levels from blood
tests. Researchers suggest that because the prevalence
of both allergy and vitamin D defciency is on the rise in the
U.S., these two phenomena could be related.
Another study looked into the question of whether the
introduction of food at an early age affects the development
of food allergy.
6
This study involved a cohort of mothers
and their infants in the metropolitan Detroit area, and it
investigated the relationship between the introduction of
complementary food (defned as solid foods and cows
milk) before the age of 4 months and egg, milk, and
peanut allergy. Researchers interviewed mothers about
their feeding practices and collected blood samples from
their children at age 2 to 3 to determine their IgE levels
to egg, milk, and peanut. In general, early introduction of
complementary foods was not found to be signifcantly
related to food sensitization. Among children whose
parents had a history of asthma or allergy and who were
introduced to complementary food prior to 4 months,
however, researchers observed a reduction in the risk of
peanut sensitization by age 2 to 3 years, and a possible
reduction in the risk of egg sensitization.
Another study that has attracted global attention
investigated the association between peanut allergy and
the Filaggrin gene, which has been found to be a factor in
eczema and asthma. Researchers from Canada, Ireland,
the Netherlands, and the United Kingdom teamed up for
this study to determine whether a Filaggrin mutation was
associated with peanut allergy.
7
A Filaggrin defect had previously been linked to eczema,
but researchers found that some people with peanut
allergy who did not have eczema also had a Filaggrin
defect. This suggests people who have a Filaggrin
mutations may have a signifcant risk of peanut allergy.
Now, for the frst time, we have a genetic change that can
be frmly linked to peanut allergy, Sara Brown, M.D., one
of the studys authors, told BBC News.
Diagnosis
The diagnosis of food allergy is not always straightforward.
According to the clinical guidelines released in late 2010,
blood or skin tests alone cannot serve as the basis for
a food allergy diagnosis. Your healthcare provider should
also take into account clinical history, and an oral food
challenge may be warranted. While the double-blind,
placebo-controlled food challenge is the gold standard for
AUTUMN 2012
10
Food Allergy
Research in 2011
food allergy diagnosis, this procedure is time-consuming
and costly. An equally important factor is the concern that
a patient will experience a severe reaction during a food
challenge.
Researchers in the U.K. have shown that the majority of
children with sensitization to whole peanut are not allergic
to peanuts.
8
Using component diagnostics, researchers
found differences in the peanut component proteins
sensitization profles of children with peanut allergy
compared to those who could tolerate peanut. These
fndings bolstered many scientists belief that the peanut
allergen Ara h 2 could be the most important predictor
of allergy. However, this diagnostic tool (microarray
technology) is not yet ready for clinical use.
Another study looking into diagnosis was conducted at
the University College Cork in Ireland, where researchers
sought to develop and test a model that would predict the
outcome of a food challenge.
9
The Cork-Southampton
calculator, which was developed by devising an allergen-
specifc algorithm for foods such as milk, egg, and peanut,
gives 96% accuracy, according to the studys fndings.
Researchers compared the outcomes of combinations
of data based on clinical factors such as skin prick test
results, total IgE, clinical history, and age to the results of
patients food challenges and then developed a prediction
model.
Young children can fnd the normal food allergy tests
quite stressful and this test will take a lot of the distress
out of the process, even just by delaying a challenge until
the odds of passing it improve over time, said study co-
author Audrey DunnGalvin, M.D., in a news release. It has
also implications for oral immunotherapy where clinicians
try to desensitize children to their allergies by giving them
controlled doses of the food to which they are allergic.
Treatment
Last year, scientists published the results of several studies
that are very encouraging and offer hope for treatment or
therapy for food allergy in coming years.
In 2011, researchers continue to study the safety and
evaluate effcacy of therapies such as sublingual
immunotherapy (SLIT) and oral immunotherapy (OIT) for
peanut allergy.
SLIT is a form of treatment in which a small amount of
the allergen dissolved in a solution is placed under the
tongue for a period of 1 to 2 minutes before swallowing.
At Duke Universitys Clinical Research Unit, a group of
children with peanut allergy underwent a double-blind,
placeb-controlled study. All of the children who received
the peanut SLIT (others received a placebo) were able
to safely ingest approximately six to seven peanuts after
completing 12 months of dosing. The SLIT was found to
have induced signifcant desensitization, but researchers
conclude that more studies are required to assess long-
term clinical tolerance.
10
A separate study, conducted at both Duke University and
Arkansas Childrens Hospital, is continuing to look at the
safety and effcacy of peanut oral immunotherapy.
