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MaltaToday 31 August 2022 MIDWEEK

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15 maltatoday | WEDNESDAY • 31 AUGUST 2022 WORLD self-diagnosing, and their diets are suffering lose out on calcium, get osteo- porosis." That's not to say that label- ling food for allergies isn't important – it clearly is. But people who think they have an allergy avoid foods they don't need to, and restricting diets is unhealthy and should only be done as a last resort, under clinical advice. "The key, if people think they have an aller- gy," says Sunil Bhopal, a pae- diatrician at the University of Newcastle, "is to seek out sup- port from the NHS from a pae- diatric allergist specialist, not just cut things out. Cutting out foods reduces the opportunity to have a varied diet, so we're very cautious about it." Treatment and prevention Parents, understandably nervous about the risk of ana- phylaxis, have often avoided fa- mously allergenic foods – nuts, for instance – in early child- hood. But there's increasing evidence that this is counter- productive, and it's even possi- ble that doing so may be a par- tial contributor to the increase in allergy rates. "Early introduction of foods like cow's milk, egg, and pea- nuts seems to be increasing tol- erance in children as they get older," says Ms Kelman. "We need to have those in the diet, especially in infants." She worries that some ad- vice – such as avoiding whole peanuts for children under three – gets misinterpreted, so parents, in that case, might avoid all peanut products com- pletely. But studies have shown that eating peanuts in infancy reduces the risk of peanut al- lergies, and one hypothesis for the reason Israel has far lower peanut allergy rates than most comparable countries is the popularity of a peanut-based snack called Bamba. And if you've got no reason to think that your child would have a severe allergy, then you shouldn't be avoiding foods. Get them in the diet, and keep them in the diet, Ms Kelman says. Even if you or your child do have an allergic reaction, you shouldn't go straight to cutting foods out – see a clinician in- stead. "We can assess the risk of anaphylaxis with reasonable certainty," says Mr Arshad, and they can provide ways of man- aging the symptoms. In recent years, it's also be- come possible to treat even se- vere allergies. It's been known for a century, says Mr Arshad, that exposing people with some allergies to small amounts of the allergen and then building the dose up helps them develop tolerance. "It improves hayfe- ver and bee and wasp allergies," he says. "Patients don't get an- aphylaxis." But when people tried it for food allergies, pa- tients went into anaphylactic shock. However, recently research- ers found that if you give the allergen orally, as a droplet – rather than injecting it, as was previously done – then you can avoid that problem. "The risk of anaphylaxis was low and it proved very effective," says Mr Arshad. "There have been quite a few trials over the last 12 years, mainly in the US, but some in the UK, and serious food allergies like pea- nuts, eggs, and milk have been treated with this 'oral immu- notherapy', as we call it, until the patient tolerates a serious amount and doesn't have to worry about avoidance or to carry an EpiPen." It takes months, but it works. His lab is now doing further research into whether this im- munotherapy technique can be carried out using normal foods available in supermar- kets, rather than medically pu- rified extracts, to make it more cost-effective for use on the NHS. Perspectives Anaphylactic shock is disas- trous and real, but – merci- fully – very rare: about five or 10 deaths per year in the UK. "If you ask people, they over- estimate the risk of fatal out- comes," says Mr Boyle. "People think it's about 10 times more likely than it is." And despite the increasing prevalence of allergies, the number of deaths has remained roughly stable – suggesting, says Mr Arshad, that surveillance and manage- ment are working, although Mr Boyle would argue that it's because the apparent increase is at least partly driven by over-diagnosis. It's also become clear over recent years that earlier ap- proaches – cutting food out of diets, and avoiding potentially allergenic foods in infancy – have been counterproductive. Eating a varied diet is good, and exposure to allergens ear- ly on reduces the likelihood of having an allergy later. And while food allergies re- ally are a problem for a num- ber of people, there's a greater percentage who have wrong- ly self-diagnosed – or been wrongly diagnosed – with an allergy, which is making them restrict their lives unnecessar- ily. "The main burden of food allergy on society is the restric- tions," says Mr Boyle. "We're making food allergy more problematic than it is." "Early introduction of foods like cow's milk, egg, and peanuts seems to be increasing tolerance in children as they get older... We need to have those in the diet, especially in infants"

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