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new zealand

AUTUMN 2013 $6.95 inc GST

TAKE CONTROL of autumn allergies


Seven great reader competitions – see inside

Keeping your allergic child safe REAL LIFE: I have 1,200 different allergies Common NZ moulds (and what to do about them)

Delicious allergy-free recipes

Inside: Gluten-free living + 10 ways to deal with eczema

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8 Common NZ moulds (and what to do about them)


REAL LIFE 12  I have 1,200 different allergies 51 Catherine Huxford: Teacher, mum, inventor

ENVIRONMENTAL ALLERGIES 18 Autumn allergies: Take control 25 Sore itchy eyes, do I have an allergy?

KIDS & ALLERGIES 20 Does my child still have a food allergy? 22 Oral challenge: Step by step


38  Keeping allergic children safe at school

RECIPES 28 Allergy-free cooking for all the family 57 Autumn flavours



Every new subscriber goes into the draw to win a Nilfisk Extreme Complete vacuum cleaner (RRP $699). Subscribe online at


GLUTEN-FREE LIVING 54 Coeliac disease diagnosis changed my life 56  10 top tips for digestive health

REGULARS 6 Allergy aware 17 Subscribe and win 59 Allergy guide 62 MiniAds 64  Endpoint: When should I see an allergy specialist?


GIVEAWAYS SEVEN amazing reader giveaways in this issue. See inside for how to enter.

32 Dairy-free or glutenfree: What nutrients are you missing?



35 10 ways to deal to eczema

BABIES & ALLERGIES 42 Choosing the right baby formula

TREATMENT 46 Insect sting allergy and immunotherapy

ASTHMA 48 Is your asthma under control?

BE IN TO WIN! Gift yourself or a friend a 12-month subscription to Living with Allergies and you will be in to win one of three Sodastream prize packs worth $200. See for details.


LIVING WITH ALLERGIES Editor: Caroline Wood Email: Design: Rose Miller at Kraftwork & Megan Colquhoun Proofreader: Stella Clark


ADVERTISING Sales manager: Debbie Davis Phone: 09 571 9494 or 021 340 360 Email: SUBSCRIPTIONS Subscribe online at Phone: 09 589 1054 Email: subscribe@ PRINTER McCollams Print PUBLISHER Published quarterly by Hawkhurst Media Services Ltd PO Box 90 059, Auckland Mail Centre, Auckland 1030 Phone: 09 589 1054

Member of the Magazine Publishers Association. Member of the Audit Bureau of Circulation (First audit due 30 June 2013). ISSN: 2324-2213 Disclaimer: Every effort is made to ensure accuracy but Living with Allergies accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. If in doubt check with your allergy specialist, GP, nurse, dietitian or other health care professional. Editorial and advertising material does not necessarily reflect the views of the Editor or publisher. Advertising in Living with Allergies does not constitute endorsement of any product. © All rights reserved. No article in whole or part should be reprinted without permission of the Editor.




he team behind Living with Allergies magazine is delighted to welcome you to our first issue, packed with informative articles, expert advice and real life case studies. Living with Allergies is all about you. A common theme running through this first issue is ‘control’ – trying to keep the upper hand so allergies don’t rob you, or your child, of quality of life. In this issue, we have expert advice on dealing with mould and eye allergies, dairy and gluten-free living, immunotherapy and how to get your asthma and eczema under control. We have special reports on food allergies in children and babies, plus some delicious familyfriendly recipes for autumn. Dealing with serious allergies can be tough. I hope reading the case studies in this issue will help you realise you are not alone. I was particularly struck by Katie Neale’s story.

She has allergic asthma, 1,200 different allergies and developed life-threatening anaphylaxis after having her baby. But she remains positive about the future, in fact she wants to share her amazing story to help others. Thank you to everyone who has been so supportive of our magazine. I hope you enjoy reading the first issue and are inspired to take control of your own allergies. I would love to hear from you – please get in touch with your ideas, questions and stories. Email editor@

Caroline Wood Caroline Wood Editor

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allergy aware

NEWS AND VIEWS A flu shot for allergy?

Preventing allergy and asthma with a simple jab is not as far fetched as you may think, according to researchers from New Zealand’s Malaghan Institute of Medical Research. Allergic diseases, such as asthma, food allergy, eczema and hay fever, are caused by an overreaction of the immune system to harmless environmental triggers. The part activated is called the Th2 immune response, which normally protects the body from parasitic worm infections. Researchers believe they can develop a vaccine to turn off the Th2 response. Severe allergy symptoms are currently treated by steroids. Malaghan Institute director Professor Graham Le Gros said: “What we are attempting to do here is develop an immunotherapy, or vaccine, that specifically shuts down the Th2 immune response. This is a more natural approach to treating allergic disease.” The idea of an annual ‘allergy shot’ is still a way off but scientists say they have made significant progress in the basic research required to make the vaccine.

Immunotherapy declaration

A group of leading European allergy experts has published a European declaration calling for more public funding of immunotherapy (desensitisation) treatment. The European Academy of Allergy and Clinical Immunology predicts that half of all Europeans will have an allergy within the next few decades. Immunotherapy is currently the only medical intervention that has the potential to alter the course of the disease. It can alleviate symptoms and stop disease progression, the group argues. Writing in Clinical and Translational Allergy, they are calling for better promotion and public funding of immunotherapy and more research into allergies and their potential treatments.


Allergy epidemic

The number of people with allergies has risen sharply in recent decades with research suggesting more than 10 per cent of infants under the age of one have a food allergy. The Australian research found that anaphylaxis increased by 350 per cent in 10 years, with New Zealand experts saying the rise will be similar here. Meanwhile a New Zealand study found that 16 per cent of under-fives out of a group of 110 had diagnosed eczema. Doctors say allergies are rising in New Zealand, as they are in other developing countries, but more research is needed into the number of people who have allergies, causes and treatment. Diagnosis is also difficult in New Zealand because of a lack of allergy specialists in some parts of the country.

Office bad for health

Have you ever felt like working in an office is bad for your health? You may be right, according to research carried out by the charity Allergy UK. Its survey of office workers found that at least 5.7 million Brits could be allergic to their working environment. Half the group had experienced an allergic reaction at work, with 62 per cent of respondents experiencing itchy or watery eyes, and 27 per cent breathing difficulties.

Sensitive choice

You can trust the blue butterfly. Made4Baby skincare is the latest brand to be added to the Sensitive Choice programme endorsed by the Asthma Foundation. To join the programme products must go through rigorous testing to ensure they are safe for people with asthma and allergies.

Daisy goes global

Daisy the cow sparked international media interest when Kiwi scientists announced she was the first in the world to produce low allergy, high protein milk. Her story featured in 65 international media outlets from France to Brazil, including the Wall Street Journal, BBC World Service, National Geographic Russia, Science, Nature and CNN. New Zealand’s largest crown research institute AgResearch is continuing its research, which could lead to the world’s first commercially-available low allergy milk. Researchers want to breed from Daisy and determine the milk composition and yield from a natural lactation. They will also perform cell culture tests to determine whether the milk has hypoallergenic properties.

Allergy-friendly cookbooks

It is becoming easier to find great allergy-free recipe books. Check out Supercharged Food by Lee Holmes, which features more than 90 recipes that are gluten, wheat, dairy, yeast and sugar-free. Baking is the greatest challenge when it comes to cooking gluten free. Gluten-free baking for Dummies by Dr Jean McFadden Layton and Linda Larson has 150 recipes plus lots of tips on flour combining and other techniques to recreate your favourite breads, cakes and biscuits. The Allergy-Friendly Cookbook by Alice Sherwood was created after the author’s two-yearold son was diagnosed with severe food allergies. All 100 recipes are approved by the Royal Children’s Hospital, Melbourne.

For information on allergy-free products, see The Allergy Guide on pages 59–61 LIVING WITH ALLERGIES Autumn 2013 7

healthy home


Do you know your aspergillus from your cladosporium? Mould can make you feel miserable at any time of year but can be especially bad in autumn and winter, as Caroline Wood reports.


EW ZEALAND’S wet humid climate provides an excellent habitat for all kinds of mould, which is bad news for those who are sensitive to it. It is not known how many Kiwis have an allergic reaction to these tiny fungi and doctors say more research is needed as some may be going undiagnosed. Allergy specialist Dr Vincent St Aubyn Crump said: “It’s difficult to say what proportion of people have a mould allergy because we are not certain if we are testing for all the different moulds that occur in New Zealand. “There definitely needs to be more research. I think we are missing some kinds of moulds that are causing problems.” The term ‘mould’ is applied to a large and diverse number of fungi species, which release spores into the air that can cause an allergic reaction in sensitive people. When someone inhales tiny airborne spores, their body reacts by releasing antibodies to fight them – triggering symptoms similar to other kinds of upper respiratory allergies including: runny or stuffy nose; sneezing; cough and postnasal drip; watery


COMMON ALLERGY-CAUSING MOULDS Only a few moulds cause an allergic reaction. Being allergic to one kind of mould does not mean you will be allergic to another. In New Zealand you can get a skin prick test for the following moulds.