11
This
trial involved 28 children with peanut allergy who were
given peanut four or placebo. The children went through
an initial day escalation phase, home dosing, build-up
visits, and a maintenance phase. Approximately half
of the children undergoing the peanut OIT experienced
reactions that required treatment with antihistamines
two were administered epinephrine during the initial
day escalation, but those who did move onto the food
challenge stage were able to ingest approximately 20
peanuts. This study confrms earlier peanut OIT studies
that show this method induces desensitization. Studies
continue to determine whether long-term tolerance can
be achieved through peanut OIT.
AUTUMN 2012
11
Food Allergy
Research in 2011
Promising results have also been seen in milk allergy
studies, such as one conducted at Mount Sinai School
of Medicines Jaffe Food Allergy Institute.
12
Under the
careful observation and guidance of the researchers,
children with milk allergy who were enrolled in this long-
term study made baked milk part of their regular diet.
Previously, researchers had found that the majority (about
75%) of children with milk allergy could tolerate baked
milk products such as muffns or waffes. Children with
milk allergy were observed to fall into one of two groups:
those with a mild phenotype of IgE-mediated milk allergy
who were tolerant of baked milk but not unheated milk,
and those with a severe phenotype who were baked milk-
reactive.
According to the studys fndings, it appears that the
children who were baked milk-tolerant who achieved
unheated milk tolerance did so at a signifcantly faster rate
compared with those who strictly avoided milk. This is
signifcant for children who pass a baked milk challenge in
that they may be able to outgrow their milk allergy more
rapidly than a child who does not. Researchers caution
that these food challenges absolutely should not be
performed without strict guidance from a trained health
specialist.
Another future possible treatment involves anti-IgE
therapy for peanut allergy. Last year, the limited results
of a phase II, randomized, double-blind, parallel-group,
placebo-controlled oral food challenge trial of Xolair
(omalizumab) were published in the Journal of Allergy and
Clinical Immunology.
13
Researchers set out to determine
whether Xolair, which has been approved for use in asthma
patients, could be effective in preventing allergic reactions
to small amounts of peanut. This study was halted early
because of anaphylactic reactions that occurred during
oral food challenges before the drug was administered.
Just 14 patients had reached the studys primary endpoint
before the trial was discontinued. However, researchers
documented some positive trends in post-therapy peanut
challenge thresholds.
Data collected from oral food challenges conducted
after the patients had received Xolair treatment suggests
that they experienced an increase in tolerability to
peanut four. Scientists from some of the nations most
prestigious food allergy research centers say these limited
results demonstrate that Xolair studies may merit further
investigation.
Conclusion
As you can see, food allergy treatment remains a priority
for many researchers around the world. Well continue to
keep you posted on the fndings of key studies throughout
the year in this newsletter as well as our members-only
Quarterly Research E-Update.n
References:
1 The prevalence, severity, and distribution of childhood food allergy in the United States.
Pediatrics, 2011;128:e9-e17.
2 Frequency of U.S. emergency department visits for food-related acute allergic reactions. J.
Allergy Clin Immunol, 2011;127:682-683.
3 Estimating the economic burden of food-induced allergic reactions and anaphylaxis in the
United States. J. Allergy Clin Immunol, 2011;128:110-115.e5.
4 Prevalence of challenge-proven Ig-mediated food allergy using population-based sampling
and predetermined challenge criteria in infants. J. Allergy Clin Immunol, 2011;127:668-676.e2.
5 Vitamin D levels and food and environmental allergies in the United States: Results from the
National Health and Nutrition Examination Survey 2005-2006. J. Allergy Clin Immunol,
2011;127:1195-1202.
6 Early complementary feeding and risk of food sensitization in a birth cohort. J. Allergy
Clin Immunol, 2011;127:1203-1210.e5.
7 Loss-of-function variants in the flaggrin gene are a signifcant risk factor for peanut allergy. J.
Allergy Clin Immunol, 2011;127:661-667.
8 Quantifcation of specifc IgE to whole peanut extract and peanut components in prediction of
peanut allergy. J. Allergy Clin Immunol, 2011;127:684-685.
9 Highly accurate prediction of food challenge outcome using routinely available clinical data. J.
Allergy Clin Immunol, 2011;127:633-639.e3.
10 Sublingual immunotherapy for peanut allergy: Clinical and immunologic evidence of
desensitization. J. Allergy Clin Immunol, 2011;127:640-646.e1.
11 A randomized controlled study of peanut oral immunotherapy: Clinical desensitization and
modulation of the allergic response. J. Allergy Clin Immunol, 2011:127:654-660.
