Walking on Eggshells

19th July 2019

Allergies are on the rise, which means a huge amount of anxiety for all those involved. Lisa Botwright reviews a new book that offers tips and advice for the whole family…

When I was in my early 20s I suddenly developed an allergy to shellfish. I’ll spare you the gory details of my symptoms, but I ended up in hospital on a drip several times before I identified the specific problem – and I simply didn’t understand how I could have eaten and enjoyed it (it was my favourite food) all my life without any previous issues.

It turns out that 15% of allergies start in adulthood, and a shellfish allergy (medically divided into a reaction to molluscs and/or crustaceans – you can have one or both) is one of the most common kind. It’s also one of the top 14 allergens that must now be clearly labelled on food prepared for direct sale, following a campaign by the parents of Natasha Ednan-Laperouse, the 15 year old who died after suffering an allergic reaction to sesame seeds in a Pret a Manger baguette. Under ‘Natasha’s Law’, which came into effect last month, food businesses will have to include full ingredients labelling on all pre-packaged food, something that undoubtedly would have saved the allergy-savvy teenager’s life.

Allergies are hypersensitive responses to normally harmless substances. We can ingest our allergens (eggs, shellfish etc), breathe them in (pollen, spores from mould) or touch them (nickel, latex) but the result is essentially the same: our immune systems go into overdrive and cells release histamine to attack the threat. There are all kinds of allergies and our bodies manifest symptoms in all sorts on unpleasant ways; but the most serious are IgE-mediated allergies, where the body produces immunogloulin E antibodies to fight the threat; in some cases this can cause a severe life-threatening reaction called anaphylaxis.

Emma Amoscato, author of Living with Allergies: Practical Tips for all the Family, tells how her eldest son, then 14-months-old, took a sip from another child’s milk bottle and immediately had an anaphylactic reaction. “Within minutes his airways were closing up and he was struggling to breath,” she recounts. Luckily she had already been prescribed an adrenaline auto-injector and was able to administer it before calling an ambulance. James is now 6, happy and well, and has even outgrown his milk allergy after ‘climbing the milk ladder’ (more on this later); but Amoscato, who also has another child with multiple allergies, remembers the experience as “absolutely terrifying”. Her advice, which is detailed in the book, along with insight from leading medical professionals, includes “do your research, trust your instinct and always be prepared.” She manages the risks by cooking meals from scratch and “putting allergy plans in place to cope with the psychological impact”.

Studies into how and why allergies develop are ongoing, but recent high profile research is exploring a link between allergies and intestinal gut health. The use of antibiotics in early life is now seen as a risk factor for developing allergies as it disrupts the microbiome, and it’s suggested that pregnant and breastfeeding women should take probiotics to help their children develop immune tolerance. (Please check with a midwife or GP first if you are considering doing this.). Another leading theory is exploring the relationship between eczema and allergies, and suggests that since eczema breaks down the barrier of the skin, it allows proteins, such as those from milk or peanuts – two of the most common childhood allergies – to enter babies’ bodies before they’ve consumed them by mouth. This makes it more likely for the immune system to see them as a threat.

Another correlation has been found between a lack of vitamin D and a greater prevalence of allergies – research shows more children with sensitivities were born in autumn or winter. Other studies claim that modern households are ‘too sterile’ for children to develop successful immunity. According to experts, the hygiene hypothesis isn’t just about cleaning too much, but also about our water and food being more sanitised and children not playing outside as often.

So what can we do to treat allergies? Most people are simply advised to stay away from their environmental or food triggers, and are given medication to treat the symptoms should they arise, relying on inhalers, antihistamines, eye drops, and in severe cases, epi-pens.

But there has been a certain amount of success with immunotherapies, which means that, in some cases, children and adults can raise the threshold of their sensitivity to something by re-introducing it to the body in incremental doses (always under medical supervision). The ‘milk ladder’ (there’s also an ‘egg ladder’) means moving through several stages from a tiny taste of a biscuit baked with milk, to an entire glass of milk. Dr Adam Fox, Consultant Children’s Allergist for St Thomas’ Hospital, London, has found that “allergies to egg and milk are most likely to be outgrown… nuts and fish much less”.

If you’re concerned that you or your child has an allergy, the GP should be your first port of call, but be aware that “the process of diagnosing and treating allergies can be frustrating,” according to Amoscato. Neil Shah, Paediatric Gastroenterologist at Great Ormond Street Hospital, agrees and says that even though he’s seeing a “big increase in allergies,” he believes that “recognition and training needs to improve at primary care level upwards.”

Finally, Amoscato cautions, “always be kind to yourself. Allergies can take a lot out of you, mentally and physically. Stay as healthy as possible to support your body and seek help if you need to.”

‘Living with Allergies: Practical Tips for all the Family’ by Emma Amoscato is published by Pen and Sword Books and is available in hardcover from all good bookshops RRP £19.99

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