Seasonal moulds

Alternaria alternata is a common mould that causes leaf spot in plants such as tomatoes. It is often found on damp window frames and is considered an outdoor mould, where it lives in soil, rotten wood and compost. It is an important cause of asthma in people with sensitivity and there is a link between sudden deaths for asthma and Alternaria. Cladosporium herbarum is one of the most common moulds in the world. Its spores are dispersed in the air and appear in the spring, rising to a peak in the late summer or early autumn. Cladosporium is found in dying

or dead plants, in the soil and on food. It is also found in fridges, moist window frames and damp houses with poor ventilation. Clinically cladosporium is the most likely mould to produce a positive skin test reaction.

Perennial (year round) moulds

Aspergillus fumigatus is found worldwide. There are several hundred different species of aspergillus fungi. It grows on cereal grains and indoors in damp homes, especially in the bathroom. Most people are naturally immune to aspergillus but some people with depressed immune function may experience an allergytype illness or life-threatening infection. Penicillium is commonly found in damp basements and on spoiled foods. It can grow in areas with 15 per cent or less moisture. It is less allergy provoking than other moulds.

eyes; and itchy eyes, nose and throat. Moulds can trigger asthma attacks in some people. Signs and symptoms of asthma include coughing, wheezing, shortness of breath and chest tightness. Symptoms may be mild to severe and vary from person to person. They may occur year round or only at certain times of the year. People with mould allergy may also get eczema. Others will have chronic sinus problems. “I think it’s very possible there are people who have an allergy but don’t realise their symptoms are caused by mould. We have the kind of climate that mould thrives in, particularly in the autumn and winter months, when houses are shut up and not ventilated,” Dr Crump added. Diagnosis is undertaken using a combination of a skin prick test and a full medical history. The best defence is to stay away from the mould that triggers your allergy. If that is not possible there are medications that can help. See your GP or allergy specialist for advice. For more information about mould allergies go to LIVING WITH ALLERGIES Autumn 2013 9

healthy home

(A WARM, DRY) HOME IS WHERE THE HEART IS Mould flourishes in damp, dark and warm environments. Try the following ideas to prevent and remove mould in problem areas.


Air your home regularly even in the colder months. Wipe condensation from windows daily and consider double glazing in troublesome rooms. An in-roof ventilation system will reduce condensation.


In the bathroom use an extractor fan, open the window daily, and scrub shower walls and floors to remove black mould. Check the back of the shower curtain, walls and ceilings for mould.


Open windows regularly in the kitchen and use the extractor fan when boiling water. Watch out for mouldy food in fruit bowls and avoid storing food in plastic in the fridge. Check fridge seals and the drip tray, which can be heavily contaminated with mould.



If a room smells musty check for mould on walls. Many firms offer free quotes and advice. Ask an expert to help you find the source of the moisture and test for mould if necessary.


Remove any furniture, carpets or cushions that smell musty. Using vapourisers in children’s rooms can create dampness – air the room thoroughly after use.


A dry house is easier to heat and keep mould free. Keep the heat in by insulating the roof first and then under the floor.


Many New Zealand homes are too cold. The World Health Organisation says homes should be kept at a minimum of 18°C. Check out for independent advice on heating solutions.

Dry washing outside if you can, or use a vented dryer, to avoid hanging wet clothes inside. Dry damp shoes outside as well.


Check humidifiers, vapourisers and air conditioners with water storage units. They can be contaminated with fungi and become a source of airborne mould spores.

* It is thought 30 per cent of New Zealand homes suffer from problems associated with being damp. For more ideas on how to reduce moisture and mould in your home go to



Outside the house, remove vegetation and fallen leaves. Keep the compost heap covered and away from the house.

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real life



Katie Neale has life-threatening atopic asthma and allergies. Her asthma improved markedly after moving to New Zealand from the UK. But she still struggles with 1,200 different allergies and developed foodrelated anaphylaxis after having a baby. Katie tells her story in the hope it will help others.


HAVE HAD allergies all my life. When I was a baby I had terrible eczema and I had to be moisturewrapped to stop me scratching until I bled. I was allergic to eggs, milk and cheeses. When I was about five I had chicken pox, mumps, measles and rubella in one year. I couldn’t have the MMR vaccine because I was allergic to eggs. I am also allergic to penicillin. I have had asthma since I was 18 months old. It was under control as a child – I only had three hospital admissions until I was 15 years old. Then I got terrible flu in 1999 and was in hospital for a week. I had been so active until this time – I rode and danced,

I did most kinds of sport. After that the asthma settled down again, and I had maybe three or four admissions per year. The trouble started when I was in my early twenties and working with event horses. I had been around horses since I was three years old. I was fit and healthy and outside all day. I have had regular skin prick tests for allergies all my life. The tests showed I was allergic to grass, trees, cats, dogs and horses. The doctors said I had to get rid of my animals and stop working with horses. So I did but my asthma got worse not better. Within five weeks of avoiding horses and starting work in an office, I had had

two admissions to hospital. I realised then my asthma was more than just a reaction to allergens, there was an emotional side to it as well. As they say: ‘You need to be in control of your life to be in control of your asthma’. I moved into a newly-built house with no animals but my asthma was worse when it should have been better. I was on steroids for three years. I married my wonderful husband David in February 2010. We went to New Zealand for our honeymoon and my asthma was so much better. I didn’t use my Ventolin and I could

walk five kilometres a day. I found out I was pregnant on the honeymoon. Five days after returning to the UK, I had my biggest asthma attack ever, my lips went blue. I felt like I was drowning. I was admitted unconscious to intensive care. The doctors saved me but we lost the baby. I was in and out of hospital 52 times that year. I tried keeping away from horses another six months but it didn’t work. In December 2010 I was back in intensive care. Again, they had to resuscitate and intubate me. They put me into a coma to control my

symptoms, I woke up three days later and said to David “we have to do something drastic”. I knew that if I had another winter in the UK I would be dead. The cold and the pollution also affect my asthma, not just my allergies. The hospital referred me to see a top allergy specialist Professor Anthony Frew. I took a blood test and found I was allergic to 1,465 different allergens. It later dropped to 1,200. He gave me the confidence to be able to cope with my allergies and asthma. I needed someone to reach out and help me. I didn’t want to be scared all the time. He

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For the first time I am really looking forward to my life. Asthma has controlled me for so long but now I feel I can control it. — Katie Neale

told me that moving to New Zealand was probably the best thing I could do because of the air and different pollens. David has helped me so much. I thank God every day I have got David in my life. He has been there every time and held my hand and said: “It will be ok”. We left the UK in October 2011. I was pregnant with Jessica. I felt better immediately I arrived in Auckland. I didn’t see a doctor for three months until I had a minor car accident. I told the hospital my history and they referred me to the respiratory team at Wellington Hospital, who have been brilliant. For me my asthma is

under control, I am using less medicine and I am working. Six weeks after having Jessica, I ate some Indian pappadums – I’ve never had a problem with them before. I started getting welts on my skin, my tongue and lips started to swell and I needed adrenaline. A few weeks later the same thing happened and then last September I ate some green beans that were slightly mouldy – within 10 minutes the anaphylaxis started. Now I carry an EpiPen. I was warned that my allergies might change after having a baby. My doctor is trying to work out what caused the reaction. He is also talking about

immunotherapy in the future. For the first time I am really looking forward to my life. Asthma has controlled me for so long but now I feel I can control it. For me these are giant steps. I want people to know there is hope and there is a way out of it. Fight for your health if you feel you are not getting the treatment you want, ask for a second opinion or to be referred to a consultant.

Do you have a story to share? Email

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LIVING WITH ALLERGIES – Take control today!

Living with Allergies is a new family-friendly quarterly magazine all about allergies. LIVING WITH Allergies

Allergies lerg r rg LIVING WITH


AUTUMN 2013 $6.95 inc GST



Autumn hay fever and asthma


Kids & allergies Back to school guide Healthy home: Common NZ moulds

(and what to do about them)


Inside: Gluten-free baking

LW_Allergies_CoverBB.indd 1

10 ways to deal to eczema 10/8/12 2:06:39 PM

Each issue features lively, easy-to-understand articles including: • latest allergy treatments • focus on kids & allergies • expert advice • real life stories • delicious food & recipes. Informative articles from Kiwi experts you can trust: Food allergies, hay fever, eczema, asthma, eye allergies, children and babies, healthy home, gluten-free living and lots more.

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environmental allergies

TAKE CONTROL OF AUTUMN ALLERGIES Many people find their allergies linger into late summer and autumn – in fact as long as airborne pollen, dust mites and moulds are about. But there are things you can do to fight back.



