Written By NATASHA BITA
Herald Sun News Limited Network - December 16, 2012
BABIES would be fed solid foods sooner under new health guidelines to slow an alarming surge in the number of children with life-threatening food allergies.
Anxious parents are giving toddlers their first taste of peanuts in hospital carparks and doctors' surgeries, for fear they might suffer an anaphylactic reaction.
Demand for diagnosis is so high that children are now having to wait up to two years to be tested for potentially deadly food allergies in a public hospital.
The number of prescriptions for adrenaline pens, used to treat anaphylaxis, has quadrupled in a decade.
Pharmaceutical Benefits Scheme data reveals that 101,558 subsidised prescriptions were filled last financial year, compared to just 25,294 in 2001/02.
Australia's top allergy researchers remain baffled by a 20-year surge in the number of Australian children with food allergies.
But many now suspect that delayed weaning, a lack of vitamin D from sunlight and hyper-cleanliness could be to blame, through overstimulating children's allergic reaction to certain foods.
The National Health and Medical Research Council will soon release new guidelines for infant feeding, which will relax its current recommendation that babies be exclusively breastfed for six months.
The new draft guidelines state that weaning should commence at "around six months of age", giving parents more leeway to introduce solids at four or five months.
The NHMRC's existing limit of six months mirrors that of the World Health Organisation, but clashes with advice from Australia's top allergy specialists.
The Australasian Society of Clinical Immunology and Allergy says parents should start introducing solid foods from the age of four months, in addition to breastmilk.
Professor Dianne Campbell, who chairs ASCIA's paediatric committee and heads the paediatric allergy services at Westmead Children's Hospital in Sydney yesterday said ASCIA had advised the NHMRC to change its guidelines.
"Our recommendation was ... introduction of solids/complementary foods from 4-6 months, with no specific avoidance of any foods," she said.
"We don't recommend (total) weaning at this time, but for the continuation of breast feeding where possible for at least six months."
Canberra specialist Raymond Mullins, who heads ASCIA's anaphylaxis working party, yesterday said 3 per cent of Australian children were allergic to peanuts.
"It's now so common it's a public health issue," he said.
"Waiting lists in some public hospitals are one or two years to get an appointment to see an allergy specialist."
Dr Mullins said the longstanding advice to avoid risky foods like peanut and egg until children are older had not prevented allergies.
"People have had egg on their faces by giving advice and later it's been shown not to work," he said.
Professor Katie Allen, who leads the study of food allergies for the Murdoch Children's Research Institute at the Royal Children's Hospital in Melbourne, said she was aware of parents who had given kids their first taste of peanuts in the hospital carpark.
"Parents are so frightened," she said. "I've heard it's quite common to have them sitting in the carpark."
An Adelaide mothers' group even hosts "peanut butter parties" to give toddlers their first taste in a park near the Women's and Children's Hospital.
Australian Medical Association president Steve Hambleton said doctors were still advising parents to wait six months before introducing any solid foods.
"For families we've been saying wait til six months and delay egg," he said yesterday.
"Maybe that's not right, but we need hard evidence before we can make that change."
Dr Hambleton said some parents wanted to play safe by feeding their child peanuts in a doctor's surgery, if they already had a child with allergies and feared serious side-effects.
The NHMRC yesterday refused to give details of its latest guidelines, which are due to be unveiled within weeks.
Action and reaction: One mother's story, every family's worry, science's conundrum
SALLY Rothberg was just following doctor's orders. The first-time mum breastfed baby Amelia for six months, waiting to wean her. First rice flour, followed by mashed fruit and vegies - and absolutely no eggs for nine months.
"Then we fed her scrambled eggs when she was 10 months old and her face puffed up and she started breathing funny," Ms Rothberg recalls. "It was quite dramatic".
When the anxious Glen Iris mum tried to make an appointment for an allergy test at a Melbourne public hospital, she was put on a year-long waiting list. Someone cancelled, so she was lucky to have her daughter diagnosed with a peanut allergy in hospital - without having to learn the hard way that her toddler would suffer an attack of life-threatening anaphylaxis. Other parents have made their kids sample nuts in a hospital car park or doctor's surgery, where help is at hand in case of a medical emergency.
Amelia is among the three-in-100 young Australian children allergic to peanuts. When the 16-month-old starts daycare next year, she will have to carry an adrenaline auto-injector. More than 100,000 were prescribed in Australia in the past year, four times more than a decade ago.
The "allergy generation" is how the medical fraternity describes today's children, banned from taking peanut butter sandwiches or boiled eggs in their lunchbox in case they trigger a classmate's anaphylactic episode. Some childcare centres insist that kids wash their hands before they enter, if they've eaten an "unsafe breakfast" with eggs or nuts.
An Adelaide mothers' group even hosts "peanut butter parties" to give toddlers their first taste, in a park near the Women's and Children's Hospital.
The number of Australian kids admitted to hospital with severe food allergies tripled in the decade to 2005. In the past 10 years, the number of under-5s allergic to peanuts has risen five-fold. One in every 10 Aussie children is born with an allergy. Boys are more likely to suffer than girls. Why?
Allergy experts are pointing the finger at delayed weaning, originally intended to postpone kids' exposure to known allergens, and hence minimise any allergic response.
The Murdoch Children's Research Institute is carrying out the world's biggest paediatric study of food allergy, HealthNuts, involving 5300 babies and toddlers. Based on its findings, it is now advising parents to "introduce a wide range of foods early on".