12 Dietary baked milk accelerates the resolution of cows milk allergy in children. J. Allergy Clin
Immunol, 2011;128:125-131.e2.
13 A phase II, randomized, double-blind, parallel-group, placebo-controlled oral food challenge
trial of Xolair (omalizumab) in peanut allergy. J. Allergy Clin Immunol, 2011:127:1309-1310.e1
AUTUMN 2012
12
Thanks to our
Medical Advisory Board
The AAI national Committee, state
coordinators and phone support volunteers
would like to thank our Medical Advisory
Board members for their ongoing support and
commitment. We sincerely thank:
Dr Brynn Wainstein
Dr Richard Loh
Dr Jane Peake
Dr Raymond Mullins
Dr Mimi Tang
Dr Michael Gold
for sharing their knowledge, time and expertise with AAI, its
members and non members. These men and women, all
with families and a life away from allergy and anaphylaxis,
have continued to relentlessly drive allergy management
forward for all Australians. Often they say, we would not
have been able to progress without the support of a loud
patient voice (i.e. AAI) but we too, would not have been
able to achieve what we have achieved without their
ongoing dedication, guidance and enthusiasm.
Our Medical Board members liaise closely with AAI
Executive, responding to emails, organising meetings
and making themselves available, returning calls between
heavy patient clinics and other commitments, writing an
article or reviewing material for our newsletter or advising
on a diffcult case that comes across our desk to name
just a few areas of daily interaction.
Thanks to each and every one of our Medical Board
members and ASCIA Executive Offcer, Jill Smith. Please
be aware of how much we appreciate your efforts.
Together, we are making a difference.
Maria Said on behalf of all AAI Committee and members
n
Cont. from page 7
It is best to discuss the decision to prescribe an adrenaline
autoinjector, or not, with your doctor so that you can
understand why they are recommending a particular
management plan. Finally if an adrenaline autoinjector is
prescribed it is essential that the individual is provided
with a red ASCIA Action Plan for Anaphylaxis (personal)
for the brand of device prescribed. For children who are
prescribed an adrenaline autoinjector, an original copy of
the plan should be given to the school or childcare facility
together with the adrenaline autoinjector device.
Individuals who are not prescribed an adrenaline
autoinjector should still have a green ASCIA Action Plan
for Allergic Reactions in place. Please note that ASCIA
Action Plans need to be completed and signed by your
doctor as they are a medical documents and cannot be
altered or amended in any way unless by your doctor.n
AUTUMN 2012
13
Dr John Ruhno Award and
Be a MATE Award
Huge thanks to members who nominated schools,
preschools and individuals for our 2011 Dr John Ruhno
and Be a MATE Awards. As always, it was diffcult
for the AAI Committee to decide on those nominated
as so many are now doing what they can to increase
awareness and therefore safety in the Australian
community.
The nominee selected to receive the Dr John Ruhno
Award is Alessandro Teghini. Sandro is a young man
who has lived with multiple food allergies all his life. He
grew up at a time when there was very little community
awareness. Although he knows just how important it
is for all in the community to be aware of food allergy
Sandro has owned his allergies and learned to navigate
life safely around them; he has taken responsibility and
lives, works and holidays owning his food allergy. He
is a great inspiration to many and never hesitates to
help increase awareness and encourage others who
live or care for those with severe allergy and the risk of
anaphylaxis. Congratulations Sandro!
The successful nominee of Anaphylaxis Australias
Be a MATE Award is Quarry Hill Primary School in
Victoria. Principal Andrew Schaeche and his staff are
to be commended on doing what they can to support
children with any food allergy. The school has embraced
food allergy management and thought outside the
square, implementing strategies to increase school
community awareness and help keep children with
food allergy stay safe. The education of the school
community, recognition of non allergic students who look
out for children with allergy and the installation of extra
taps at school for hand washing are wonderful steps
forward for all.
In liaison with the Royal Childrens Hospital, this school,
over 100 years old, applied for a state government
grant to help with plumbing and installation of two hand
wash stations where taps are operated by a foot pedal
- this novelty encourages children to wash hands after
eating. Foods are not banned but children and families
are informed of food allergy, students are reminded not
to share food, parents of children with allergy notifed
prior to any food related activities, there are awards for
children for being a champion hand washer and for
those displaying allergy aware behaviour. Well done and
congratulations to Quarry Hill Primary School!
Sandro and Quarry Hill Primary will be receiving a plaque
or trophy to commemorate their success.