HE SEASON of mists and mellow fruitfulness does not always bring relief to those who suffer from airborne allergies. The onset of cooler weather brings respite from some kinds of pollen, but not all, and then the dust mites and outdoor moulds kick in. The changing seasons also bring winter illnesses and it can sometimes be hard to differentiate between a common cold and some allergy symptoms. About 20 per cent of New Zealanders suffer from allergic rhinitis (hay fever), according to Allergy New Zealand. And one in five of them experience symptoms for more than nine months of the year. The most common culprits are tree and grass pollens, and mould spores. In New Zealand the seasons are less defined than in the northern hemisphere, and vary according to where in the country you live and its local climate. Allergy specialist Associate Professor Rohan Ameratunga says people who have allergic rhinitis symptoms beyond summer tend to be reacting to dust mites and moulds. “Dust mites tend to be worse in autumn and

some people will also react to autumn moulds,” he said. Symptoms and diagnosis Allergy symptoms caused by pollen, dust mites and mould include: runny or stuffy nose; watery eyes; sneezing; coughing; itchy eyes and nose; and dark circles under the eyes. Airborne allergens, such as pollen, can also trigger asthma, which causes symptoms such as coughing, wheezing and shortness of breath. The first port of call is your GP, who will ask you about your symptoms, look at your medical history and, if necessary, refer you for a skin prick test. Treatment There are lots of options – ask your doctor or pharmacist to recommend suitable products for your symptoms. Common treatments include: • Antihistamines work by blocking the action of the histamine (the substance produced during an allergic reaction in the body). They can reduce sneezing, runny nose and itching but do not help nasal congestion. • Decongestants relieve congestion and swelling, clearing the nasal passages. They shouldn’t be used more

than a few days at a time. • Anti-inflammatory nasal sprays (corticosteroids) reduce inflammation in the nasal lining. These should be used as a preventative. Ask your doctor for advice. • Eye drops are available for symptomatic use and some brands can be used preventatively. Ask your doctor for a recommendation. • Saline (salt water) nasal sprays and washes may also help clear and soothe your nose without the use of harsh chemicals. • Immunotherapy (also known as allergy shots or desensitisation) can be used to turn off the body’s response to an allergen). Avoidance Work out your trigger(s) and try to avoid them. Hay fever is usually triggered by wind-born pollen from trees, grass and weeds. Check the Allergy NZ pollen calendar on or the pollen counter on Stay indoors as much as you can on days when the pollen count is high. Avoid freshly cut grass as mowing the lawn stirs up pollen and moulds.


kids & allergies

DOES MY CHILD STILL HAVE A FOOD ALLERGY? Parents often worry about the idea of intentionally exposing their child to a food they have previously reacted to – in some cases with a life-threatening anaphylaxis. Caroline Wood went to Wellington Hospital to learn about the ‘oral challenge’ allergy test.


OW DO you know

whether your child has outgrown their food allergy? In some cases it may be obvious but for many parents it is less than clear-cut. You may be wondering if your child has outgrown the allergy but you don’t know because you’ve spent the last three years avoiding the food(s) in question. Or perhaps you know your child still has allergies but want to know what will happen if they inadvertently digest a small amount of fish, or eat hazelnut spread? How bad will the reaction be? Your allergy specialist or doctor may suggest an ‘oral challenge’ test to find out whether your child still has an allergic reaction to a particular food (or medicine). It is done at hospital under close supervision in case the allergy is still present and 20 LIVING WITH ALLERGIES Autumn 2013

a severe reaction occurs. Tiny amounts of food (or medicine) are given and a child’s reaction is closely monitored. The amount of food given will be increased every 15 minutes until the required portion size is given. The challenge stops if the child has an allergic reaction. Many parents are understandably anxious about the prospect of feeding their child a possibly life-threatening substance, even in the safe confines of a hospital. But in the 10 years Wellington paediatric staff nurse Marie

Smolnicki has been doing oral challenges, she has never had to give adrenaline to a child, only oral antihistamine. Marie said: “I try to reassure parents that I have everything in place were something to happen. I show them the bottle of cetirizine (oral antihistamine) and the adrenaline. I put the child’s weight on my hand so if I have to give adrenaline in a hurry, I know exactly how much to give. “We aim to see how far the child can tolerate a particular food. When you get a reaction

you stop. We don’t have to see what an anaphylactic reaction looks like.” “Every child is different, they all react differently. The most common allergic response is the development of welts on the skin – from small to very large. Then itching, sneezing, runny nose, coughing. Less common responses are abdominal pain, vomiting, swelling up of the lips/eyes and face.”

ADVICE FOR PARENTS • Get as much information as possible from the nurse who is going to do the test about what will happen and how to prepare. • You will need to withhold antihistamines before the test: Talk to the nurse about how long they need to be withheld. • Bring the food in a form you think your child will eat. Bring snacks and games to fill in waiting time between tests. Bring a change of clothes in case your child is sick. • Make sure your child is

“When you get a reaction you stop” Marie Smolnicki

completely well before you come in for the test – runny nose and coughs can be misinterpreted as an allergic reaction. • Keep calm at all times during the test. It helps the child and ensures the test is not influenced by anything you say or do. • Remember your child is in a safe environment and medical help is on hand should the unexpected happen. • Your child may react in a way that you do not expect – this is normal and nothing to worry about. Children are referred to Wellington’s Paediatric Outpatient Clinic for allergy testing (skin prick and oral challenges) by their GP, Plunket or a paediatrician. The majority of children are under five years old. The most common oral challenges are for peanut, eggs and milk allergies. Marie, who has just completed a professional certificate in Allergy Nursing from the University of South Australia, said: “Allergies are a growing problem. Ten years ago I was doing a handful of skin prick tests a week. Now we can be doing five on clinic day. We do two to four oral challenges a week.” • For Edward’s oral challenge test – see overleaf. LIVING WITH ALLERGIES Autumn 2013 21

kids & allergies

ORAL CHALLENGE: A STEP-BY-STEP GUIDE Challenge participant: Edward Allergen: Fish Venue: Wellington Hospital Edward, four, is allergic to cashew nuts, fish, dogs, cats, dust and grass pollen. He also has asthma. He was first diagnosed with allergies at six months when he reacted to his mum’s breast milk. When he was a toddler, he was allergic to milk, eggs and cheese. He outgrew these allergies but went on to develop allergies to cashew nuts and fish. He has never had an anaphylactic reaction. Edward’s family want to do the oral challenge test because he is about to go to

Edward is checked for welts before his challenge. 22 LIVING WITH ALLERGIES Autumn 2013

school. Mum Sacha Fell said: “It’s not a nut-free school, we need to know how allergic he is to cashew nuts and fish so we can tell the teacher and make sure he gets what he needs at school. We also want to know if we need to get an EpiPen for him.” 9am – Staff nurse Marie Smolnicki welcomes Edward and his mum to the clinic and explains what is going to happen during the oral challenge test. 9.10am She takes Edward’s blood pressure, checks his weight and thoroughly examines his face, neck and body for any pre-existing

rashes, spots or welts. She reassures us that everything is in place should Edward experience a strong allergic reaction. There is oral antihistamine and adrenaline on a nearby table and a doctor nearby in the unlikely event he should be needed. 9.15am – Marie rings the paediatric registrar to let him know she is starting the test. 9.20am – A tiny amount of cooked fish (about two millimetres) is held against the inside of Edward’s lip for 20 seconds. We wait for 15 minutes to see if he reacts. 9.35am – The nurse checks his face, neck and body for any signs that he has reacted

to the fish on his lip. No reaction is found. He is cleared for the next challenge. 9.40am – ½ a teaspoon of fish is given. If there is no reaction, the challenge will be repeated with one teaspoon, two teaspoons and then a full portion of fish. 9.45am – Edward complains of a ‘hot’ mouth and drinks some water. He develops a small welt on his mouth. Everyone is very calm. Marie checks him all over and says we must wait 20 minutes to see what happens. 10.05am – Another two welts have appeared, so no more fish will be given just now. We wait another 10

minutes to see if the welts are going to disappear. 10.15am – The three welts are still there – they are not big but they don’t go away. Marie calls a halt to the test. The family have to wait another 30 minutes before they can go. 10.45am – The welts have gone away without the need for oral anti-histamine. Test result: If Edward eats fish he will have an allergic reaction but it is unlikely to be a life-threatening anaphylaxis. The previous week Edward took a challenge test for cashew nuts, which provoked a stronger reaction. He vomited after eating a quarter

of a cashew nut and was given oral antihistamine. His mother Sacha said: “I feel very relieved and pleased we did the challenge. I now know he will not have a severe allergic reaction to fish or cashew nuts. I feel lucky that we don’t have worse allergies. There are people in a worse situation with very serious life-threatening allergies.” The challenge results will be given to Edward’s paediatrician, who will meet with the family to go through the test results in more detail and work out an allergy plan for Edward before he goes to school.

Take it from someone who knows.

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Itchy red eyes?


YOU MAY BE SURPRISED BY WHAT’S CAUSING THE PROBLEM Itchy, red eyes are a common complaint. In most cases the cause can be attributed to allergens, and with the correct diagnosis, the problem can be easily treated. Understanding the causes and the issues surrounding diagnosis is a good place to start.



I’m just tired. While red eyes may be due to fatigue or a late night – itchy, red inflamed eyes are often allergy related. The key to getting the right treatment is the correct diagnosis. You don’t want to use ineffective products – so seek advice from a pharmacy professional.

Clear Eyes™ - Allergy is a pharmacy only medicine that can provide you with instant relief. The active ingredients work as a vasoconstrictor and decongestant. A triple action formula clears away mucus build up and relieves itching associated with exposure to airborne allergens. Redness is also removed immediately and eyes are left moisturised and soothed.

I’m already taking an antihistamine. If you suffer from allergies and use antihistamines, you may be unaware that not all of these drugs relieve the symptoms of itchy eyes. I can easily put up with it. Treatment is simple and readily available – you don’t need to suffer the effects of red and itchy eyes.


You may be interested to know, that The Clear Eyes™ Brand has a trusted 20-year history in New Zealand, and is the number one selling eye drop in pharmacy.1 With Clear Eyes™ you can find relief.

If your eyes are affected by allergens and they are red and itchy, you may feel like you need constantly rub them. You may also suffer from other symptoms such as sneezing and a runny nose.



