Friday 20 October 2017

Life with a severe allergy to nuts: 'Nuts could have killed my son'

US experts now advise that introducing nut products to infants could prevent allergies. Arlene Harris, whose son was diagnosed with anaphylaxis, finds out more about the life-threatening condition and how to treat it

Arlene Harris and her Son Cailan at home in Barefield, Co Clare. Photo: Eamon Ward
Arlene Harris and her Son Cailan at home in Barefield, Co Clare. Photo: Eamon Ward

Arlene Harris

For years parents have been warned about the dangers associated with feeding nuts to young babies. Official advice stated that not only were they a potential choking hazard but even a pureed form (such as peanut butter) could cause children to develop potentially life-threatening allergies later on.

Recently however, there has been a complete U-turn regarding this advice and experts in the US say eating nut products from early childhood could actually prevent the development of allergies.

While current guidelines advise against introducing nuts to babies until they are least a year old, researchers at the National Institutes of Health in America have stated that infants should start eating peanut-containing foods from as early as four months old in a bid to dramatically reduce the risk of allergies.

Dr Paul Carson is an allergy specialist based at the Slievemore Clinic in Dublin. He says that while parents should heed the new advice, they should also be cautious not to overdo it.

"The logic for the previous advice was that too-early exposure to an immature immune system in babies might allow for 'sensitisation' and eventually an allergy to peanut," he says.

"The recent 'about-face' change is based on US research where clinical trial results (reported in February 2015) showed that regular peanut consumption - begun in infancy and continued until five years of age - led to an 81pc reduction in development of peanut allergy in infants deemed at high risk because they already had severe eczema, egg allergy or both."

"This finding came from the landmark, NIAID-funded Learning Early About Peanut Allergy (LEAP) study, a randomized clinical trial involving more than 600 infants. The guidelines (also) recommend that all infants start other solid foods before they're introduced to peanut-containing foods. And they shouldn't get whole peanuts or a big blob of it as both are choking hazards. Instead, the guidelines include options such as watered-down peanut butter or peanut-flavoured snacks. One US allergist recommends dabbing a bit of peanut butter on a baby's lip, allowing him or her to taste it and then offering more in small amounts."

My own son (who is now 18) was diagnosed with anaphylaxis (severe allergy) when he was seven-years-old. We discovered his allergy completely by chance and were promptly issued with several Epipens (injector pens filled with adrenalin) to administer in the event of an attack, told to avoid products containing any trace of nuts and never allow him to eat unless the Epipen was within easy reach.

The discovery that your child has a condition which could be fatal is very frightening indeed as products which are completely innocent to the rest of the population suddenly become poisonous and appear to be everywhere. And this in itself is terrifying as the realisation that I could have fed my son something which could potentially kill him was a very sobering thought.

We have no way of knowing how or why my son is anaphylactic to nuts but Dr Carson says that while it is advisable to follow the new US guidelines, some babies may be in a higher risk bracket and parents should seek advice beforehand.

"I would follow the advice from the US as it has a lot of street credibility and the specialists involved are emphatic in their advice and wouldn't suggest this unless they were pretty sure," he says. "Babies who have a severe form of eczema or an allergy to eggs (or both) should be exposed to peanuts earlier, the earliest, at around four to six months.

"But some allergists insist such babies first should be evaluated by a doctor, who may order a blood or skin test, to ensure that they don't already have a peanut allergy and indeed these 'at risk' babies may only get their get their first introduction to peanuts under the care of an allergist.

"However, for most other babies, parents can start introducing peanut-containing foods at about six months, following a process similar to that used in introducing cereal and pureed vegetables."

The Irish Food Allergy Network has compiled a list of tips to help understand food allergies in children. These include:

• Food allergies are common; occurring in 5-6pc of young children in Ireland. The exact incidence is unknown but is likely to be very similar to that in the UK - 3-6pc of preschool children and 1-2pc of older children and adults.

