All About Allergy

11th March 2016

It’s very ‘on trend’ to have an intolerance or an allergy. But have we actually become more allergic or is this just food faddishness by another name? Jennifer Lipman investigates…

In the supermarket ‘free from’ aisles, the world is your oyster. Shoppers with food allergies can buy dairy-free custard and wheatless pasta, along with quinoa flour and rice porridge. And buy they do; the ‘free from’ market is predicted to be worth £551m by 2019, up from £173m in 2009.

So, are we genuinely more allergic nowadays, or are we a nation of fuss-pots, convinced gluten will give us a dodgy tummy or wheat will make us bloat?

In truth, it’s complicated. In 2007, politicians warned that ‘allergy in the UK has now reached epidemic proportions’, having risen steadily since the 1950s. Nearly ten years later this shows no sign of abating. There was a 7.7% increase in hospital admissions down to allergies in the year to February 2013, while according to NICE, up to 8% of British children have a proven food allergy.

And, as Angela Loftus, a nutritional therapist who runs Nutrition4Change in Rickmansworth, explains, ‘the pattern of allergy is changing’. What was initially a jump in hayfever and asthma in the 1960s is now being seen with food allergies across the western world.

Crucially, though, not everyone who swears off a food group would be diagnosed as allergic. Some might be ‘intolerant’: a condition that divides doctors and that some dismiss as quackery. “There’s definitely evidence that allergies are becoming more prevalent,” says paediatric cardiologist Dr Gina Dahel. “But obviously there are lots of people claiming they’ve got allergies when they haven’t.”

A true food allergy, explains Beverley Gibbs, a Nutritional Therapist who practices in Berkshire and Hertfordshire, relates to the immune system not working correctly. The effects are frequently immediate and often serious, including vomiting and anaphylactic shock, which can be fatal. In contrast, she says, intolerance “can make someone feel quite ill, but the symptoms are not usually life-threatening and often take longer to develop”.

Thanks to Dr Google and home blood prick tests, it’s easy for people to self-diagnose as intolerant or allergic, and go to a doctor armed with the answer they’d like to hear. Yet according to Sense About Science, which published the Making Sense of Allergies guide last June, most shop-bought tests have no scientific basis. They warn that allergy ‘has also become a catch-all diagnosis for unexplained symptoms’ accompanied by substantial non-medical treatment.

Certainly, intolerances are almost trendy: a stamp of being middle class and healthy. A whole generation of food writers have staked their careers on advocating ‘clean eating’ and the message that we can’t take the modern diet.

“A lot of people are choosing to go gluten free for ‘health’ reasons,” observes Elana, a London-based professional who was diagnosed as coeliac (allergic to gluten) at 13. “Not being catty, but in my opinion and in medical opinion, there’s really no reason unless you’re diagnosed gluten intolerant,” she says. As she points out, it’s not exactly convenient. “My food costs way more, and gluten-free substitutes are really unhealthy.”

Despite the scepticism, plenty of experts agree there’s more to intolerance than faddishness. Maureen Jenkins, who sits on Allergy UK’s Health Advisory Board, suggests it is simply that, unlike clear-cut cases of allergy, “it can be much more difficult to decide whether food intolerance is the cause of persistent symptoms, and which foods may be responsible.”

“The blood tests don’t always correlate – it’s so difficult to diagnose,” echoes Dr Gina Dahel. Yet as she points out, “bloating, vomiting and diarrhoea can have just as much impact on a person’s life as a medically diagnosed allergy.”

“Most people roll their eyes and think I’m lying,” explains Natasha, a north Londoner who was diagnosed as lactose intolerant 18 months ago. “I tell them to smell my reaction. I also say that if they want me to go to hospital, I will gladly eat what they’re offering!”

The mysteries of the gut are the subject of much research, with scientists discussing an array of factors, from genetics – allergic parents are more likely to have allergic children – to stress, whether a baby is breastfed, and increased use of medication and pesticides. “The increase in allergies has corresponded with a similar increase in the amount of pollution we are exposed to,” explains Gibbs. “But not everyone agrees.”

Her view, shared by many, is that diet plays a key role. “We’ve lost connection with our food production,” she says. “We are eating in ways our bodies have not evolved to tolerate – fewer whole-foods and more processed and adulterated foods.” But others maintain that everything in moderation still applies. After all, in days gone by, a tummy ache probably meant we’d eaten too much, not that we should cut something out entirely.

There’s also evidence that in the west we are too hygienic: too reliant on cleaning products and too convinced that kids should stay away from dirt and animals. “The first five years are the most important in building up immunity,” explains nutritionist Sophia Villiers of NourishNaturally.co.uk. “A baby’s immunity matures through the introduction of a broad biodiversity of micro-organisms, slowly learning what is friend or foe.” She refers to the rise in elective caesareans – “which don’t allow infants to pick up on vital microbes” – and to our fixation with wet-wipes, “which eradicate all the good bacteria with the bad ones”.

What’s clear is that not only do we know far more about treating allergies these days, we’re also increasingly willing to talk about food issues. Allergies have been normalised; the subject is all over the media and it’s no longer socially isolating to have a ‘free from’ child, or be the fussy guest. “Allergy awareness has grown in leaps and bounds since I was diagnosed,” agrees Elana. “People are more inclined to listen to their bodies and symptoms and speak to their friends or doctors.”

Sceptics, however, view this increased awareness as a factor in the rise of reported intolerances, and warn that the health consequences of cutting out certain foods are still poorly understood. Shockingly, Sense about Science recently highlighted a rise in malnutrition, warning that fears about allergies “are leading parents to cut major food groups from their children’s menus and causing people to follow necessarily restrictive diets’”
“If there is a food allergy present, then the person must stop eating that food,” says Gibbs. “However, if there is no known health reason to eliminate foods, then nutritional deficiencies can occur.”

Questions also abound over how to guard against becoming allergic in the first place. Jenkins refers to research into nut allergies – which can be fatal and which children don’t grow out of – that has found ‘that exposing babies to peanut protein can protect them from allergic reactions’. Yet there is no definitive conclusion on whether this works; indeed as Dr Dahel notes, “there are some people who, if they are not exposed to what they are allergic to, it helps them; and for some it can be harmful”.

While science seeks answers, people are voting with their feet. Whether because of allergies, intolerances, or a belief that the modern diet simply isn’t working, not being able to eat certain things is becoming the norm. Already the food world is waking up to this sizeable consumer market; witness the choice on offer at supermarkets.

“It’s getting there - my local restaurants and cafes are starting to become more accommodating,” says Natasha. But it isn’t perfect. “I call ahead at restaurants or only visit those I know can cope with my allergies. It can be a little restrictive’.

In the meantime, the advice is clear; if you think a food is causing you problems, seek medical advice – don’t just cut it out arbitrarily. After all, the objective is to get better. “The aim is to identify and eliminate intolerant foods and restore the balance of the gut,” says Loftus. “A healthy gut bacteria level can mean a re-introduction of most foods.”

And if you are told to cut out a food, you will, whatever your initial reaction, be able to make it work. When Elana was diagnosed, she was eating vegetable lasagne – for the last time. She cried for ten minutes. “It was tricky to adapt,” she admits. “I’ve had moments of feeling sorry for myself, but ultimately it’s not the end of the world.”

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