2. Tilt your head back

Allergens are the most common causes of itchy, red eyes. Some of these include:

3. With your eye open, gently pull down your lower lid

Airborne allergens



Mould spores


Pet hair



1. Clean your eyes and wash your hands

4. Look up and instil one or two drops 5. Close your eye for 30 seconds, and look up, down, left and right 6. Use up to four times a day for instant relief

House dust mites

For more information on Clear Eyes™ visit CLEAR EYES ALLERGY Contains: Zinc Sulphate 0.25%w/v, Naphazoline HCl 0.012% w/v, Glycerin 0.2% w/v. PHARMACY ONLY MEDICINE. MEDICINES HAVE BENEFITS AND SOME MAY HAVE RISKS. ALWAYS READ THE LABEL AND USE ONLY AS DIRECTED. IF SYMPTOMS PERSIST SEE YOUR DOCTOR. RECOMMENDATIONS: Do not touch the bottle tip to any surface as this may contaminate the solution. If you experience eye pain, changes in vision, continued redness and irritation or if the condition worsens or persists for more than 72 hours, discontinue use and consult a doctor. Not to be used by individuals suffering from narrow angle glaucoma or serious eye diseases. If youare already using a prescription eye product, seek the advice of your doctor. Remove contact lenses before using. REFERENCES: 1. Synovate Aztec data May (MAT) 2011. Clear Eyes™ is a registered TM of Prestige Brands Inc. Distributed in New Zealand by Healthcare Logistics, Auckland. TAPS PP2757-12SP

environmental allergies

SORE, ITCHY EYES DO I HAVE AN EYE ALLERGY? Allergic eye disease is common in New Zealand but there are plenty of things you can do to help relieve the itch.


O YOU sometimes suffer from red, watering, itchy eyes? You may have an allergic eye disease. There are plenty of treatments available but the first step is to isolate the cause of the problem. Eye allergies affect two in five New Zealanders and are often associated with other allergies, such as hay fever, eczema and asthma. They occur when someone comes into contact with a usually harmless allergen or trigger, such as pollen, dust,

pets, or preservatives in eye make up or eye drops. As with other kinds of allergies, the trigger will make your body’s immune system go into overdrive and cause discomfort and irritation in the eyes. The most common kind of allergic eye disease is allergic conjunctivitis. Symptoms include itchy and watery eyes, clear mucous discharge and eyelid swelling. Allergic conjunctivitis can occur year round if caused by an allergen such as house dust or animal dander. LIVING WITH ALLERGIES Autumn 2013 25

Treatment for eye allergies The first step if you have sore, itchy eyes is to see your GP so they can diagnose the cause of your eye symptoms – an allergen or infection (bacterial or viral) and advise a treatment plan for you. Simple non-medical treatments for eye allergies include cold eye compresses, which may bring relief to sore itchy eyes. Artificial tears can help wash away the allergen. Antihistamine drops can provide immediate relief from the itch but will be temporary. Ask your pharmacist for over-the-counter recommendations. Your doctor may suggest the use of a long-term mast-cell stabiliser, which acts as a preventer but takes several weeks to become effective. Decongestants help reduce watering and redness in the eye but should not be used long-term. Anti-inflammatory steroid drops may be needed in severe cases but their use must be closely monitored as they can cause glaucoma and cataracts. If your symptoms are seasonal, the eye allergy is more likely to be caused by airborne allergens, such as pollen. You will typically have a history of repeated episodes of conjunctivitis, which come on quickly and go away rapidly. Christchurch opthalmologist and eye surgeon Dr Malcolm McKellar said: “Eye allergies are very common in New Zealand, a combination of our outdoor lifestyle, Celtic


stock, and reasonably high dust and pollen levels. “Most people can be treated by their GP or optometrist without needing specialist help. Only about one or two per cent need a higher level of support. “Severe allergic eye disease is vision threatening, as are some of the treatments for it, which is why they need to be prescribed by a specialist and their use monitored.”

Severe allergic conjunctivitis (atopic keratoconjunctivitis) is rare and needs specialist treatment. It usually occurs in patients with other allergies. Symptoms typically begin in spring and are often severe. The eyes are extremely itchy, watery, ‘burning’ and very sensitive to light. In severe cases vision is reduced. Dr Malcolm McKellar can be contacted via his website

Movie and tv show rental site, Fatso, is giving first-time customers a free one-month trial. Use the code LWA55 at Everyone who trials Fatso goes into the draw to win a year of Fatso (valued at $275). Enter online at or email giveaways@livingwithallergies. with Fatso in the subject line. Entries close 15 April 2013. 26 LIVING WITH ALLERGIES Autumn 2013

fast relief from eye allergy Naphcon-A® provides fast relief and soothing comfort from eye allergy in minutes. It contains an antihistamine to quickly relieve the itch and a decongestant to remove the redness. Use one drop three times per day for short term relief of eye allergy. Pharmacy Medicine. Naphcon-A contains naphazoline hydrochloride (0.25mg/mL) and pheniramine maleate (3mg/mL). Medicines have benefits and some may have risks. Always read the label and use only as directed. If symptoms persist see your healthcare professional. ® Registered Trademark. Alcon – Freephone 0800 101 106. TAPS PP2440



Award-winning dietitan, academic and author Dr Sue Shepherd specialises in treating dietary intolerances. She is a leading international expert in coeliac disease and irritable bowel syndrome. Sue turned her attention to food allergies in her latest publication Allergyfree Cooking, which has more than 80 new recipes.


All the recipes are suitable for people with allergies to gluten, wheat, dairy, peanuts, tree nuts, seeds, shellfish, seafood, soy and egg. No more studying the fine print to see whether the recipe is allergy-free, you can just dip in and enjoy. Today we have three fabulous recipes from Sue’s book. Go on, you know you want to!

HERB-CRUSTED RACK OF LAMB WITH MINTED PEA PUREE It’s hard to beat fresh herbs with roast lamb, and as mint is a natural partner for both lamb and peas, the minted pea puree is the perfect side dish. Serves 4. 3 tablespoons oregano leaves 4 tablespoons flatleaf parsley leaves 1 tablespoon rosemary leaves 1 large red chilli, chopped (optional) 3 cloves garlic, crushed 3 tablespoons olive oil salt and freshly ground black pepper 4 racks of 4 lamb cutlets, trimmed of fat

Method: Preheat the oven to 180°C. Combine the herbs, chilli (if using), garlic, olive oil, salt and pepper in a small bowl. Rub the herb mixture over the lamb cutlets. Place in a baking dish and bake for 30 minutes or

until the lamb is medium–rare. Meanwhile, to make the minted pea puree, bring a small saucepan of water to the boil. Reduce the heat
to medium, add the potato and cook, covered, until just tender. Add the peas and cook for a further 5 minutes. Drain, then mash with a potato masher with the dairy-free spread, rice milk and mint leaves. Season to taste with salt and pepper. Cut each rack into twocutlet pieces. Serve two pieces per person with the minted pea puree.

Method: Preheat the oven to 180°C. Place the kumara on a baking tray, drizzle with a little olive oil and bake for 40 minutes or until golden brown, turning occasionally. Set aside to cool. Meanwhile, place the prosciutto on another baking tray and bake for 15 minutes or until crisp. Set aside to cool. Cook the potatoes in a medium saucepan of boiling water until just tender. Drain and transfer to a

large heatproof bowl. Cook the beans in a small saucepan of boiling water until just tender. Drain and add to the potato. Break the crisp prosciutto into small pieces and add to the potato and beans, along with the kumara. Add the mayonnaise and stir until the vegetables are well coated. Season to taste, then cool in the fridge before serving.

MINTED PEA PUREE 1 large potato, diced 1 cup (120g) frozen peas 2 tablespoons soy-free, dairy-free spread 3 tablespoons rice milk 2 tablespoons mint leaves salt and freshly ground black pepper

KUMARA, PROSCIUTTO AND GREEN BEAN SALAD This is a colourful twist on traditional potato salad – fresh green beans, vibrant orange kumara and the salty hit of crisp prosciutto. Serves 4. 500g orange kumara, peeled and cut into 3cm cubes olive oil, for drizzling 75g prosciutto 500g cocktail kipfler or jersey benne potatoes, cut in half 200g green beans, trimmed 3 tablespoons gluten-free, wheat-free, dairy-free, soy-free mayonnaise* salt and freshly ground black pepper * For egg allergy: Use egg-free mayonnaise.



We have three copies of Allergy-free Cooking (RRP $45) by Dr Sue Shepherd to give away. To be in to win, enter online at or email with Allergy-Free Cooking in the subject line. Entries close on 15 April 2013.

RHUBARB, RASPBERRY AND APPLE CRUMBLE I love fruit crumbles but they often have wheat and oat toppings, which makes them off limits for many of us. This recipe is a delight as it contains no allergens. It can be enjoyed warm or cold and is especially good served with allergen-free custard. If you are allergic to coconut, leave it out of the recipe – it will still taste great! Serves 6. 1 bunch rhubarb, stalks trimmed and cut into 1.5cm pieces 4 apples, peeled, cored and diced ½ cup (110g) sugar 1 × 400g tin raspberries in syrup, drained (or use fresh, if preferred) 3 tablespoons pure icing sugar 1½ cups (195g) fine rice flour 1 cup (220g) brown sugar ¹⁄ 3 cup (25g) desiccated coconut 120g soy-free, dairy-free spread, at room temperature

Method: Preheat the oven to 180°C and lightly grease a medium baking dish. Place the rhubarb, apple, sugar and 1.5 litres water in a medium saucepan over mediumhigh heat. Bring to the boil, then reduce the heat and simmer for 6–8 minutes or until just tender. Drain. Combine the rhubarb mixture, raspberries and icing sugar in a bowl, then spoon into the baking dish. Place the flour, brown sugar and coconut in a medium bowl and rub in the spread until the mixture resembles fine breadcrumbs. Sprinkle evenly over the fruit mixture and bake for 30 minutes or until golden brown.