"Do not avoid foods with the hope of preventing an allergy," it says. "Let babies get down and dirty... (introducing) children to a range of `good bugs' could help to protect children against food allergies."
And finally, "get some sunshine in your life to optimise your child's exposure to sunlight and increase Vitamin D".
Huh? Aren't we supposed to protect babies from germs and sunlight, and then delay and carefully stage the introduction of solid foods?
All that modern-day medical advice is now being reassessed, as experts grapple to understand the alarming surge in the number of children with life-threatening allergies.
"Everything is turned on its head," admits Professor Katie Allen, who leads the HealthNuts study based at the Royal Children's Hospital in Melbourne.
"We say that avoidance of egg is unnecessary as there is no evidence it protects you from developing allergies. Introduce egg at five or six months.
"Those who eat cooked egg at four to six months are five times less likely to get an egg allergy than those who wait until after the age of 12 months."
Like many of her colleagues, Professor Allen now suspects that delayed weaning, a lack of vitamin D from sunlight and hyper-hygiene could be triggering an extreme allergic response to certain foods.
"Get a pet," is her advice to families hoping to minimise the chance of developing severe allergies. "Don't worry too much about letting kids run around in the mud. We used to be more exposed to microbes, when there were less antibiotics in the food and the water supply was dirtier. We used to get parasites more often."
Even the slip-slop-slap routine drummed into parents and then into schoolkids to shield them from skin cancer is being challenged.
"The further you live from the equator, the more likely you are to have food allergies," Professor Allen says. "We think it could be because children aren't getting enough Vitamin D in sunlight."
Mums are no longer being advised to avoid peanuts, prawns or strawberries, all high-risk food allergens, during pregnancy or breastfeeding. And the HealthNuts study has also ruled out hypoallergenic baby formula as reducing the risk of allergy. But a separate Murdoch Children's Research Institute study of 700 infants this year discovered that those with an eczema gene had a higher risk of food allergies.
In the Journal of Allergy and Clinical Immunology this year, British doctor Gideon Lack from St Thomas' Hospital in London linked "prolonged breast-feeding" with an increased risk of asthma and eczema. He noted that food allergies were highest in the "non-Hispanic white population".
An allergy to bird's nest soup was common in Singapore, he noted, royal jelly allergy was common in Hong Kong, and mustard seed allergy in France. Jewish children living in the UK were 10 times more likely to be allergic to peanuts than those in Israel.
Danish researchers discovered that the children of mothers who ate lots of peanuts during pregnancy were less likely to have asthma at the age of 18 months, according to a study published in the same journal by paediatric specialist Scott Sicherer from the Mount Sinai School of Medicine in New York. They did not investigate the impact on food allergies.
Professor Allen notes that south-east Asian immigrants are developing food allergies after moving to Melbourne - suggesting that it is indeed an "affluent western" disease.
Unsurprisingly, many parents may find all the conflicting advice a tad confusing. The trend towards delayed weaning began in 1974 when a group of British paediatric experts, concerned by a rise in celiac disease, recommended breast milk-only until four months of age. Then American health officials told parents to delay nuts and fish until children turned three, and eggs until the age of two.
In Australia, parents today are confronted with nine sets of guidelines for weaning, all giving slightly different advice. The Australasian Society of Clinical Immunology and Allergy advises parents to start introducing solid foods from the age of four months, in addition to breast milk. But the National Health and Medical Research Council recommends that children be exclusively breastfed until six months of age. The agency is about to relax its guidelines, to commence weaning at "around six months of age", giving parents more leeway to introduce solids earlier.
Professor Allen can understand why parents might be bewildered. "Parents are confused and get a bit annoyed because we all seem to change our minds," she says. "Every other country has two guidelines - one for the general population and one for high-risk groups - but we have a state-based health system and nobody seems to be able to agree. I ask, can we at least agree, because it does drive concern and anxiety (to have conflicting advice)."
Canberra allergy specialist Raymond Mullins, who heads the anaphylaxis working party for the clinicians' group ACSIA, says the longstanding advice to avoid risky foods like peanut and egg until children are older has failed to prevent allergies.
"People have had egg on their faces by giving advice and later it's been shown not to work," he says. "There is some evidence that delaying the introduction of egg by waiting until a child is 12 months old could be bad for them."
So what is driving the allergy epidemic? "I don't think anybody knows, to be honest," Dr Mullins admits. "Is it food additives and preservatives? There isn't really good evidence. Is it pesticides? We just don't know. It took a long time before the relationship between tobacco intake and lung disease was established, and it took years to link the sleeping positions of babies to SIDS. I'd be optimistic we might have an answer in five years."
Dr Mullins notes that children from bigger families are less likely to have allergies, cementing the theory that a bit of dirt doesn't hurt.
He advises mothers to "breastfeed as long as possible", while simultaneously introducing solids at four to six months. "Introduce new food in the morning on a Monday to Friday during business hours, not over a long weekend or during a long drive," he suggests - just in case they need medical assistance.
But family doctors are still advising parents to wait six months before introducing any solid foods, and to delay the introduction of egg. "Maybe that's not right, but we need hard evidence before we can make that change," says Australian Medical Association president Steve Hambleton. "Parents are entitled to feel a bit confused."
** This is a topic we will personally at Babysmiles keep up to date with and keep posting more information as it comes to hand.