Our CEO Lynne Regent attended the European Academy of Allergy and Clinical Immunology (EAACI) Congress 2017 in Helsinki to keep up to date on latest research and developments in allergy #EAACI2017.
Our CEO Lynne Regent attended the European Academy of Allergy and Clinical Immunology (EAACI) Congress 2017 in Helsinki to keep up to date on latest research and developments in allergy #EAACI2017.
The proposed new law will replace the current term ‘Special Educational Needs’ (SEN) with ‘Additional Learning Needs’ (ALN); it will remove the system of statements and instead give every learner with ALN the same type of Individual Development Plan; require local government and health bodies to work more closely together; and improve the information and advice on offer to families.
At the moment, the reforms don’t include medical conditions. There is now an opportunity for children with medical conditions at schools to have the same protection in legislation as those with disabilities, learning difficulties and sensory impairments. We are working for this change, partnering with other leading health and children’s organisations in Wales to recommend that children with medical conditions are included. Welsh Government has said that if there’s a desire for it to be included, then it will reconsider its position.
Almost everyone believes the system for helping children and young people with these needs must be improved and the Welsh Government recognises this too. Now that there is a proposed new law to consider, Committee members at the Assembly want to hear from as many people as possible.
The survey below is a chance for you to tell them what you think about the way people and organisations working with children and young people should give them extra support with their learning, where they need this.
Please complete the survey about your child or your experience of support in school. There is a free text box at the end where you can let the Committee know that you are responding about a medical condition and ask for this group to be included in the reforms. Please include this information, as well as any other useful background information for the Committee. This will help them to see why this is such an important issue.
The Anaphylaxis Campaign is an integral part of this campaign and our National Coordinator Mandy East will be giving evidence at the Welsh Assembly when they hear the Bill next month. If you would like to write to your AM about this issue and need any extra help or information please contact us at [email protected]
On behalf of all my staff and the trustees of the Campaign I wish you all a very Happy Christmas!
The International Flight Services Association (IFSA) World Food Safety Guidelines for Airline Catering has previously not included allergen management, however agreement was obtained last year that an additional allergen section would be included. This covers expectations around allergen management in the catering kitchen and provision of accurate information to crew.
This is a guideline document that airline caterers worldwide rely on, so the inclusion of an allergen section is a significant step forward.
The 2016 guideline can be downloaded here.
Professor Clare Mills
Food allergies present everyday problems for allergic consumers and food companies alike. Sometimes it seems we simply have to come to terms with these problems and manage them on a daily basis. However, revolutionary scientific work is being carried out behind the scenes that aims to help food companies radically improve their management of allergens with the ultimate aim of protecting consumers at risk.
This article is intended to summarise some of those projects.
Data collected by the EU-funded EuroPrevall project – which looked at the patterns and prevalence of food allergies across Europe and beyond – are now being utilised in a global, EU-funded venture called iFAAM*. The intention is to develop evidence-based approaches to improve the control of allergens by the food industry and also help patients cope better.
Briefly, the aims of iFAAM are:
The project’s partners also hope to obtain the scientific evidence necessary to provide recommendations on the introduction of allergenic foods into infants’ diets in order to prevent the development of food allergies later in their lives.
Most allergen exposures occur in one of two ways: either the consumer makes a mistake and eats a food they should avoid; or a manufacturer or other food supplier fails to manage allergen handling properly and a food expected not to contain an allergen contains enough to trigger an allergic reaction.
There are many anecdotal reports of how people with allergies experience reactions in the community but until now, a systematic approach to studying them has not been widely undertaken.
Working with patient organisations such as the Anaphylaxis Campaign, DAAB in Germany and Anaphylaxis Ireland, iFAAM is systematically collecting details on the reactions experienced by allergic patients in Ireland (AlleRisc) and the UK (AlleRic). Where possible food samples have been collected and analysed for the presence of undeclared allergens. The study is due to be completed in the coming months and is now being rolled out to other European countries such as Germany.
iFAAM acknowledges that in practice it is not possible to exclude allergens completely from foods otherwise free from a particular allergenic ingredient when shared facilities and processing lines are used. As a result allergen management strategies need to focus on how much residual allergenic ingredient can be tolerated in such foods. An excellent body of research on how much of an allergenic food is required to cause a reaction is now available for foods such as peanut. These data are being used to build population-level dose distribution models which can predict the dose at which, for example, five per cent of the allergic population (known as the ED 05) might react. The ED05 level of allergen is thought to combine a good level of patient safety.
The ED05 level is being verified in the iFAAM project for three allergenic foods: hazelnut, egg and milk. Using a study design implemented to validate the ED05 values for peanut, patients are given the allergenic food in a single portion of chocolate dessert. Data from these studies are encouraging and promise to provide a means of validating any dose level chosen that is considered generally safe for the food allergic population.