Source: Allergy-free Cooking by Dr Sue Shepherd. Reprinted by kind permission of Penguin. 30 LIVING WITH ALLERGIES Autumn 2013

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food allergy

You may be missing out on vital nutrients if you are not able to eat certain food groups because of a food allergy. Dietitian Barbara Stet advises on how to avoid problems if you are on a dairy or wheat-free diet.



A DAIRY-FREE DIET T CAN BE difficult to get your daily calcium requirement if you are avoiding milk and milk products, such as cheese and yoghurt. Calcium is essential for healthy bones and teeth and the proper functioning of the heart. A low intake of calcium has been associated with osteoporosis, which weakens the bones of the body and can lead to fractures. 32 LIVING WITH ALLERGIES Autumn 2013

The best way to ensure an adequate intake is to use soy milk that is fortified with calcium. The amount of calcium you need varies with age. For example adults aged 31–50 years need 840–1000mg of calcium per day, while children aged 4–8 years need 520–700mg. One glass of fortified soy milk usually provides about 250mg of calcium. Foods containing calcium

include: Soy yoghurt; broccoli; tinned fish with bones, such as salmon and sardines; prawns; wholegrain cereals and breads; tofu; tempeh; baked beans; and almonds, brazil nuts and hazel nuts. You may want to consider a calcium supplement if you (or your child) has multiple food allergies. If you have a seafood allergy, check the derived calcium isn’t from shellfish sources.

If you are on a combined soy and milk-free diet, your dietary intake of the B vitamin riboflavin may be low. Good sources of B vitamins include breakfast cereal, meat, nuts, fish, and products such as Marmite. Milk is also a good source of zinc, which is needed for growth, wound healing and fat metabolism. Other good sources of zinc include seafood, lean beef, wholegrains, chickpeas and lentils. Sources of non-dairy and non-soy protein include lean meat, chicken, eggs, lentils and beans, fish and seafood. A GLUTEN OR WHEAT-FREE DIET n increasing number of people are adopting a gluten-free diet and deciding to avoid wheat, barley and rye. If you are on a gluten or wheat-free diet, you need to make sure you get enough protein, fibre, B vitamins and energy from your food. Wheat isn’t necessary for a healthy diet. However wheat in bread contributes a significant amount of protein and energy to the diet of an average Kiwi. Don’t cut bread out of your diet – look at substituting one of the many gluten-free breads now available in the supermarkets. Gluten-free foods, including breads and cereal, may be more highly refined and lower


Bread is an important part of the Kiwi diet in fibre. Fibre is important for gastrointestinal health so you will need to find ways of increasing your fibre intake from other sources. To make sure you get enough nutrients on a wheatfree diet focus on wholegrains. Grains provide lots of energy, fibre and B vitamins. Try making your own wholegrain breads adding Hi Maize resistant starch (high in fibre); psyllium husks (a source of soluble dietary fibre); pumpkin or sunflower seeds; ground almonds, oats or oat bran; rice bran or soy bran. Experiment with nutritious grains, such as quinoa, buckwheat, cooked amaranth,

and brown rice, which make great risottos (see p57). Wholegrain oats can be made into homemade muesli, hot porridge or Bircher muesli. Eat plenty of leafy green vegetables (broccoli, brussel sprouts, cabbage, kale, spinach), which are high in folate and contain iron and other minerals and vitamins. Lentils and beans are highly nutritious providing protein, fibre, lots of potassium, folic acid and B vitamins. Fruit and vegetables (raw and cooked) are critical in any healthy diet. Eat fruits and vegetables daily to ensure you are getting enough vitamin C, fibre and other nutrients. Eating protein in the form of lean meat, chicken, fish and seafood, egg and dairy is especially important for wheat-sensitive people. Add protein when you have carbohydrates to slow down carbohydrate digestion. For example have some shredded chicken breast with your toasted, gluten-free bread.


We have six packs of Sodastream syrups to give away (RRP $24). Each pack contains three standard bottles of syrup. To be in to win, enter online at or email with Sodastream in the subject line. Entries close 15 April 2013. LIVING WITH ALLERGIES Autumn 2013 33

Itchy Dry Skin and Eczema interferes with life! 1,2

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Watch out for wool Wool and synthetic fabrics such as polyester can irritate the skin. Stick to cotton and cotton blends if this is a trigger for you or your child. Washing new clothing can help. Choose a washing powder that is mild and unscented and don’t use fabric softener.

3 10 WAYS TO DEAL TO ECZEMA There are lots of triggers and no cure. Dealing with eczema can be a frustrating business. Here are 10 tried and tested strategies to avoid and treat flare ups in children and adults.


Know the trigger Lots of things can cause eczema and everyone is different. If you can work out what triggers a flare, you are halfway there. Try keeping a diary of what you (or your child) wore, ate or did before a episode and see if there is a pattern. Common triggers include household cleansers, dust mites, pet dander (skin shed from animals), pollens, foods and chemicals. Perfume is often a problem for those with eczema – look for hypo-allergenic soaps, creams and cosmetics that have no fragrance.

Avoid extreme temperatures In some people overheating or changes in temperature or humidity can cause eczema to flare up. Try to avoid getting too hot, or extremes in temperature. Keep the heating at home to a constant temperature throughout. Try using a humidifier to keep the skin from drying out in colder temperatures. Shower straight after exercise.


Break the stress cycle Adults and children are liable to experience a worsening in eczema following physical, mental or social stress. This might be anything from a mild common cold to moving schools. Eczema may also be the source of stress: it is uncomfortable and can be embarrassing. Just being aware of the role stress plays will help. Find ways to relax, whether it’s a walk in the fresh air, yoga, meditation, exercising or socialising.


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Identify food allergens Some foods may cause eczema but don’t restrict your diet until you are sure what they are. This is especially important in children who need a wide range of nutrients and may grow out of food allergies as they get older. Food allergies affect about a third of children with eczema. Ask your GP for a skin prick test to find out what allergens affect you or your child.


Bath or shower daily Hot showers or baths are a common cause of eczema flare-ups. Keep water temperature warm rather than boiling hot. Avoid scrubbing your skin, and use a hypo-allergenic cleanser instead of soap on the areas that need it. Make sure you moisturise straight after a shower or bath. This will help protect the skin, especially in the colder autumn and winter months, when it tends to dry out.


Moisturise constantly during the day Dry skin is the enemy. Well moisturised skin acts as a barrier to irritants and allergens that may penetrate it and cause inflammation. Choose a plain, unscented moisturiser. Look for one that doesn’t contain additives or chemicals, which can irritate the skin. Try thicker products, such as ointments and creams, for maximum protection in colder weather.


Protect hands Hands can get dry and sore very easily especially as the weather turns colder. They are often exposed to water and other substances that irritate them. Cotton gloves can protect your hands while you clean the house. You can wear rubber gloves for washing up. Use a gentle liquid soap with moisturiser and have a tub of hand cream by the tap. Remember wool gloves may cause irritation.


Control the itch Cold compresses, frequent moisturising, baths, soothing creams, and medications can help control that itch and prevent it getting worse. If you can control the itch, you won’t scratch and damage the skin. Keep the skin covered and moisturised to avoid infections. Seek medical help if your skin becomes infected.


Use medicated creams during a flare up If lifestyle changes alone do not help your eczema, your doctor or nurse specialist may suggest using medication to ease symptoms. They may advise an over-the-counter cream, oral antihistamine, or a prescription medication. Always use as directed.



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kids & allergies

HOW TO KEEP YOUR CHILD SAFE AT SCHOOL Starting at preschool or school can be a worrying time if your child has a severe allergy. Putting a plan in place before they start will help, as Caroline Wood explains.


ARENTS often worry

about their child when they first strike out on their own to start preschool or school: Will they make friends, like their teacher, enjoy being there? There is an extra layer of concern for those who have a child with a severe or life-threatening allergy. Parents want to know if their child will be safe. What will happen if they eat a nut? Do the teachers know how to use an EpiPen? There is a lot to think about before your allergic child starts school and it can feel isolating. But you are not alone and many others will be in the same position. In fact every preschool and school in New Zealand will have at least one child with an allergy, including anaphylaxis, according to Allergy New Zealand. Liam Maxwell, five, started school in February. He was 38 LIVING WITH ALLERGIES Autumn 2013

diagnosed with a wide range of allergies at four months old. Liam still reacts to egg, dairy, kiwifruit, penicillin and dust mites. He has asthma and gets eczema if he eats berry fruits or watermelon. Mum Sarah said: “The school is experienced with allergies and has processes in place to protect children so I feel comfortable sending him there. My children are used to self-managing their allergies and know the consequences of not doing so. Liam has lived all his life with allergies and sees it as normal. “I listed Liam’s allergies on the enrolment form and the school contacted me about them. I talked directly to his teacher about how they keep allergy children safe. I have given them simple instructions about what to do if he needs treatment at school.”