2011 Anaphylaxis Australia
Awards
AUTUMN 2012
14
An inspiring
Greatest Moment
Hi, my name is Swapnik. My Year 7 class teacher recently
asked the class group to write a story about our Greatest
Moment. I decided to write about my great food allergy
moment! Here is my short story:
Many people believe that their greatest moments may be
passing the Selective test or winning a sporting and other
competition however, mine is a little more personal. I was
only 5 and starting school when I was called up for an
allergy test. You see, I was and still am allergic to a great
many things (which I wont go into) and had not gotten
over any. My most dangerous allergies were peanuts and
dairy. This time I was called up for a peanut test as the
doctor thought I may have gotten over it.
As I reached the doctors surgery I was told to sit down
and wait. The time eventually came and I was called into
a room. In the room the nurses conducted several tests of
which I have no memory. However, the actual test was far
from done. A small portion of peanut butter was smeared
onto my lip and left to see if it would induce any reaction.
After approximately 30 minutes I was given a small piece
of bread with peanut butter and told to eat it. This process
kept going on and on until I was told to eat an entire
peanut butter sandwich. This produced no reaction. I was
clear and could now eat peanuts freely without any worry
of causing an anaphylactic reaction.
It had been fve hours since the entire process had started.
Even though I was cleared of all doubts, the process was
not over. I was kept under observation for another hour
to see if any last minute reactions occurred. The wait was
fnally over and I was clear to go home beyond all doubt.
To put it simply, I was ecstatic. The only thing I could
think of was going out and eating every peanut related
thing that I could eat until I could eat no more. It was the
best feeling to be able to walk into a store and pick up
peanuts /products off the shelf without hesitating. I could
eat peanuts and there was no need for my EpiPen. My
peanut allergy was gone. You may think that what is the
big deal and why I am so happy but the answer is that I
had gotten over the most diffcult allergy to get over and
the greatest thing was that I was only fve.
Getting over my peanut allergy would defnitely be one
of the greatest moments of my life however I am only 11
years old. So far nothing can compare to this feeling of
absolute joy and it is one moment that I will never forget!
Swapnik, NSW AAI member.
Dear Swapnik,
THANK YOU for sharing your story with us! I know
you still have allergies to egg, milk, tree nuts and
seafood so to read of your excitement at losing
your peanut allergy is really inspiring. You know,
sometimes we feel badly done by because we live
with food allergy or insect sting allergy, but we really
can make the most of what we do have and not
make what we cannot have the focus of our lives.
Editor
AUTUMN 2012
15
AUTUMN 2012
16
Food Alerts
SOY ALERT
Food Product: Bakery item
Brand Name: Kiss Kiss Pastizzi, Bonza Bacon and
Ricotta, Cheeky Curry Chicken, Funky Fetta, Perfect
Pizza, Playful Pea and Bacon, Super Spinach and
Ricotta, Wicked Vegetable, Raging Ricotta, Awesome
Apple
Best before date:
All best before dates up to an including 24/09/2012
APN/EAN/TUN Number:
Bonza Bacon and Ricotta - 9344034000010
Cheeky Curry Chicken - 9344034000041
Funky Fetta - 9344034000065
Perfect Pizza - 9344034000058
Playful Pea and Bacon - 9344034000119
Super Spinach and Ricotta - 9344034000072
Wicked Vegetable - 9344034000089
Raging Ricotta -9344034000027
Awesome Apple - 9344034000034
Pack Description:
500g pack, 12 pieces in sealed white plastic bag
Country of Origin: Australia
Distribution: WA
REASON FOR RECALL: UNDECLARED SOY
Company Responsible:
Kiss Kiss Food Supplies Pty Ltd
FOR RECALL INFORMATION: 0422 280 823
SESAME ALERT
Food Product: Bakery processed foods
Brand Names:
Coles Chocolate Cake with Icing (cake mix)
Coles Chocolate Mud Cake (baking mix)
Coles Chocolate Fudge Brownies (baking mix)
Coles 97% Fat Free Chocolate Cake (baking mix)
Coles 97 % Fat Free Choc Chip Muffns
Coles Chocolate Drop Cupcakes (baking mix)
Coles Smart Buy Chocolate Cake Mix
Best before date:
All Best Before Dates up to and including
All best before dates up to and including 16 Dec 12
All best before dates up to and including 16 Dec 12
All best before dates up to and including 16 Dec 12
All best before dates up to and including 19 Oct 12
All best before dates up to and including 19 Oct 12
All best before dates up to and including 19 Oct 12
All best before dates up to and including 19 Oct 12
APN/EAN/TUN Number:
Pack Description: cardboard box
1. 470g, 2. 600g, 3. 600g, 4. 600g,
5. 500g, 6. 300g, 7. 340g
Country of Origin: Australia
Distribution: National
REASON FOR RECALL: UNDECLARED SESAME
Company Responsible: Coles Supermarkets Pty Ltd
FOR RECALL INFORMATION: 1800 061 562
AUTUMN 2012
17
Food Alerts (cont.)
