Just as I was blissfully settling into my first year of motherhood, life threw a curveball at me when my daughter was diagnosed with life-threatening food allergies.
At that time, I was enjoying the stage of introducing my baby to the recommended new foods: rice cereal, fruits and vegetables. However, after a few weeks of persistent atopic dermatitis – or eczema – my then eight-month-old daughter’s paediatrician suggested we do a test for food allergies.
We were in disbelief when the results arrived, revealing a list of allergenic foods that could be life-threatening for her: peanuts, tree nuts, eggs, fish, shellfish, soy and sesame. These were foods that she had yet to ingest as an infant.
As someone who had absolutely no familiarity with the concept of food allergy, this diagnosis left me stumped. Food allergy is an immune-based disease and we were told that possible allergic reactions could range from mild to life-threatening anaphylaxis, which requires emergency treatment. My daughter was prescribed an epinephrine auto-injector – or an epipen – as the primary treatment for anaphylaxis, and we were sent home with a stack of reading material to educate ourselves about managing food allergy. The reality of its seriousness started to sink in.
Managing food allergies
Food allergy can only be managed by strictly avoiding the allergens and by treating any symptoms. Since my daughter was still an infant and being cared for at home, the food allergy was worrying but comfortably manageable at first because we were in complete control as her primary caregivers. We would take extreme care to prepare her food and ensure that there was no cross-contamination with any of the allergens during the food preparation and feeding process. But there were still unexpected scares along the way. At the age of 18 months, we found out that she was severely allergic to lentils as well, after a serious reaction that made us frantically rush to the hospital.
It was as she grew older that living with a food allergy started impacting our lives even more significantly. It required a whole new level of planning, including sharing our food-safety protocols with family and friends, especially when it came to travelling, eating out, celebrations and social activities.
With most social events and celebrations being food-centred – and desserts always being the star attraction – the goal would always be to make sure that my daughter didn’t feel left out and would be eating something similar to what the host was serving. We worked out a system from an early age for attending birthday parties where she couldn’t eat the colourful, tempting dessert. Instead of her feeling left out and it ending in tears, she would take along a safe, yummy treat of her choice, or be promised one right after the party that she would then look forward to. This would also be the case for events like trick or treating at Halloween or birthday goody bags; we would swap out the unsafe candies with safe treats so she wouldn’t feel left out. Of course, this meant that we always had to have a stash of allergy-free treats at home to prepare us for any unexpected events.
Facing new challenges
Travelling also became a challenge, especially to places where English was not widely spoken and communication about safe (and hidden) ingredients in restaurants was often exasperating. This required intensive research and planning beforehand. The possibility of airborne allergens in enclosed spaces like airplane cabins made our anxiety even worse. Grocery shopping for pre-packaged foods was never quite the same again either, requiring vigilant reading (and re-reading!) of ingredient labels and the manufacturer’s processing details.
The next big leap was once my daughter’s schooling began. This triggered a new height of anxiety for me as she was out of my care for much of the day. How vigilant was the school about food allergy? Were the teachers trained to use epipens? How far was the closest hospital, in case of an emergency? I made her wear a medical alert bracelet, and allergy action plans were shared with school staff. Requests were made to teachers to notify me in advance about any classroom celebrations involving food so I could send in an allergy-free option. And then, of course, there was the importance of educating my own young child that she could only eat her own food and not ‘share’ anything that a friend might be eating, without making her feel like she’s an ‘outsider’. What would the emotional and social impact on my child be in this new setting, away from my protective care?
Since her allergy diagnosis as an infant, the possibility of my daughter growing out of some of her allergies meant that there was some light at the end of the tunnel. Her allergy testing has been carried out annually, and while she thankfully grew out of a few allergies by the age of eight, the ones remaining will likely continue to be severe and life-long.
Why have they risen?
As a parent of a child with life-threatening food allergies, there have been many times when I have felt incredibly alone in a crowd of people unaccustomed to food allergy, but the fact is that food allergies are on the rise and are fast becoming a serious global health concern.
Over the past 20 or so years, there has been a significant increase in the incidence of food allergies worldwide, with food allergies more prevalent in children than adults, especially in infants and toddlers. This phenomenon is no different in the UAE. Food-allergy-related stories are now regularly making news globally and a gradual awareness is starting to emerge, although there is still a lot that is uncertain about this immune-based disease.
There have been numerous theories to explain the increased prevalence of food allergy. According to Dr Carlos Baptista, paediatric specialist at Novomed, "one of the theories explaining this increased prevalence is the changed intestinal microbiota associated with the evolution of health conditions, excessive use of antibiotics and increased Caesarean births," he says.
"Other theories could be related to lower rates of breastfeeding, lower exposure to dirt in early childhood and higher exposure to processed foods (containing many food additives and drugs for animal use); all these situations could favour the emergence of food allergy, particularly in genetically predisposed children. The improvement of diagnostic methods, the understanding of food allergy and the spread of information have also contributed to this perceived increase in recent times.
"There is no single explanation for an overall increase in food allergies, but medicine has some theories," continues Dr Baptista. "One is that improving hygiene can be one of the causes, since children are not having as many infections. Parasitic infections, in particular, are usually counteracted by the same mechanisms involved in combatting allergies. With fewer parasites to fight, the immune system turns against elements that should be harmless."
Dr Baptista also adds that "a new theory of ‘dual allergen exposure’ suggests that the development of food allergy is due to the balance between timing, dose and form of exposure. For example, the development of anti-allergic antibodies can occur through the skin, especially the inflamed skin of infants with eczema."