Try these steps to help make the transition to (pre)school easier. STEP 1 Make a plan in advance Don’t wait for something bad to happen – put a plan into place before your child starts preschool or school. Assume they will need treatment for their allergy at some point. You will need a supply of medication and a treatment plan. Tell the teachers about your child’s allergy as early as possible. Be clear on exactly what triggers the allergy or asthma. For example the specific foods, insects or allergens involved. If appropriate, you will need to provide an individual anaphylaxis plan signed by your doctor. This will include details of medication, including adrenaline auto-

injectors, anti-histamine and asthma medication. STEP 2 Help your child avoid triggers The most important thing is to teach your child how to avoid allergens in the first place. Allergy New Zealand does not recommend the banning of food as it leads to complacency and is difficult to enforce. Think about when your child is going to come into contact with known allergens and how you can mitigate the risk. If your child has a food allergy consider other children’s lunch boxes, shared morning teas, trips outside school, the school bake sale. If it’s allergic asthma, what might trigger an attack? For example exercise or dust. Make some rules with your child. For example,

they must never share food; they can only eat from their own lunchbox; they are not allowed to buy anything from a bake sale. These rules will change as your child gets older and more independent. Many families provide treat boxes in the classroom so their child can take an item from the box instead of eating the shared morning tea. That way they don’t feel left out. If the school has a freezer, you can store cupcakes so your child can join in special occasions such as birthdays.

what strategies they have to reduce the risk for your child and what you can do to help. Supply a clearly-labelled allergy box. It will contain your child’s medication, treatment instructions and action plan for anaphylaxis. It should be easily accessible and stored out of sunlight. It is important everyone knows where it is and how to use any medication.

STEP 3 Communicate with staff Visit the school and talk to all the teachers and office staff who will be in contact with your child. Make sure everyone is aware of your child’s particular allergies and what to do in an emergency. Ask them

Allergy New Zealand has developed The Allergy and Anaphylaxis Guidelines for Early Childhood Services and Schools to help them prevent and treat a range of allergic reactions, including anaphylaxis. For details see

Case Study • Read about Izzi’s transition to school overleaf on p40.


kids & allergies

LIFE-THREATENING NUT ALLERGY NO BARRIER AT SCHOOL Six-year-old Izzi Anderson has been at school for 18 months and hasn’t had any problems despite being highly allergic to walnuts and hazelnuts. Izzi had to be given adrenaline and taken to hospital for anaphylaxis three times in the year leading up to starting. Each time she had been told by adults that the food she was eating was safe to eat. Mum Jodi Anderson tells their story.


ZZI HAD had a couple of allergic reactions before she started school so I knew that if she ate a nut there was time to get medication into her and get her to hospital safely. On each occasion she knew instantly she had eaten a nut and told an adult. I felt confident that if anything happened at school she would immediately go to an adult and tell them to ring an ambulance. Izzi goes to a small school so I felt I could talk to the teachers and they would know who Izzi is and what she is allergic to. I went to a staff meeting with her photo and told them that if she eats a walnut or hazelnut, she will

know straight away and she will come to them and say “please call an ambulance and find my EpiPen”. I took in all our old EpiPens and let the teachers practise using them on an orange. I saw her doctor before she started school and we agreed a new anaphylaxis plan – there were too many words on the old one. Different doctors had given me different advice about what to do in an emergency. I wanted a clear simple message to give the teachers. I have put clear instructions on top of the allergy box as well. What makes me feel safest are all the rules I have got in place to stop Izzi eating a

“What makes me feel safest are all the rules I have got in place” Jodi Anderson nut in the first place. She never shares food, she never eats anything unless she has checked the ingredients herself. She has a treats box in the classroom. We have a list of foods on the classroom wall. The foods that are safe to eat are in green and those that are not are in red. She has her allergy box in the outside pocket of her bag, so it goes everywhere with her.

SUBSCRIBE TODAY! Call 09 589 1054 or go to 40 LIVING WITH ALLERGIES Autumn 2013

babies & milk allergy

CHOOSING ALTERNATIVES TO COW’S MILK FORMULA FOR BABIES It can be a stressful time when a young baby develops a cow’s milk allergy. The advice is to breastfeed if you can but this isn’t always possible. Sometimes you will need to use a formula. Two of Australia’s leading paediatric allergists Dr Mimi Tang and Dr Katie Allen give their expert advice on which formula to choose. The following extracts are from the new edition of Kids’ Food Allergies for Dummies. We have five copies to give away. See overleaf for details.


OW’S MILK allergy is one of the most common food allergies in children. In the first year of life, breast milk or formula milk is the predominant source of nutrition for a baby and most formula milks are made from cow’s milk. So, if your baby has cow’s milk allergy and is under one year of age, you need to choose the right replacement that still provides an adequate source of nutrition. 42 LIVING WITH ALLERGIES Autumn 2013

Breastfeeding A good way to manage cow’s milk allergy is to breastfeed your baby. Although small amounts of milk allergen can cross over into your breast milk, most babies don’t react to such small amounts of milk allergen and you can continue to take cow’s milk and cow’s

milk products in your diet. Some babies with delayed forms of allergy to cow’s milk do react to the small amounts of cow’s milk allergen in breast milk and you may need to avoid cow’s milk and cow’s milk products in your diet while you’re still breastfeeding. Your child’s doctor can advise you on this. Some mothers and babies are unable to breastfeed, and need an alternative milk formula that doesn’t contain cow’s milk allergens. The formula that’s suitable for your baby depends on the type of cow’s milk allergy and how old your baby is.

Choosing the right formula If your baby has an IgE mediated allergy and is: • Under six months of age, current recommendations advise to use an EHF (Extensively Hydrolysed Formula) – a special lowallergy cow’s milk formula as a replacement for standard cow’s milk formula. • Older than six months, you can use soy formula. • Also allergic to soy milk, your doctor prescribes an EHF for your baby. • Unable to tolerate EHF, your doctor prescribes a different formula called an Elemental

Formula. Around five to 10 per cent of infants who are allergic to cow’s milk can’t tolerate EHF (because they react to the small amounts of cow’s milk allergen that remain in EHF) and need an elemental formula. Elemental formulas are made of single amino acids (the building blocks of proteins) and don’t contain any cow’s milk or soy proteins. Delayed cow’s milk allergy If your baby has a delayed form of cow’s milk allergy, the type of formula that’s suitable as a replacement for cow’s milk formula depends upon the type of delayed allergy


babies & milk allergy READER GIVEAWAY Grab a great book

We have five copies of Kids’ Food Allergies for Dummies to give away to five lucky readers. Each book is valued at $45.99. Kids’ Food Allergies for Dummies has everything you need to know about looking after children with a food allergy. It has detailed, easy-to-understand advice on: • Different food allergies and allergy testing • Latest research and treatments • Key lessons to teach children with food allergy • Suggestions for food replacements • Clear instructions on how to use EpiPens and Anapens. The authors of the Australia/NZ edition are Associate Professor Mimi Tang, a paediatric allergist and immunologist; and Associate Professor Katie Allen, a paediatric gastroenterologist and allergist.Visit www. for more information.

Enter online at or email with Dummies in the subject line. Entries close on 15 April 2013.

your baby has and whether your baby is growing nicely. For babies who: • Have poor growth due to a cow’s milk allergy and babies with the non-IgE mediated conditions (food protein induced enterocolitis or food protein induced procto-colitis), the appropriate replacement is EHF. • Have eosinophilic oesophagitis (inflammation of the esophagus), one of the mixed IgE/non-IgE mediated forms of cow’s milk allergy, an elemental formula is recommended. 44 LIVING WITH ALLERGIES Autumn 2013

• Are older than six months, with milder forms of delayed cow’s milk allergy that cause tummy pain and diarrhoea, eczema or colic, and who are growing well, soy formula can be offered. Your doctor can also advise you on the best formula replacement for your baby. Remember Partially hydrolysed cow’s milk formulas (PHF), also known as hypoallergenic cow’s milk formulas (available without prescription) aren’t suitable for babies with cow’s milk allergy because they contain some cow’s milk allergens that

Alternatives to cow’s milk for older children If your child is older than one year of age and no longer on formula, you can replace cow’s milk products with soy versions, including soy milk, soy yoghurt, soy cheese, soy ice cream and soy cream. Milk-free butters and margarines are widely available, as are other milk options, including cereal milks, such as rice milk or oat milk. Just make sure you choose products that are fortified with calcium because this means calcium has been added to the soy or cereal milk product to match the levels contained in cow’s milk.

can cause allergic reactions. Goat’s milk, sheep’s milk and other animal milks are very similar to cow’s milk and usually cause allergic reactions in babies with cow’s milk allergy, so formulas made from these milks aren’t a suitable alternative for babies with cow’s milk allergy. Nonformula milks, such as whole soy milk and cereal-based drinks, aren’t suitable for babies under one year of age. *Source: Kids’ Food Allergies for Dummies by Assoc Prof Mimi Tang and Assoc Prof Katie Allen. Reprinted by kind permission of Wiley.