SESAME ALERT
Food Product: Cocoa powder, cake mixes and
fudge mix
Brand Name:
Spencers Cocoa Powder
IGA Signature Chocolate Cake (cake mix)
IGA Signature Fudge Brownie Mix
IGA Signature Chocolate Baby Cake Mix
Best before date:
1. All Best Before Dates up to and including 5 OCT 2013
2. Best Before 22 NOV 12 and 12 DEC 2012
3. Best Before 21 AUG 2012 and 21 NOV 2012
4. Best Before 29 NOV 2012 and 15 DEC 2012
Pack Description:
1. Cellophane sachet, 500g
2. Cardboard pack, 500g3. Cardboard pack, 500g
4. Cardboard pack, 300g
Country of Origin: China
Distribution: National
REASON FOR RECALL: UNDECLARED SESAME
Company Responsible: Anchor Foods Pty Ltd
FOR RECALL INFORMATION: 1800 800 868
BRAZIL NUT AND ALMOND ALERT
Food Product: Confectionery
Brand Name: Walkers Chocolates of London Milk
Chocolate Selection Fruit and Nut Selection
Best before date: 1st August 2012
APN/EAN/TUN Number: 9326407017283
Pack Description: Plastic jar, 450g
Country of Origin: United Kingdom
Distribution: National through Kmart stores
REASON FOR RECALL: UNDECLARED BRAZIL
NUTS AND ALMONDS
Company Responsible: Ontrack Pty Ltd
FOR RECALL INFORMATION: 03 96456247
MILK ALERT
Food product: Bakery product
Brand Name:
1. Pepes Vegetable Peas Pastizzi
2. Pepes Apple Pastizzi
3. Pepes Pea and Bacon Pastizzi
Best before date:
Use by: All up to and including 10 Dec 2012
APN/EAN/TUN Number:
1. 9323753000129
2. 9323753000150
3. 9323753000167
Pack Description: Plastic packet containing 12
individual pieces
Country of Origin: Australia
Distribution: NSW
REASON FOR RECALL: UNDECLARED MILK
Company Responsible:
Quality Patisserie Food Pty Ltd
FOR RECALL INFORMATION: 0418 729 301
AUTUMN 2012
18
Food Alerts (cont.)
SESAME AND TREE NUT ALERT
Food product: mixed and/or processed food
Brand Name: Coles Deli 200g Spicy Capsicum Dip
Best before date: 19th March 2012
Batch Code: 06028
Pack Description: clear plastic container, 200g
Country of Origin: Australia
Distribution: NSW, ACT and VIC
REASON FOR RECALL:
UNDECLARED SESAME AND TREE NUTS
Company Responsible: Coles Supermarket Limited
FOR RECALL INFORMATION: 1800 061 562
MILK AND EGG ALERT
Food Product: Mixed and/or processed food
Brand Name: Koh-Kae Peanuts Coconut
Cream Flavoured Coated Snack
Best before date: All best before dates
currently in the marketplace
APN/EAN/TUN Number: 1. 8 852023664224
2. 8 852023664248
Pack Description: 1. 125g and 2. 265g in
orange tin with plastic lid
Country of Origin: Thailand
Distribution: National
REASON FOR RECALL:
UNDECLARED MILK AND EGG
Company Responsible:
Oriental Merchant Pty Ltd
FOR RECALL INFORMATION: 1800 806 842
SOY ALERT
Food Product: Dried meat
Brand Name: Chinese style dried pork sausages
Best before date: Use by 23rd Jan 2013
APN/EAN/TUN Number: 9315018000111
Pack Description: Vacuum sealed package
(12 sausages each pack) 375g
Country of Origin: Australia, WA
Distribution: ACT, NSW, QLD, VIC and WA
REASON FOR RECALL: UNDECLARED SOY
Company Responsible: Wing Chun company
FOR RECALL INFORMATION: 08 9249 5388
AUTUMN 2012
19
Dear Editor,
I am writing to you as a concerned parent regarding my experience with staff and the treatment of my son earlier this year
at our local hospital.
