29 September 2010

The Allergy Epidemic

Dr Adam Fox

Consultant in Paediatric Allergy

Guy’s & St Thomas’ Hospital16 October 2013

Ancient History

2

Modern History

3

• Hay fever – Dr John Bostock first described in 1819

• Based on his own symptoms

• Second paper on 28 cases - took 9 years to acquire

Modern History

allos = "other"

ergon = "reaction"

Clemens Von Pirquet 1874-1929

An inappropriate, potentially harmful reaction by the immune system to a harmless stimulus.

Allergic Diseases

• Eczema

• Asthma

• Allergic Rhinitis

• Food Allergy

• Drug Allergy

• Venom Allergy

• Latex Allergy

5

at least 2

1 other

Alone

0

20

40

60

80

100

Asthma Suspectedall rhinitis

Eczema Oral-gastrointestinal

symptoms

%

Proportion of the children with asthma, suspected allergic rhinitis, eczema and oral-gastrointestinal symptoms in

combination with other allergic manifestations n= 1417

Wickman et al, Allergy 2004

Allergic Disease in 21st Century UK

8

40% of UK children have an allergic diagnosisGupta et al Clin Exp All 2005

3-4 will have eczema but 12 will have suffered at some point

In a classroom of 30 primary school childrenIn a classroom of 30 primary school children

3 or more children are likely to have asthma

In a classroom of 30 primary school childrenIn a classroom of 30 primary school children

4 or more children will be suffering from rhinitis

In a classroom of 30 secondary school childrenIn a classroom of 30 secondary school children

Impact of Allergic Rhinitis

• Significant decrease in Quality of Life

• Effect on exam performance

– 50% increased risk of dropping a grade from mocks to formal exam

Juniper EF et al. Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol. 1994 Feb;93(2):413-23. Juniper EF et al. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998 Feb;101(2 Pt 1):163-70.Simons FE Learning impairment and allergic rhinitis.Allergy Asthma Proc. 1996 Jul-Aug;17(4):185-9Walker S et al. Hayfever has a significant detrimental impact on national exam performance in UK teenagers: case control study. JACI 2007.

1-2 children are likely to have a food allergy (although 10 may think they have)

In a classroom of 30 primary school childrenIn a classroom of 30 primary school children

Food allergy in the UK?

• Community cohort of 969 children born 2001-2

• Cumulative incidence of FA was 5.0%

• 33.7% of parents reported a food related problem (only 12.9% of these confirmed)

Venter C et al. Allergy. March 2008

Is peanut allergy getting out of control?

Rates of Peanut Allergic in UK Paediatric Cohorts

Allergy Service Provision

• Remains variable

• 27 adult & 20 Paediatric consultants identified in 2010 RCP report

• No significant expansion planned

• Est 2% of appropriate children receive IT (Vance. Clin Exp Allergy 2010)

16

Key UK Organisations

17

The future

• 2848 Australian infants SPT at 12months

• Prevalence of food allergy 10.4%

Summary

• Increasing pattern of disease

• Multisystem problem

• Relative lack of service provision

• Challenging future

20