Real vs false perceptions
"There’s no question that there has been much more food allergy in the past 20 years," says Dr Michael Loubser, specialist paediatrician, clinical immunologist and allergist at Infinity Clinic. "What’s increased for sure is real food allergy. Unfortunately, along with real food allergy skyrocketing, so too has the false perception of allergy and the adverse events associated with it. About 25% of people think they have a food allergy, but in adults it’s actually less than 1% and in children it’s about 3-5%."
Since food allergy diagnosis is bound to have an adverse impact on the quality of one’s life, Dr Loubser – who helped develop Canadian guidelines for managing life-threatening food allergies – stresses the importance of correct diagnosis, as non-allergic food reactions and intolerances that don’t involve the immune system can often be misinterpreted as food allergies.
What causes them?
Dr Loubser explains that there are two components to developing food allergy – one is genetic and the other is exposure. "In the main, you have a genetic predisposition to developing allergy and how you manifest your allergies can vary," he explains. "You might have a genetic predisposition but you might get eczema, you might develop asthma and some people develop food allergy. But there are also people who don’t have awfully much in the way of an allergic history who get allergic to food. Your immune system is designed to be tolerant to yourself and to pretty well kill everything else, because its job is to stop invading microorganisms. If you are exposed to a food very early on and if you are exposed to it a lot, your immune system tends to see it and go, ‘I’m seeing a lot of that – it’s no risk to me – I’m going to leave it alone.’ However, if you introduce food late, or if you have an intermittent exposure, your immune system starts to get suspicious of that and that’s the risk."
Should you give young babies allergens?
According to Dr Loubser, recent studies suggest increasing evidence that early exposure to allergens may potentially prevent food allergy. "Almost certainly part of this epidemic of food allergy was created by us telling people to avoid foods," he explains. "Because now the guidelines are very clear – that you can reduce food allergy by up to ten-fold by early introduction of foods." He refers to the LEAP trial – a clinical study investigating how to best prevent peanut allergy – which shows a massive reduction with early intervention. The trial showed that the kids who had peanuts introduced early had a much lower incidence of being peanut allergic compared to the group that had avoided peanuts. "We’re talking introduction of peanut at age four months for example, which is the design of the LEAP trial," says Dr. Loubser. "So what might have happened when we say no nuts and other allergenic foods until a certain age, is that we may have actually precipitated this issue. All of the very important allergens were being withheld, which is perhaps wrong."
Signs of a food allergy
What should parents look for if they suspect their child might have a food allergy? "Your first clue in most babies is eczema, and then obviously it is the immediate reaction to the food," explains Dr Loubser. "The important thing about food allergy is the timing: 15 to 40 minutes roughly is the average time that it takes somebody to react after ingestion of a food. If you’re getting a reaction that happens the next day, it isn’t food allergy. Even if you’re getting a reaction that happens six or eight hours later, it probably isn’t a pure food allergy. The manifestation in babies would typically be immediate rash and gastrointestinal – they would typically vomit. Babies seldom present with major respiratory problems for their first time. The other thing about food allergy is that it’s repeatable. It isn’t dose dependent. It’s very consistent, it’s very immediate and it mainly involves skin and gut in babies."
Growing in and out of allergies
Is there a cure for food allergies? Dr Baptista explains, "So far, there is no treatment that can cure food allergies, but rather control the symptoms. Immunotherapy with allergens – administration of small amounts of the substance – has been shown to reduce the sensitivity of allergic patients and may protect against accidental exposure. But this is not completely safe, has many side effects and the protocols are circumscribed to only some centres."
However, the good news is that children can typically outgrow some food allergies, although it might not always be the case. "Most forms of food allergy (such as milk and eggs) that affect children are transient, and the mechanism of tolerance to allergenic protein is established even in the first years of life", says Dr Baptista. "An exception is allergies to peanut protein, nuts and seafood, which are usually persistent. Thus, it is important to establish the correct diagnosis of food allergy and adequate diet, allowing the child to grow and develop until they are tolerant and stop being a carrier of food allergy."
What can new parents do?
Is there anything we can do during pregnancy and infancy in order to reduce the risk of our children having allergies? "The first advice is that you can’t do tests to predict if your child is allergic – we can’t predict who will have an allergic reaction or not," says Dr Loubser. "You can’t use testing as a crystal ball. The earlier you introduce solids, the safer it’s going to be. The guidelines will say that the higher at risk you are, the earlier you introduce, which would generally be around four months of age. If there is a reaction, you need to see an allergist to make a diagnosis. We know that we encourage breastfeeding, and we know that we now encourage early introduction of solids. We ask mothers to eat a broad-based diet, but to the best of our knowledge, there isn’t any ‘primary prevention’ for
food allergy yet."
A supportive local community
For parents who are navigating the daily challenges of living with food allergy, a community support group can be an invaluable source of comfort. Dubai resident Ghadeer Jaamour has been actively trying to spread awareness about food allergy in the local community by carrying out awareness campaigns at schools and talking about food allergy in the local media. She also co-founded a website with her husband that lists local restaurants accommodating allergic eaters. (Wecaneatout.org).
"Our support group consists of members whose lives are impacted in one way or another by food allergies," says Ghadeer, whose son was diagnosed with life-threatening food allergies as an infant. "We have an active Facebook page called Teal Community for families living with food allergies in Dubai. We are also currently in the process of putting together a cookbook that doesn’t include the top eight allergens." The group’s goal is to eventually get a food allergy support group officially registered. This will enable them to carry out further community initiatives that will help families to live with food allergy both safely and confidently.