My son showed signs of an allergic reaction after eating pizza prepared outside the home. His early symptoms were
mild, but symptoms he had not experienced before, so I took him to the local hospital emergency department. By the
time we arrived at the emergency department, my son was very drowsy, struggling to stay awake and he vomited soon
after arriving.
I told an ambulance offcer that my son was having an anaphylactic reaction and he needed a wheelchair. I was told by
the ambulance offcer that he could walk. When I asked again for a wheelchair, I was told in a harsh tone that it didnt
make any difference if he walked. My sons ASCIA Action Plan for Anaphylaxis says not to stand or walk. I could not
believe that it was such a big deal to get a wheelchair at a hospital. From that point on, our experience was a diffcult one.
I did wonder, at that stage, whether I should give the adrenaline in the hospital car park but we were at the hospital so I
put my trust in hospital staff.
I asked a nurse for a wheelchair and they brought one out to my son and I told the nurse that I was concerned about my
sons blood pressure. My son was wheeled into the waiting room and we were told to wait our turn, it wouldnt be long.
I had expected that he would go straight through and they would treat him. My son was still so drowsy, I again expressed
that I was concerned about my sons blood pressure to the triage nurse they did not check his blood pressure.
When we were admitted to the emergency I explained my sons reaction. He had no hives or rash and they said his
chest was clear I again expressed my concern about his blood pressure they did not check his blood pressure. What
was particularly diffcult was the way I was treated by the staff, like I was a nuisance because I mentioned that it was not
unusual for my son to have a reaction with no hives or rash and that I was concerned about his blood pressure because he
was so drowsy. I felt like I was not heard at all. They did not treat my son with adrenaline. They inserted an intravenous
line, but did not give him fuids, only intravenous antihistamine and steroids. I was sitting there thinking, should I give him
his adrenaline autoinjector? Then I thought, what will they do if I give it will they refuse to continue treating him?
My son was monitored in the emergency department for about 45 minutes and then he was admitted to the paediatric
ward where the nurse monitored only his heart rate, not his blood pressure.
The treatment of my son was not the treatment for anaphylaxis according to his ASCIA Action Plan, despite this being
the diagnosis made by the hospital staff. Furthermore, from the moment I asked for a wheelchair, I was perceived as an
over-anxious parent and the staff were quite off-hand with me. They did not listen to my concerns about his condition or
for the treatment my son received or did not receive. I felt quite intimidated by the staff. I believe the way I was treated as
a parent was inappropriate and I would not want another parent to be treated the same way. The way I was treated made
me second guess myself. As a parent, I question how I raise my children, they dont come with an instruction manual
and every day you can be presented with an issue you never expected and werent prepared for. When it comes to my
sons allergies however, I have always trusted my instincts. I rely on them to alert me to when something is not right. I
have been with my son for every reaction he has experienced over the past 10 years and I would have thought that the
information I could offer to the emergency department staff would be a help and not a hindrance. Instead, all I did was
question myself, and as a result, my son did not receive optimal care.
Letter to the Editor
AUTUMN 2012
20
I believe the hospital gave my son the wrong message that night the message that you dont need your adrenaline
autoinjector even if you have symptoms of anaphylaxis. I have had to explain to my son that he should have been given
adrenaline and that if he has those symptoms again, he must tell an adult that he needs adrenaline.
I am sharing this experience, because I would hate for other families to be treated the same way by hospital staff and for
them to second guess themselves at a time when it is so important to be strong and trust our instincts. I have met with the
hospitals patient liaison offcer to discuss our experience in the hope that it will prevent this happening to other families. I
have also met with my sons allergist and discussed the progress of the allergic reaction and hospital management.
I hope your members will beneft from us sharing our experience. n
Dear AAI member
Thank you for sharing your experience with us and being so open to what has been a very personal, challenging and
emotional time for you and your son. Living with the risk of anaphylaxis certainly does not come with any manual.
It takes time for us to understand and implement our strategies so we can live a balanced life, a life that is careful but not
fearful. The gold standard of management is to look to evidence based information, be guided by our treating doctors,
and avoid listening to anecdotal stories or searching randomly on the internet for answers. We take all this information, put
it into perspective and hope we can come up with a balanced approach. Few of us are doctors or medical professionals;
we are adults, parents and/or carers of someone close who has been prescribed an adrenaline autoinjector. When we feel
we have our internal compass set, along comes an experience like yours which tips us over and leaves us questioning
ourselves.