The amount of allergen eaten by a person with a food allergy is not the only factor that can impact on severity of the reaction. Through a set of integrated studies the iFAAM project is seeking to investigate how the food matrix and medication, such as antacids, may alter a patient’s reactivity to foods through clinical studies undertaken in Switzerland (Zurich), Spain (Madrid) and the UK (London and Manchester). These data will be used to assess whether these factors do indeed need to be taken into consideration in the risk assessment process and contribute to identifying safe allergen doses.
In the iFAAM project analytical tools are being developed for allergen analysis which target biologically relevant molecules known to cause allergic reactions, using foods with a defined allergenic activity. Ensuring such “clinical relevance” will aid interpretation of test results which play such a critical role in food allergen management and help to support food allergic consumers to avoid problem foods. It will also help to provide analysts with much-needed quality control samples which have the potential to be developed into properly-validated reference materials in the future.
The methods include tests suitable for in-factory analysis (e.g. immuno-based) and confirmatory in-laboratory tests (e.g. mass spectrometry-based) for peanut, hazelnut, walnut, egg and milk.
Processing-induced changes to allergens (for example, heat-induced chemical modifications) and the food matrix may alter the allergenicity of food proteins. It can also modify the effectiveness of extraction and detection methods used for allergen determination. These factors are being taken into account in iFAAM so that the analytical methods being developed are robust and suitable for use in a number of different food matrices such as chocolate and baked goods such as cookies.
As part of this activity an inter-laboratory comparison of both immunoassay and mass spectrometry methods is being undertaken, involving analytical laboratories from Europe, the USA, Australia and Japan. This initiative is also supporting the harmonisation of reporting units, since allergen risk assessment is undertaken using a measure of protein – the component in foods that causes allergies – rather than on a commodity basis.
The project involves a comprehensive risk analysis of food production, which takes into account all the components in the food supply chain from the raw materials to the finished products, and including manufacturing and processing steps.
In order to take account of variations in portion size, the iFAAM risk assessment builds on food consumption data collected from individual allergic consumers.
The project leaders hope that knowledge gained from this part of iFAAM’s work will lead to a transparent way forward for the application of precautionary allergen labels and will seek to ensure phrases on labels clearly communicate the level of risk that low levels of allergens may pose to consumers.
*iFAAM stands for the Integrated Approaches to Food Allergen and Allergy Risk Management. The €9million project involves the world’s leading experts in the UK, Europe, Australia and US. Together they mark the biggest study of food allergy in the world. The project leader is Professor Clare Mills, of the Institute of Inflammation and Repair and Manchester Institute of Biotechnology, Manchester Academic Health Science Centre, University of Manchester.
Methods for managing allergens in food production: advances from the global iFAAM project. E. N. Clare Mills1, K. Beyer2, L. K. Poulsen3, S. Taylor4, S. Baumgartner5, R.W.R. Crevel6, S. Schnadt7, R van Ree8
1Institute of Inflammation and Repair and Manchester Institute of Biotechnology, Manchester Academic Health Science Centre, University of Manchester, 131 Princess Street, Manchester M1 7DN, UK; 2University Children’s Hospital Charité of Humboldt University, Berlin, Germany; 3Allergy Clinic, Copenhagen University Hospital, Gentofte, Denmark; 4Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, USA; 5 Universität für bodenkultur, Vienna, Austria; 6SEAC, Unilever Colworth, Sharnbrook, UK; 7Deutscher Allergie- und Asthmabund, Mönchengladbach, Germany; 8Academic Medical Centre, Amsterdam, The Netherlands.
Nursing in schools: how school nurses support pupils with long-term health conditions looked at school nurses’ confidence in managing five prevalent long-term health conditions: asthma, epilepsy, diabetes, anaphylaxis and eczema. The research included a national survey, completed by one in seven of the school nurses working in England.
Encouragingly nearly three-quarters (73%) of school nurses felt confident or very confident in supporting pupils with asthma – important because this is the most common long-term health condition facing children and young people. Even higher numbers (82%) were confident in treating anaphylaxis.’
Read more and access the report here.
Anaphylaxis Campaign’s “AllergyWise” online training for healthcare professionals offers comprehensive training to enable school nurses and other healthcare professionals to run their own anaphylaxis training for others working in schools and early years settings. Find out more about this and our other online training courses here.
Allergy sufferers are being urged to stay aware of the symptoms and signs of anaphylaxis as the UK moves into the height of wasp season.
The risk of getting stung by a wasp highest in September and the recent heatwave has intensified risk even further.
As the height of the wasp season approaches, a national campaign supported us is highlighting the dangers of anaphylaxis from wasp stings and the importance of awareness, prevention and treatment options to beat the condition. The call from the charity comes in September, the month when wasps in the UK are most active and the most critical time to be vigilant against wasp sting allergies.
