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Copied and posted from the Irish Times, June 28, 1999 [url="http://www.ireland.com:80/newspaper/features/1999/0628/fea1.htm"]http://www.ireland.com:80/newspaper/features/1999/0628/fea1.htm[/url]

Monday, June 28, 1999 The nut buster

No one should die from a violent food allergy, say Irish campaigners for better awareness and prevention of the condition. Anne Dempsey reports Could Scottish athlete Ross Baillie's life have been saved if he had carried an adrenaline pen with him? The promising 21-year-old hurdler suffered a seizure, known as anaphylactic shock, triggered by a nut allergy while eating a coronation chicken sandwich. He died two days later, on June 18th, in intensive care at a local hospital. Baillie knew nuts were dangerous for him and tried to spit out the sandwich as soon as he tasted it. But by then it was too late.

Chand Kohli, whose daughter Dominique also suffers from a lethal food allergy to nuts, is one of the founders of the Irish Anaphylaxis Campaign: "This is such a tragedy because we don't believe that anyone should die from an anaphylactic reaction these days," he says. "Adrenaline can save lives in 99.9 percent of cases. The Epi-Pen can be self-administered; you merely stab yourself in the leg and immediately the adrenaline gets working. Deaths like these are one of the reasons why it's so important to raise awareness about fatal allergies, which we feel are on the increase."

Peanut allergy first hit the headlines in 1993 when 17-year-old Sarah Reading from Surrey died at home some hours after eating lemon meringue pie in a local department store restaurant. The pie base contained crushed peanuts. Three other deaths took place around the same time. As they were publicised, scores of parents began talking about near-misses when children became extremely ill after eating products containing nuts.

Dominique Kohli is one of an unknown number of Irish people suffering from a life threatening allergy. The reaction occurs because the body's immune system overreacts in response to the presence of a foreign body which it wrongly perceives as a threat. This causes it to release a chemical substance which acts negatively on blood pressure, blood vessels and lungs. An immediate injection of adrenaline counteracts these symptoms. The adrenaline pen contains a ready loaded dose of adrenaline.

There have been three known Irish deaths in recent years and a further unknown number which may have been misdiagnosed as asthma deaths. While peanuts have hit the headlines as the fatal foods, there are other allergens: "There are 125-145 deaths per year in Europe from anaphylactic shock," says Dr Joe Fitzgibbon, allergist. "They died not only from peanut, but from fish, sesame seed, egg, fruit. We need an accurate diagnosis, not a woolly ban on all foods.

"The latest data - as yet unpublished - indicates that people with pre-existing asthma need to be extra vigilant. Many anaphylactic deaths have been of people with pre-existing asthma - which doesn't mean that those without asthma can be complacent," he says.

Child allergies have been described as a 20th-century disease and as a price we pay for affluence. A study into the lives of east German families following reunification found a sharp rise in allergies among the children. Western prosperity was blamed, with its wall-to-wall carpets which hold dust mites, central heating, more processed foods, more household pets, more access to an international cuisine.

"It's true I didn't see peanut butter until I was 10 years old," says Joe Fitzgibbon. "When children taste foods earlier, it makes for earlier desensitisation."

Last November, the Allergy Foundation of Ireland was set up by a group of doctors specialising in allergies and respiratory problems. The aim is to educate the medical profession and to disseminate up-to-date and accurate information on allergies.

"Allergies have always been the poor relation of medicine," says Dr Conor O'Toole, the foundation's secretary. "The public don't necessarily know the difference between proper allergy testing and going to some quack. Many people with allergies don't take them sufficiently seriously. Someone who has had a fright through a severe reaction needs appropriate information and advice. An attack which caused a swelling of the tongue, problems with throat, fainting, wheezing must always be taken seriously. Our basic message to doctors and to the public is that the only thing that works in a severe attack is adrenaline."

Increased awareness of serious food allergies, coupled with a greater variety of global foods and a greater tendency to eat out, makes allergies a consumer and catering issue as well as a medical one. It is proving impossible to have manufacturers list every single ingredient in food. Instead, the EU has issued draft directives on food labelling which state that if certain listed products are present in a particular food, they must always be named as such. This list includes gluten foods, shellfish and shellfish products, eggs and their products, fish, peanuts, soya and other legumes, milk and milk products, tree nuts, and seeds such as sunflower, sesame and millet, peach plum and apricot. This directive is not yet law.

Chand Kohli deplores a growing practice in which Irish manufacturers and supermarkets are issuing general disclaimers such as all the yoghurts or all their bakery products "may contain nut traces". "This is an appalling practice as the technology exists to detect allergens in foods, and it allows the manufacturer to evade responsibility while unnecessarily restricting the food choices," he says. "Parents contacting us were annoyed about the yoghurt, which is a very good food for children; it puts all the responsibility on the parent and lets the manufacturer off the hook."

There is no allergy-related legislation regarding unprocessed foods, so when it comes to eating out, Dr Fitzgibbon is unequivocal: "I have to tell my patients who have had a life-threatening incident: `never put your life into the hands of a caterer'. Some people with a severe allergy have experienced their eyes swelling up by just entering a seafood restaurant. The simple advice is never eat out," he says.

"It's a very hard station but we mustn't be afraid to bite the bullet. If there has been a severe attack, take appropriate care for the future, and always carry your adrenaline with you. We also need to educate the caterers." He refers to the "Quality" or "Q" mark for hygienic food preparation and storage now being awarded to restaurants and caterers, and says he would like to see allergen awareness given the same priority: "It would be nice to piggyback on this scheme so that, say, if a melon were being sliced on a clean board we would know it contained no traces of the previous food," he says. "When you're talking about food allergies, all the risk factors are outside the home," agrees Dr O'Toole. "A child gets something at a party, an adult eats in a restaurant. Restaurants don't understand that very little is lethal. If you fry some peanut based food in a pan and wipe it clean for the next food, that's not enough. The changing pattern in people's lives means that, when it comes to serious allergies, the more we eat out, the more we are at risk."

The Anaphylaxis Campaign is forging links with catering interests here: "When you visit a food-processing plant, you do understand the difficulties they have," says Kohli, "and we are in the process of producing an information chart for the catering industry which we think will be helpful. "Finally, I would say if you work in a restaurant and someone tells you they are allergic to something and asks you if that food is present, do take them seriously and tell the truth, it could literally be a matter of life or death."

Irish Anaphylaxis Campaign, PO Box 4373, Dublin 18 (01-2952791)

Allergy Foundation of Ireland, PO Box 6668, Blackrock, Co Dublin

[This message has been edited by Jim (edited June 28, 1999).]

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