As parents/individuals we learn that each allergic reaction can be different in presentation due to the many different factors
that determine the potential severity of an individual reaction. Some of these factors include the individuals age, whether
the individual has asthma, the amount of food ingested, concurrent illness, and exercise during or after ingesting the food,
access to ambulance services and of course the past history of reactions mild, moderate and severe allergic reactions).
This is a lot of information to process and remember in an emergency.
As a patient support organisation we pride ourselves on delivering sound messages to our audience. If we awarded a
medal for doing the right in a time of emergency, then you would most defnitely be receiving it. You did all the correct
things at the time:
you took your son to the emergency department
you referred to your sons ASCIA Action Plan for Anaphylaxis for guidance
you used your prior knowledge of past reactions
After rapidly processing all this information you made a decision about the care your child needed most and yet this
differed from the treatment he was receiving. This is a very diffcult situation to fnd oneself in however you handled it
well. Your open communication with your son is great and talking him through what you feel could have been the better
treatment path i.e. giving the adrenaline autoinjector is important. The important learning point from your experience for
Letter to the Editor
AUTUMN 2012
21
Letter to the Editor
continued from page 20.
all of us is to know we can give the adrenaline autoinjector ourselves even in an emergency department because this is
the frst choice, frst aid treatment for anaphylaxis. Our ASCIA Action Plan guides us to recognise signs and symptoms
and you interpreted your sons drowsiness as a sign of possible lowering of his blood pressure. The message we receive
from our peak medical body ASCIA www.allergy.org.au is to not delay administration of the autoinjector, if in doubt, it is
better to give it, than not.
Meeting with the hospital liaison offcer and your sons allergist to discuss what occurred is an important step for all parties
involved. Thank you again for sharing your experience with us, learning for others experiences helps us to improve the
care of all involved. n
Dear Editor,
Being part of the preparation to get our two peanut allergic kids back to school recently has reminded me of an incident
at one of the kids schools late last year. I have described what happened below and ask that AAI use this example
when next discussing updates to the Anaphylaxis in Schools policies with the various departments.
It may be that the Guidelines are missing an important point.
Our high school child presented to the offce to say she wasnt feeling well, and was then sent to the sick bay room.
Our child knows what should happen immediately according to the (ASCIA) Anaphylaxis Action Plan which the school
had. When the action for a mild or moderate allergic reaction did not happen our daughter called her mother to say she
was not feeling well.
Later an adult charged with attending to children in the sick bay came past and discovered our daughter, and asked
whats wrong. The answer came, I feel sick.
Again, no one followed the Action Plan. Our daughter said to this person that she had called her mother to which she
was told, Well, thats our job, but ok.
My wife had spoken our daughter and asked to be put on to an adult, or have the school call her immediately, but our
daughter refused and said, Please just come and get me. Our daughter told us later that she no longer trusted any
adult she had spoken to, to take care of her and now wanted her mother to come as soon as possible. She was no
longer thinking clearly. This is a normal reaction for adults or children under pressure or stress.
When my wife arrived at the school she asked if our daughter had been given any medication. The answer was no. My
wife was now trying to communicate what was clearly written on our daughters ASCIA Action Plan for Anaphylaxis.
AUTUMN 2012
22
Letter to the Editor
That is:
1. Stay with person and call for help. (not done)
2. Give medications (if prescribed). Our doctor prescribes a non drowsy antihistamine at this point. (not done)
3. Locate EpiPen. (not done)
4. Contact family/emergency contact. (not done)
My wife administered the antihistamine and watched her to see if any further signs or symptoms developed. My
daughter, aged 14 years, was upset. When she was alone with her mum she burst into tears sobbing uncontrollably
saying she thought she was going to swell up and die.
Ive since met with the Principal and explained what I felt went wrong in this incident.
When our daughter presented to the offce she wasnt immediately identifed as a child with a history of anaphylaxis
Because of that, NOBODY at the school invoked the ASCIA Action Plan, and therefore nobody asked our daughter
if she was experiencing:
swelling of lips, face, eyes
hives or welts
tingling mouth
abdominal pain, vomiting
If they had asked these carefully written, very specifc questions they would have found out that our daughter was
experiencing several of these symptoms.
A fnal key point: When asking for an appointment with the school to discuss the above I was told that our daughter
was not showing signs of anaphylaxis.
Those of us who live by the ASCIA Action Plan for Anaphylaxis know that the plan starts by looking for signs of a mild
to moderate allergic reaction.
We know that most allergic reactions start with a mild/moderate sign/s or symptom/s and then can quickly progress to
anaphylaxis.