The prevalence of allergy in the UK has been increasing at an alarming rate over the last 20 years – so much so, that the number of hospitalisations caused by severe allergies have increased by seven fold in the last decade1.
Professor. Steve O’Hickey (Consultant with a special interest in Allergy) from Royal Worcester Hospital said: “The exact reason for this growing allergy epidemic across the UK is unclear, but it is likely attributable to three key factors: a general increase in incidence; an increase in the severity of these incidents; an increase in the complexity of these more severe and common incidents.
“Seasonal allergies, especially insect allergies, are becoming increasingly common and as the latter end of the summer approaches we do receive an increase in incidents of anaphylaxis as a result of wasp stings.
“Through the Bee Resistant campaign, we’re aiming to raise awareness by explaining the dangers and signs to look out for, as well as the treatments that are available within the NHS that can reduce the worry of sufferers and their families.”
To add to the woes of allergy sufferers, the recent heatwave is set to further increase the aggression and persistence of wasps – as it becomes uncomfortably hot for them inside their nests – meaning a higher chance of getting stung2. Hot weather also leads to improved breeding conditions for wasps and a higher prevalence of the insects they feed on, meaning they are more likely to thrive and be higher in numbers than would normally be the case.
Lynne Regent, CEO, Anaphylaxis Campaign said: “September is about enjoying the last of the warm weather but for those who have experienced a serious allergic reaction to a wasp sting in the past, it’s a time of increased anxiety as the chances of getting stung – potentially fatally – significantly increase.
“The Bee Resistant campaign is about raising awareness of anaphylaxis and educating the public on the dangers and symptoms to look out for, as well as the treatments that are available that can dramatically reduce the potentially life-threatening effects of getting stung.”
Guidance from the National Institute for Health and Care Excellence (NICE) states stings caused more than 70% of all deaths from anaphylaxis in the UK between 1992 and 20013.
1% of the UK population is at risk of a sting that can provoke an allergic reaction and a small minority of these people will go on to develop the potentially fatal allergic symptoms of anaphylaxis4.
Symptoms of anaphylaxis include itching commonly affecting the palms, soles, groin area and scalp, general hives, swelling of the lips, tongue or throat, difficulty in breathing, tightness in the chest, faintness or dizziness and a feeling of fear or impending doom.
In case of an emergency5:
Local (i.e. at the site of the sting) allergic reactions do not require emergency treatment, cold compresses or pain killers can be used to quell the burning sensation caused by the sting. Keeping a swollen limb elevated can also help to ease the pain and antihistamines can be taken to help reduce swelling and itching. For people who suffer from a large local reaction, steroids can help to speed up the healing process. The earlier they are used the more effective they are. In the case of a larger reaction which may require steroids, always seek advice from a doctor or nurse first.
Sufferers who have experienced severe allergic reactions should be referred to an NHS allergy clinic for further assessment. In people with confirmed allergy, a longer term solution may be venom immunotherapy treatment (VIT) which can change the way a patient’s immune system reacts when stung and is effective in preventing anaphylaxis in the future.
VIT has to be administered in specialist clinics by medical professionals – there are about 60 NHS specialist allergy centres around the UK.
To find out more about the campaign visit www.beeresistant.com or follow us on Twitter @BeeResistant. If you are concerned about anaphylaxis, visit your GP or contact our helpline on 01252 542029.
On 25 June 2015, the European Medicines Agency (EMA) recommended several measures, including the introduction of more effective educational material, to ensure that patients and carers use adrenaline auto-injectors (AAIs) successfully.
Adrenaline auto-injectors are potentially life-saving treatments for anaphylaxis (severe allergic reactions) while the patient waits for emergency medical assistance. In the UK the following brands are available – Emerade, Jext and EpiPen.
The EMA carried out a review of adrenaline auto-injectors following concerns that currently available devices may deliver adrenaline under the skin instead of into a muscle, and this may delay response to treatment.
Having assessed all the available data, EMA’s Committee for Medicinal Products for Human Use (CHMP) acknowledged that giving the medicine by injection into the muscle is the preferred way to obtain a rapid response in anaphylaxis. However, the CHMP noted that several factors may affect whether adrenaline is actually delivered into a muscle; these include needle length, the thickness of fat under the skin, the way the auto-injector works (e.g. if it is spring loaded or not), the angle at which the device is placed on the skin and the force used to activate the device as well as how well the user follows the instructions for injection.
The CHMP also concluded that further data should be generated to better understand how adrenaline penetrates body tissues when given with each of the different auto-injectors. This means there will be further clinical trials to try to establish his.
