This is a guest post written by Dr Kulkarni, Consultant at Nuffield Health
Finally, we can breathe easy as COVID-19 is receding. The incidence of allergies is increasing alarmingly though. A clear trend I often see is parents having hayfever and then children presenting with food allergies!
Inhalant allergies such as pollen / dust mite as well as food allergies are mediated by IGE antibodies which can be confirmed on a blood test / skin prick test. The typical presentations as you know are asthma, eczema, hay fever, hives, and anaphylaxis.
Interestingly there is a lot of variability both in remission and progression of allergies. For instance, egg and milk allergies start early on in life and most children outgrow them. Primary Nut allergies on the other hand persist, though there is an exciting prospect of immunotherapy on the horizon. Some teenagers will start reacting to nuts, fruits such as apples and cherries, carrots and even soya as part of an “oral allergy syndrome” due to cross reaction with pollen.
The severity of these allergies can be variable, with some children at a risk for anaphylaxis at the slightest exposure. Others though can have Nutella on their pancake with only mild tingling!
A careful evaluation of children, especially older teenagers is absolutely imperative!
So what about intolerances?
So, this is more of a complex field, but let’s say anything that you eat or drink but doesn’t agree with you and can’t be picked up on a test!
Broadly speaking, one could be intolerant to sugars such as lactose and fructose, as the gut can’t break them down causing pain, bloating & GI issues!
Proteins are the other big group of course, such as cow’s milk/soya and wheat. These activate the immune system in the gut such as Lymphocytes, triggering inflammation resulting in pain, reflux, tummy migraines, constipation & IBS!
Then of course these are other triggers ranging from histamine in foods to cinnamon!
Can we slow down the Allergic “March”?
Easy on the Hand gel!
Some of the recent theories suggest that the interaction of our gut bacterial flora plays a crucial role in development of allergies. While the use of Hand gel outside is inevitable, washing hands indoors is just as good!
Eczema as a Trigger?
Use of topical creams and emollients to maintain a good skin barrier is a must as I often see children presenting with eczema and then allergies. It transpires that when traces of allergens such as nuts enter your body through “breached” skin first, they are more likely to cause allergies than when exposed orally!
Equally, persistent eczema suggests a likely allergic trigger in the first instance! So, if the original allergen is not recognised and reduced, the eczema continues and becomes more chronic, subsequently potentiating more food allergies!
EAT Allergens early ( the EAT study )
Current weaning guidelines suggest early exposure to allergens as weaning foods and through pregnancy. There are of course genetic and gender differences with a higher incidence of boys early in life and a higher risk for persistence of the disease into adulthood in girls!
Will optimal management of allergies in adolescents and young adults reduce their incidence in the next generation?
I recommend not only young children, but especially older teenagers have a careful review of their allergies!
Please visit Nuffield Health online for further information about Dr Kulkarni.