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environmental allergies

INSECT STINGS AND IMMUNOTHERAPY Bee and wasp stings produce a temporary local reaction in most people. But a small percentage of the population will experience a serious allergic reaction that can affect the whole body. Immunotherapy can help in lifethreatening cases.


ew Zealand is blessed with few troublesome biting insects compared with Australia. Our native wildlife tends to be pretty friendly and non-threatening. But some imported wasps and bees can cause a severe allergic reaction. An average of two people die from 46 LIVING WITH ALLERGIES Autumn 2013

wasp or bee stings every three years in New Zealand, according to Te Ara – the Encyclopedia of New Zealand. New Zealand has thousands of species of wasp but most of them are tiny native species that cannot sting. Introduced species – the German wasp, common wasp and paper wasp – cause the most trouble. They possess a sting that can be used repeatedly and can cause anaphylaxis in some people. Andrew Beach, of Kapiti Bees and Wasps, said: “Wasps are more likely to sting than bees, they are more aggressive and can sting again and again. The best way to avoid bee and wasp stings is to stay away from their nests. “We have had a couple of people at our club who joined and started keeping bees but had to give up

after they passed out after getting just one sting.” Wasps are most troublesome in autumn when their natural food, such as aphids and flies, begin to die off and they go looking for alternative food sources. Most of New Zealand’s native bees are black. European settlers brought honeybees and bumblebees to New Zealand in the 19th century. They play an important role in pollinating plants by carrying pollen from flower to flower. Bees and bumblebees possess barbed stings, which means they can only sting once as the sting is ripped out of the bee when it flies off. Bumblebees tend to be more docile than honeybees.

Venom immunotherapy – a proven treatment Someone with a lifethreatening reaction to bee or wasp stings may be recommended for immunotheraphy, a treatment also known as desensitisation or ‘allergy shots’. The effectiveness of venom immunotherapy is well proven. It protects against further systemic reactions in about 98 per cent of cases, according to Allergy New Zealand. Immunotherapy involves giving injections of venom, initially in tiny and then increasing, doses to make the patient tolerant of venom. This minimises the risk of a further allergic reaction if stung again. The shots are usually given weekly until the amount of venom in

a sting can be tolerated. Once this happens maintenance injections will need to be given every few weeks up to five years. Allergy specialist Associate Professor Rohan Ameratunga treats up to 24 patients a year with venom immunotherapy in his Auckland clinic. He says it stops anaphylaxis in 97 per cent of those with severe bee allergies and 99 per cent of those with a wasp allergy. “It’s a proven treatment, I would recommend anyone with a serious reaction to insect stings to consider having the treatment. It stops anaphylaxis in most cases.” Venom immunotherapy is the only kind of desensitisation treatment funded by Pharmac in New Zealand. It is available for those with a life-threatening bee, wasp, paper wasp or

bumblebee venom allergy. Your specialist will need to apply for the treatment to be publicly funded. You will need to pay for the injection to be administered if you are seeing your specialist or GP privately. ACC also funds insect sting-related immunotherapy if the patient has an occupational risk of stings. Venom immunotherapy is only recommended for severe anaphylactic reactions to bee or wasp stings, where there are breathing difficulties or loss of consciousness. It is not recommended for local reactions. • You can contact Prof Ameratunga by going to

What to do if you are stung Bee and wasp venoms contain a complex mix of proteins, serotonin and histamine. Most people have a local reaction that affects the skin near the bite. Swelling and pain are common. The swelling may occur straight away or appear one or two days later. It will normally go away on its own. Remove the bee sting quickly or it will keep on

pumping venom. Wasps do not leave their stings. Icepacks will reduce the pain and calamine lotion, hydrocortisone cream or vinegar will relieve the itch. Oral or topical antihistamines will also help reduce inflammation and itching. Whole of body, or anaphylactic, reactions are rare and take place immediately after

the sting. Symptoms include hives, nausea and vomiting, lightheadedness, swelling of the eyes, lips or tongue, difficulty breathing, rapid heartbeat, loss of consciousness. Call an ambulance – the patient must receive immediate medical help. Some people may die if appropriate treatment isn’t given quickly. LIVING WITH ALLERGIES Autumn 2013 47


Asthma accounts for seven per cent of preventable hospitalisations in New Zealand. But there are things you can do to control your symptoms and avoid becoming one of the statistics. Why not start today? Report by Caroline Wood.




start of the winter illness season and this, coupled with the onset of cold, damp weather, spells trouble for many people with asthma. If you have asthma you are not alone. More than 340,000 Kiwi adults and 100,000 children have diagnosed asthma and are taking medication to control it. New Zealand has the second highest rate of asthma in the world after the UK. One in seven children aged two to 14 years has it, and one in nine adults. But more than half of all asthma patients in New Zealand are not controlling their asthma properly. Respiratory physician and researcher Dr Bob Hancox said: “There are a lot of people out there who have asthma which is not very well controlled. We believe the majority of people could make their control much better. “Quite a lot of people get used to living with symptoms like wheezing, and don’t realise they could be helped. The best advice is for them to go and talk to someone about it, for example their doctor or respiratory nurse or local asthma society.” Your asthma is not under control if you experience any of the following symptoms regularly: • wheeziness • coughing

• having a tight chest one person a week • waking at night in New Zealand with coughing dies from asthma. or wheezing You can take a • finding it hard simple online test to exercise or to find out how well hurry because of you are controlling asthma symptoms your asthma (see Dr Bob Hancox. • using your blue panel below). inhaler more than Dr Hancox three to four times a week added: “People can take • tiredness. the test and it will give The consequences of poor them a pretty good idea control include a poorer of how they are doing. quality of life. For example not “For many people it’s about being able to exercise in the understanding how and when way you would like, or play to use their medication and with the kids in the garden. making sure they take their You may also end up in medication regularly.” hospital for treatment. He suggests patients ask It is becoming increasingly for a demonstration of how rare but people still die to use their inhaler correctly of asthma. The Asthma to maximise the dose of Foundation estimates about medication to their lungs.

Take a simple asthma test All it takes is five minutes to find out how well you are controlling your asthma. The Asthma Control Test™ contains five simple questions and takes a few minutes to complete. It is used worldwide and has been designed for asthma sufferers 12 years of age and older. The results can help you determine the level of control you have over your asthma. It is a good idea to repeat the test at different times of the year. It may be useful for you to discuss your test results with your health care professional to help you reach the best asthma control possible. You may need to look at your medication, triggers and lifestyle to see if anything can be changed.You can also ask your doctor about newer treatment options. Take the test at LIVING WITH ALLERGIES Autumn 2013 49

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CATHERINE HUXFORD INVENTOR, TEACHER AND MUM OF FIVE Catherine Huxford has dreamed up a simple way to remind asthmatics to take their preventer. The AsthmaMinder is being launched this year. Catherine told Living with Allergies she hopes her invention can help save lives.



up in the A&E of her local hospital a number of times after forgetting to take her asthma preventer twice a day as recommended. The fulltime teacher and mum of five leads a busy life and says she found it hard to remember to take her life-saving medicine. Catherine came up with a simple way to remind her to take her inhaler. She put it next to her toothbrush. Every time she brushed her teeth, she took a puff, morning and night, about 12 hours apart as required. Her asthma symptoms improved. Catherine, who lives in Wellington, wasn’t one to leave it at that. In 2010 she started to play around with models and prototypes to build a stand incorporating a toothbrush and clip-off inhaler attachment. Now she could keep both items together – the AsthmaMinder

was born. The design has since evolved. The AsthmaMinder can be attached to any surface in the bathroom. You cannot use your toothbrush without first removing the preventer.

“I kept forgetting to use my preventer,” says Catherine. “I was getting into strife and I would use the ambulance at the bottom of the cliff rather than the fence at the top. I LIVING WITH ALLERGIES Autumn 2013 51

came to the point when I decided I wanted to fix this problem because it wasn’t much fun ending up in A&E.” “I really tried to remember to take my preventer twice a day and it worked for a while. But you need to take your preventer rain or shine every day and I blamed myself for not remembering it.” She spoke to a doctor, who told Catherine it was a huge issue, as lots of people forget to take their asthma preventer, and she decided to push on with her design. Catherine’s first lucky break was to get onto Grow Wellington’s Bright Ideas Challenge, which helps people to grow their ideas into a commercially-viable product or business. They loved her idea and provided support in the vital design and prototype stages. She also got some useful feedback from GlaxoSmithKline, which manufactures asthma preventer inhalers. This sent her back to the drawing

board to tweak her invention, which is now patented. Asthma New Zealand is backing the AsthmaMinder, launching and promoting it. The first 1,000 products will be given away free to members as part of a national trial. Asthma NZ and Catherine will review the product’s effectiveness by following up with people who use it and asking them whether their asthma has improved. Marketing manager Linda Thompson said: “We think it’s a great idea and a great product. We are planning to launch and promote it next year. It’s such a simple idea but we think it will make a huge difference for people. People forget to take their preventer, it’s the biggest reason for poor asthma control in New Zealand.” Catherine is looking forward to the nurse-led trial later this year. Developing the AsthmaMinder has been a labour of love so far but she hopes to sell the idea to a business to

GIVEWAY Protect against dust mite allergens with Miteguard 2 Ultra premium bedding range. We have one pillow cover (RRP$40) to give away. To be in to win, enter online at or email with Miteguard in the subject line. Entries close 15 April 2013. 52 LIVING WITH ALLERGIES Autumn 2013

THERE’S AN (ASTHMA) APP FOR THAT Download the Breathe Easy asthma app and manage your asthma 24/7 wherever you are. The app offers a new paperless way to manage your asthma. It’s simple and very user-friendly and best of all it is free. The app is an initiative of Asthma New Zealand. It is available for iphone and will soon be launched for android phones too. See www. nz for details.

produce it commercially. “If you had told me five years ago that I would be an inventor, developing a commercial idea and writing a business plan, I would have been gobsmacked. My hope is that it will help people remember their medicine and keep well,” she added.