The CHMP recommendation was sent to the European Commission which endorsed it and issued a legally binding decision that is valid throughout the EU.
The Anaphylaxis Campaign has followed this through with the MHRA, and we will continue to keep you updated on this review.
Key points for people prescribed AAIs
Following Britain’s exit from the EU, concerns have been raised as to whether the European Food Information for Consumers regulation (FIC), that became enforceable from December 2014, will still apply. We contacted the Food Standards Agency and received the following response from a spokesperson:
“The FSA’s priority is to ensure that food is safe; and consumers can make informed and safe food choices. Although the British public have voted to leave the EU, all existing legal requirements remain in force. The UK remains a member of the EU until it has negotiated its exit and will continue to comply with EU food and feed legislation during this time. All UK businesses will need to continue to comply with all EU legislation, including the allergen regulations.”
Results of the first-ever international survey on perceptions of food allergen thresholds and consumer habits surrounding precautionary labeling were published online in Allergy, the journal of the European Academy of Allergy and Clinical Immunology (EAACI). The study, spearheaded by Food Allergy Research & Education (FARE), Food Allergy Canada (formerly Anaphylaxis Canada), and others, were presented at the EAACI Congress in Vienna, Austria this week.
This study is the first to examine differences in the international food allergy community’s perceptions about thresholds (the lowest amount of a food allergen that can elicit a reaction) and precautionary labeling from the perspective of consumers in 16 countries. Results show that in most countries, the vast majority of individuals managing food allergies would still not buy foods that contained an allergen, even if the amount were reliably determined to not cause an allergic reaction per validated allergen thresholds.
Neither the U.S. nor Canada has established allergen thresholds. Precautionary labeling – often seen as a “may contain” statement – warns consumers about the potential for a food product to contain trace amounts of an allergen due to shared equipment lines or other manufacturing practices. This type of labeling, which is voluntary, is widely used across the manufacturing industry.
“Families and adults managing food allergies face a number of challenges in their daily lives, not the least of which is finding safe foods to eat, and relying on accurate ingredient labels,” said James R. Baker, Jr., MD, CEO and chief medical officer of FARE. “This is an important topic among stakeholders in the community, and FARE has led efforts to ensure that the consumer’s perspective on this issue is heard and understood.”
FARE has recommended to the U.S. Food and Drug Administration (FDA) that it not establish a threshold for any food allergen unless the FDA is in possession of reliable scientific data that clearly identifies a quantity of the allergen that is so small that it will not cause an allergic reaction in even the most sensitive individuals, and also a reliable analytical method for determining compliance with the threshold that can be easily used by food companies and the FDA.
FARE and Food Allergy Canada facilitated the distribution of the consumer survey to 14 other countries: Australia, Chile, France, Germany, Ireland, Israel, Italy, Japan, Mexico, New Zealand, South Africa, Spain, the Netherlands and the United Kingdom. Surveys were conducted between February 2013 and April 2014. Nearly 10,000 people managing food allergies participated in the survey, which was translated into eight languages and posed hypothetical questions about thresholds.
“We will continue to work together with other countries to enhance our educational efforts to ensure that consumers are making informed choices,” said Laurie Harada, executive director of Food Allergy Canada.
“Many families surveyed did not understand that precautionary allergen labeling statements do not correspond with the likelihood of a potential allergen in a food and that these labels are voluntary and at the manufacturer’s discretion,” said Ruchi Gupta, M.D., MPH, study co-author, of Northwestern University’s Feinberg School of Medicine. “Similarly, it was difficult for families to understand the meaning of thresholds and how they may potentially make an impact. It’s clear that we need more consistency and transparency in labeling that correspond to a demonstrable level of risk in consuming these foods and allergen amounts that may occur through cross-contact.”
Among the study findings:
The authors note that previous studies analyzing the content of allergens in products with precautionary labeling have shown there is little correlation between the amount of allergen present in a food product and the type of precautionary statement that is used. A study published in 2010 in the Journal of Allergy and Clinical Immunology analyzed a number of U.S. products with precautionary labels for milk, peanut and egg. Ten percent of these products contained milk, 4.5 percent contained peanut and 1.8 percent contained egg, respectively.
More work continues to be done in the area of food allergen thresholds. In the meantime, consumers throughout the world report confusion about precautionary statements. FARE has previously documented that U.S consumers continue to take risks when buying such products.
The study published this month advocates for the inclusion of consumers in discussions around standardisation of precautionary statements and validated allergen thresholds.
“Through its Patient Organisation Committee, EAACI has long advocated to ensure the patient voice is present and heard,” said Antonella Muraro, president of EAACI. “We were very pleased when leaders of patient organisations developed and completed this global survey to help inform research on a complicated but important issue and look forward to supporting future collaborations on this and other advocacy priorities.”