• Very small amounts of food can elicit significant reactions.

• Symptoms of allergy can see a very rapid onset usually within 20 minutes, but often within one to two minutes (World Allergy Organisation definition is within two hours).

• Most children with food allergy have other atopic conditions, especially eczema occasionally asthma and allergic rhinitis.

• In infants under two years, food allergies can exacerbate existing eczema but there is no justification for manipulating an infant or child's diet until skincare with topical steroids and emollients/ointments has been optimised.

• Well-known common food triggers (milk, egg, peanut, nuts, fish) account for more than 90pc of cases.

• The most common food allergies in the first few years of life include milk, egg and peanut. In children under three, common food allergies include peanut, tree nuts, fish and shellfish.

• Most children will outgrow an allergy to milk or egg but most will not outgrow a peanut, tree nut, and fish or shellfish allergy.

• Cough and hoarseness which imply upper airway obstruction are underappreciated and should be treated as severe symptoms.

• Wheeze (even mild), feeling faint are severe symptoms.

• Anaphylaxis is considered a severe food allergic reaction associated with lower respiratory or cardiovascular features.

• Many children will need to have adrenalin prescribed as part of their care plan.

• Children with both food allergy and asthma are at increased risk of a severe food allergic reaction.

Around 5-6pc of children under the age of six have nut allergies in Ireland but Dr Carson believes that because so many people are 'allergic' nowadays, the distinction between feeling unwell and having a life-threatening condition has been blurred and the public is not aware of how dangerous anaphylaxis actually is and don't realise it can kill - in a very short space of time.

"I do believe the abuse of the word allergy reduces the impact of serious allergy issues like anaphylaxis which is an aggressive, life-threatening total body allergic crisis where the sufferer has multiple organ involvement, including circulation collapse, swelling throughout the breathing tract obstructing airways, skin swelling and the emotional sense of impending doom," he says.

"Then even if the auto-injector (Epipen) has been used the patient must get proper medical attention ASAP. This is based on 'second wave' anaphylaxis attacks in those who are exquisitely allergic (mainly children with eczema, allergic rhinitis and asthma) and may need more than one injection or need more intense supportive measures such as IV fluids."

The allergy specialist also says it is important for people to understand that allergies and food intolerances are very different to anaphylaxis.

"An allergy can be something as simple as sneezing during the pollen season or getting itchy skin from stroking a cat. And as for food intolerance - this is mainly bulls****t - the source of much confusion for the general public and a source of great profit for bogus clinics offering food intolerance tests.

"In a kinder explanation it's where people feel unwell when they eat certain foods and this is usually bowel-driven (bloating, flatulence or diarrhoea). However, some people believe that almost everything they feel is driven by food intolerance - headaches, joint pains, stiffness, skin rashes, poor love life or not backing winners at the races - excuse my cynicism."

* For more information visit www.allergy.ie

www.slievemore-clinic.com; www.ifan.ie

Anaphylaxis signs and symptoms

• 2pc of adults and 6pc of young children have food allergies which have the potential to cause anaphylaxis.

• Symptoms of anaphylactic shock include swelling of the throat, wheezing, vomiting and loss of consciousness.

• In the event of anaphylaxis, medical help needs to be sought immediately. And even if given a shot of adrenalin, the patient must be taken straight to Casualty.

• Young children need to be reassessed every six months, phasing out to yearly appointments as they get older.

• People who suffer from anaphylaxis should carry an Epipen with them at all times and wear an SOS bracelet to alert people to their condition.

• The most common food allergies in young children are milk, egg and peanut.

• An allergy will manifest itself initially with a rash, lip swelling, cough and hives.

• Many childhood allergies improve as the child gets older.

• Allergies to peanuts, shellfish and tree nuts tend to persist and a portion of sufferers will continue to have a reaction to these foodstuffs throughout their adult life.

• Hay fever and asthma are the most common allergies in Ireland.

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