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Naturopath Rosanne Sullivan believes the key to a person’s wellbeing is a healthy digestive system. She became a naturopath after being diagnosed with coeliac disease and now helps others change their lifestyle to optimise their health.



OSANNE SULLIVAN’S childhood years were marked by periods of ill-health, pain and low energy. She remembers stomach pains and bouts of constipation and diarrhoea. She got glandular fever at 12, followed by chronic fatigue as a teenager that lingered into her twenties. Later came years of nausea, low energy, mood swings, anaemia and four miscarriages. Finally at 33 years old, Rosanne was diagnosed with coeliac disease. Put on the correct diet she was pregnant eight weeks later. She now has two teenage daughters. Her energy increased once she withdrew gluten

Rosanne. “I was in my early forties and realised I had a family and it would mean a lot of sacrifices. But in the end I knew it meant I could really make a contribution for the next 20 years of my life.” Rosanne says the holy grail of good health is good digestion. In particular she believes allergies are often connected with poor digestive health. Rosanne studied at Auckland’s Wellpark College of Natural Therapies, where she topped her naturopathy class. Rosanne believes gut imbalances are associated with a range of problems not traditionally associated with digestive health, including eczema, asthma, chronic fatigue, fibromyalgia, recurrent urinary tract infections, thrush, Type 2 diabetes, obsessive compulsive disorder, autism disorders, multiple sclerosis, bipolar disorder and rheumatoid arthritis. “Irritable bowel syndrome and other digestive disorders are becoming increasingly common in New Zealand,” says Rosanne. “People often don’t realise how important good digestive health is to overall wellbeing. “The huge increase in the amount of processed foods, refined carbohydrates and sugars we are eating is

helping cause an epidemic of digestive disorders.” Rosanne quotes Hippocrates who said: “All disease begins in the gut”. She says gut dysbiosis (an imbalance of the beneficial and non-beneficial bacteria and yeasts in the digestive system) is widespread and causes issues such as bloating, indigestion and stomach pain. Rosanne thinks causative factors include too much sugar; refined carbohydrates or alcohol; antibiotics that wipe out beneficial bacteria; and drugs such as nonsteroidal anti-inflammatory drugs, antacids, cortisone and the oral contraceptive pill and mercury from amalgam fillings. Working from her home clinic in St Heliers and another in Kingsland, Rosanne helps clients work their way through a maze of conflicting dietary advice toward better health. She is keen to share her experiences and knowledge. Rosanne has organised a number of public education sessions on nutrition and naturopathy charging just a koha donation for attendance. She plans to do more later this year.

“All disease begins in the gut” Hippocrates

Autumn harvest: Rosanne in her Auckland garden from her diet. She started to lose weight and her mood and mental clarity increased. Rosanne’s long journey to good health gave birth to a passion to learn how the body works, so much so that she ditched a career as a city graphic designer to take a leap into the unknown and retrain as a naturopath and holistic nutritionist. “It was a big decision,” says

You can contact Rosanne via her website or call 09 630 5442. LIVING WITH ALLERGIES Autumn 2013 55

gluten-free living

10 top tips for digestive health

7 Allergies are often connected to poor gut health, says naturopath Rosanne Sullivan


Eat a diet rich in non-starchy vegetables – aim for 65 per cent of your plate. Include animal and vegetable proteins, grain-like seeds and sea vegetables, such as New Zealand karengo. Watch how much dairy, gluten, refined carbohydrates, alcohol and sugar you consume. These foods can cause digestive inflammation and feed unfriendly gut bacteria. Substitute bread with cooked ‘grainlike’ seeds such as quinoa, millet, buckwheat and amaranth. They are rich in protein, vitamins and minerals and do not feed unfriendly bacteria and yeasts. Include fermented (probiotic) foods and drinks, such as fresh sauerkraut and fresh coconut kefir. Start slowly to avoid bacterial ‘die off ’ reactions. Include organic bone broths and soups which nourish and heal the gut lining. Practice food combining: Separate proteins and carbohydrates at different meals for more effective digestion.

Include good fats, such as extra virgin olive oil, coconut, flaxseed, avocado and fish oils, a little butter and ghee. Avoid damaged (trans) fats found in margarines, commercial supermarket oils, some breads, boxed cereals, crackers, cakes, pastries, ice cream, chips and fast foods.  Minimise sweet fruit intake if it causes digestive symptoms. Favour sour fruits such as lemons, limes, kiwifruit and green apples.  Find ways to manage stress which can cause gut inbalances and digestive symptoms. Exercise and meditation help reduce stress hormones.  Reduce toxin exposure. Choose chemical-free personal care products and cleaning products. Choose composite fillings over metal amalgams.

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gluten-free recipes

AUTUMNAL FLAVOURS MILLET AND QUINOA RISOTTO WITH MUSHROOMS, OLIVES AND ROSEMARY 1½ tablespoons butter, ghee, coconut oil or olive oil ¾ cup quinoa ¾ cup hulled millet 3 cups chicken or vegetable stock (homemade is ideal) 1 onion 5 cloves garlic 6−8 mushrooms chopped into small chunks 3−4 tablespoons chopped fresh rosemary ¼−½ cup pitted olives chopped roughly Salt and pepper to taste Optional extras: red capsicum, broccoli, or other veges. Method: Sauté onion and garlic in butter, ghee or oil for five minutes. Add mushrooms and sauté for three more minutes. Add quinoa and millet, stirring for two to three minutes. Add stock, rosemary and olives (and other veges, if adding extra). Bring to the boil then turn down to simmer. Cook till the liquid is absorbed (approx 10–12 minutes). • Gluten-free; egg free; can be dairy free (do not use butter). HOMEMADE CHICKEN OR MEAT STOCK (makes 24 cups of stock)

Have 3 x 2 litre containers in which you can freeze the stock

and bring one container out each week. I believe using organic bones is very important as animals store toxins (pesticides, heavy metals etc) in their bones. Homemade stock is nourishing and healing to the digestive tract. 1 whole organic chicken (or 1−2 chicken carcases or organic lamb or beef bones) 6 litres of filtered water ½ bunch celery roughly chopped (optional) 3 large carrots chopped (optional) 1−2 onions Peppercorns Sea salt to taste Optional extras: kaffir lime leaves and lemon grass or fresh rosemary, parsley.

Method: Place all ingredients into a large stock pot. Bring to a simmer and keep lid on if the lid has a hole for steam to be released. If not leave it slightly off. Simmer for 3–6 hours. About 10 minutes before finishing the stock roughly chop up a bunch of parsley and add to the pot. Once cooked, strain the mixture. The longer you cook the stock, the richer and more flavoursome it will be. Once it has cooled a little, place in the fridge until the fat has hardened on the top of the stock. Pour the stock into containers and freeze. • Gluten, dairy and egg free. Recipes: Courtesy of Rosanne Sullivan.



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WHEN SHOULD I SEE AN ALLERGY SPECIALIST? Finding an allergy specialist in your area isn’t always easy. Here are some tips to help.



with mild allergies can be treated by their GP. They can arrange allergy tests and recommend medication to control symptoms. Allergy specialists receive general training in medicine followed by postgraduate training in immunology and allergy. They work in a range of settings including hospitals, private practice, diagnostic immunology laboratories, research centres and universities. There are a limited number of allergy specialists in New Zealand. The Australasian Society of Clinical Immunology and Allergy recommends seeing an allergy specialist for the following: • severe, life threatening allergy (anaphylaxis) • suspected food or occupational allergy • immunotherapy treatment 64 LIVING WITH ALLERGIES Autumn 2013

• continuing poor asthma control, despite regular use of medication. Public system A referral from a general practitioner is required for consultation with a clinical allergy specialist in the public system. Access to allergy specialists in the public system varies in New Zealand according to where you live. There are specialist allergy services in Northland (Whangarei Base Hospital), Auckland, (Starship and Auckland City Hospitals) Capital Coast (Wellington Hospital) and Canterbury (Christchurch Hospital) District Health Board areas. There are paediatric services for children, which include food allergy, general allergy and eczema services in Northland (Whangarei Base Hospital), Waitemata (Waitakere Hospital), Capital Coast (Wellington

Hospital), Canterbury (Christchurch Hospital) and Otago (Dunedin Hospital) District Health Boards. There are no allergy specialists in some regions and you may have to travel. Some District Health Boards may arrange for patients to be seen out of area, or refer patients to paediatric, medical or dermatology specialists instead. Private allergy clinics There are several private allergy clinics in New Zealand, mainly in Auckland. You can access private allergy clinics directly but it is preferable to ask your GP to refer you. They can send any previous test results and clinical history so you don’t have to repeat expensive medical tests. Allergy New Zealand has a useful list of allergy specialists in the public and private system on its website. See

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Living With Allergies Autumn 2013


Living With Allergies Autumn 2013