Congress of the European Academy of Allergy and Clinical Immunology: food allergy, food neophobia, new food allergy tests and allergy to GM foods

The 30th Congress of the European Academy of Allergy and Clinical Immunology was held this week in Istanbul, and here is a round-up of the more interesting pieces of food allergy research to come out from it – covering EpiPens, new egg allergy testing (and perhaps dairy allergy testing), bringing up a new baby to avoid allergy, food neophobia and social limitations in children, and allergy to GM food and novel proteins.

EpiPens may not be saving enough lives
Over 100,000 adrenaline auto-injectors like EpiPens have been given to people with severe food allergy (food anaphylaxis) over the past 20 years, but the death rate has remained at around five per year. New research from Dr Richard Pumphrey of the Central Manchester Hospitals has revealed why.

Dr Pumphrey looked at the circumstances around each of the 110 deaths that have occurred since introduction of the pens. He found that two out of three of those dying had not been given EpiPens because their previous reactions had been so mild.

Of those who had been given pens, around half used the pen late or not at all because they were not carrying them at the time of the attack.

The other half had used the pens correctly but still died, and Dr Pumphrey suspects that in a large proportion of these cases, the needle, when injected into the thigh, did not reach the muscle, possibly due to the patient being overweight and having a layer of fat above the muscle – thus reducing the likelihood of the adrenaline reaching the muscle where it is most effective.

This problem should be tackled – either with injectors with longer needles, or better training in the use of pens to identify points on the thigh with little fat in those susceptible.

There should also be more emphasis on patients taking the pens with them when they go into situations where they could be at risk. “The peak age for deaths from food allergy is between 18 and 24, and the advice needs to be tailored to them – this age group has varying views on risk,” said Dr Pumphrey.

A new test for egg allergy – and dairy allergy?
Those with egg allergies have always been told to avoid all egg, but it seems that some egg allergics can tolerate cooked egg – and yet currently available, commercial tests cannot discriminate between these different forms of egg allergy.

A new test is currently being devised by a team lead by Professor Philippe Eigenmann of the University of Geneva.

“Instead of saying to patients ‘you are allergic to egg, so you need to restrict all forms of egg in your diet’, we might be able to tell them they are allergic to egg but can eat, for example, egg pasta or foods cooked with eggs; in daily life this really makes a difference,” he says.

If the outcome of trials in people with egg allergy are successful and it is clear that the test will be useful, it will be made more widely available. Indeed, Professor Eigenmann is currently in discussions with some large diagnostic companies, and future work may involve developing a similar test for dairy products.

Bringing up baby: mothers unaware how best to avoid allergy

Only 10% of first-time mothers are aware of the link between allergy and the way babies are fed in their first year, a new study has revealed.

Despite it being accepted that breastfeeding and delaying the introduction of solid foods until a child is four to six months can help, this message is not getting through effectively to new mums and many more allergic children could result.

The study was led by Dr Kirsi Laitinen and colleagues of University of Turku, Finland. Dr Laitinen questioned first-time mothers from Finland, England, Germany, Hungary and Spain in the weeks after they had given birth.

When asked a general question about whether how an infant is fed was likely to affect future health, almost all agreed that it was. But only around 10% agreed that how the baby is fed is likely to influence the possibility of developing a food allergy. Interestingly, when the question was asked in a different way, whether childhood diet was likely to be linked to conditions such as allergy, heart disease and diabetes, the level of awareness seemed higher. “50% of mothers thought that child’s diet was important or extremely important for determining a lifelong risk of food allergy,” said Dr Laitinen.

There are a number of reasons for the poor awareness, Dr Laitinen believes. “Mothers receive information about feeding their baby from health workers and leaflets. These should be updated and the health workers need to be made more aware of how important the feeding of the child for future health,” she said.

Food neophobia and social fear in children with food allergy
Even at a very young age, children with allergies are afraid to try new foods, and many do not go to parties, according to an international study. And the parents’ own fears can have a profound influence on children too.

Dr Audrey Dunn-Galvin from Cork University, Ireland, has been looking at the quality of life of parents, children, teenagers, and adults, living with food allergy.

Her Research Group brought together information from 250 questionnaires and interviews completed by children and adults worldwide. Topics included food anxiety, social and dietary restrictions, general emotional impact, food labelling and coping strategies. Her study was part of EuroPrevall.

A study in Italy found that over 75% of children (5-11years) claimed to have a monotonous diet and that they were significantly less interested in tasting new foods than younger children. Because of their allergies, 18% of children never attended parties.

74% of parents reported that they were concerned by poor food labelling and that their child was afraid to try new foods. Allergy generates social limitations too: there are few restaurants that families can safely go to. Children with allergy were generally more anxious than other children of the same age, and feel different from children who do not have allergies. This feeling increases, particularly in teenagers.

“A better understanding of children and young people’s views on the impact of a disease on their experiences and relationships will allow us, as health professionals, to respond more appropriately,” said Dr Dunn-Galvin.

Allergy fears from new foods
People who suffer from – or have a genetic predisposition to – allergies may face risks from GM foods and new varieties of fruit and vegetables, say experts.

“The development of genetically modified plants (GMPs) and foods derived from those plants is rapidly increasing worldwide,” said Dr Jean-Michel Wal from INRA, the French National Institute for Agricultural Research.

Most GMPs are currently grown to generate a characteristic in the plant such as insect resistance or herbicide tolerance. Inserting the transgene may produce unintended effects due to interactions with plant’s own genes.

The risk of new sensitisation in people with a genetic predisposition to allergy, as well as an allergic reaction in people who are already sensitised to certain allergens, must be evaluated before the new GMP is approved for human and animal consumption.

Professor Wal said, “This situation is completely new – we have no history of allergy to GM foods and the potential for allergy should be assessed case-by-case.” How digestible newly expressed proteins in the GMPs are, how they may interact with a person’s immune system and whether the potential for allergy has been enhanced must all be investigated

It is not just GM foods that could increase the risk of allergy. Proteins found in new varieties of fruit and vegetables, such as kiwi fruit, may cause mild, unpleasant symptoms to severe life-threatening reactions. Understanding the action of separate proteins could improve the quality of life for people who have to avoid certain foods.

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