The school was looking for signs of anaphylaxis and did not see any, so did not invoke the ASCIA Action Plan, and left
our child alone in a room.
Children at risk of anaphylaxis should never be placed in a room on their own. They should be identifed promptly when
presenting and then asked specifc questions from the ASCIA Action Plan. The school now has a photo list of all the
students at risk of anaphylaxis at the offce and in sick bay. A child that comes to the offce/sickbay complaining of
feeling sick is checked alongside the list so children with food/insect allergy can be easily identifed.
AAI Member n
AUTUMN 2012
23
Letter to the Editor
Dear member,
Your experience is a reminder to all that any complaint from a child/teen at risk of anaphylaxis should be further
investigated. These children need to be watched closely. ALL school and childcare staff should be able to identify
children with known food or insect allergy, especially those with a prescribed adrenaline autoinjector having an ASCIA
Action Plan for Anaphylaxis.
Schools and childcare facilities need to have systems in place so that staff recognise the children at risk of severe
allergic reactions (whether the child is in their class or not) and have a checklist of children at risk in areas such as the
offce, sick bay, canteen, library and playground.
We also need to talk with children about disclosing their allergy and saying more than, I feel sick if they can,
understanding that children can feel sick and not necessarily know where they feel sick.
Teenagers are a group that dont like to single themselves out or create a fuss (except when parents are around!!)
Teachers and carers need to keep this in mind when a teen complains of feeling sick. We need to probe a little further
and get a clearer picture of what is happening for the child/teen. As our member says, his daughter was no longer
thinking clearly. We know that thought processes can be unclear when someone experiences a stressful situation and
an allergic reaction can defnitely be an example of a stressful experience.
It is great that our members share their experiences and that we can then share knowledge and experience with
our entire membership. We are not alone; together we can manage the risk of anaphylaxis and live very close to
normal lives.
NOTE: AAI has also spoken with the relevant authority regarding inclusion in the Guidelines for
Management of Anaphylaxis in School (currently being revised), the need for identifcation of all students at
risk by ALL school staff. n
Chemical Esters and Food Allergy
Question: My son is allergic to banana with rash and swelling soon after exposure. The science class plans to make
chemical esters including banana ester. Are there any precautions that need be taken or will this be safe?
Answer from Associate Professor Raymond Mullins:
Thank you for your enquiry about chemical esters and whether these pose an allergic risk.
It is important to note that patients allergic to food are allergic to food protein. Chemical esters are synthetic, and can
reproduce the smell and taste of food but do not represent a food allergic trigger. He may be scared about the smell
or touching an ester but I cannot see any good reason why he needs to worry about it in terms of posing allergic risk.
They dont.
See additional information:
http://www.britannica.com/EBchecked/topic/193393/ester n
AUTUMN 2012
24

Anaphylaxis Australia
Contacts & Medical Advisory Board
WA
Sandra Vale
0407 081 336
TAS
Caroline Osborne
(03) 6432 3223
tasallergy@trump.net.au
VIC
Sally Voukelatos
(03) 9572 1735
0425 703 123
SA
Pooja Newman
pooj@thenewmans.net.au
(08) 83420876
MEDICAL ADVISORY BOARD
Dr Brynn Wainstein NSW
Dr Raymond Mullins ACT
Dr Michael Gold SA
Dr Richard Loh WA
Dr Jane Peake QLD
Dr Mimi Tang VIC
LEGAL ADVISORS
Clayton Utz
FAAA MEDICAL
ADVISORY BOARD
Dr Michael Gold
Dr Raymond Mullins
NATIONAL PRESIDENT
Maria Said NSW
VICE PRESIDENT
Sandra Vale WA
NATIONAL TREASURER
Geraldine Batty NSW
NATIONAL SECRETARY
Virginia McNally NSW
ASSISTANT SECRETARY
Loretta Buchhorn NSW
PUBLIC OFFICER
Geraldine Batty NSW
RESEARCH OFFICER
Stephen Batty NSW
COMMITTEE MEMBER
Leith Pawsey VIC
COMMITTEE MEMBER
Debby Yang NSW
COMMITTEE MEMBER
Annelise Kirkham QLD
Anaphylaxis Australia Inc
Committee 2011-2012
ABN 70 693 242 620
Anaphylaxis Australia Inc
PO Box 3182
Asquith NSW 2077
1300 728 000
Offce Admin: (02) 9482 5988
Fax: (02) 9482 4113
coordinator@allergyfacts.org.au www.allergyfacts.org.au
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INFORMATION
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