Page 1

Allergies LIVING WITH

SPRING 2013 $6.95 inc GST

new zealand

Probiotics hope for allergy-free children

IS IT A COLD OR AN ALLERGY? Create a no-sneeze garden Make your own allergy-friendly cleaning products

Asthma still kills A mother’s heart-breaking story Plan the perfect BIRTHDAY PARTY

GIVEAWAYS 10 great reader competitions – see inside

Eczema breakthrough + food labelling + allergy hot spots WITH COMPLIMENTS FROM YOUR PHARMACIST OR HEALTH PROVIDER


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54

Contents LIVING WITH ALLERGIES SPRING 2013

COVER STORY

28

8 Probiotics hope for allergy-free children

ENVIRONMENTAL ALLERGIES 12  Is it a cold or an allergy? 14  Creating a no-sneeze garden

HEALTHY HOME

48

16  Target allergy hot spots 18  Dealing with dust mites

47

19  Allergy-friendly cleaning products

REAL LIFE 20  Remembering Charlie 48  Searching for the perfect chocolate cake

EYE ALLERGIES 24 Why do eyes itch?

PROFILE 27  Supernanny, anaphylaxis and me

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56

INTERVIEW 43  The Hudson family

BABIES & ALLERGIES 44  Cow’s milk allergy in infants

RECIPES 46  Child-centred recipes for all the family

ANAPHYLAXIS 50  How anaphylaxis got its name

FOOD ALLERGIES 28  Planning the perfect birthday party

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

40  Food labelling Q&A 42 Ten global facts

ECZEMA 31  Atopic eczema 32  Breakthrough in search for cause of eczema

TREATMENT 36  Preparing for a specialist appointment

DIAGNOSIS 38  Keeping an allergy diary

ASTHMA 52  Sometimes you need to make a fuss

GLUTEN-FREE LIVING 54  Tips to prevent cross-contamination 56  So delicious your guests will never know (shhh) it’s gluten-free…

REGULARS 6 Allergy aware 34 Subscribe and win 59 Allergy guide 62 MiniAds 64  Endpoint: The allergic march

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 www.livingwithallergies.co.nz for details.

7


LIVING WITH ALLERGIES Editor: Caroline Wood Email: editor@livingwithallergies.co.nz Design: Rose Miller at Kraftwork Proofreader: Stella Clark

editorial

ADVERTISING Sales manager: Debbie Davis Phone: 09 589 1054 or 021 340 360 Email: debbie@livingwithallergies.co.nz

ALLERGIES CAN STILL KILL

SUBSCRIPTIONS Subscribe online at www.livingwithallergies.co.nz Phone: 09 589 1054 Email: subscribe@livingwithallergies.co.nz PRINTER McCollams Print PUBLISHER Published quarterly by Hawkhurst Media Services Ltd PO Box 90 059, Auckland Mail Centre, Auckland 1142 Phone: 09 589 1054

Member of the Magazine Publishers Association. Member of the Audit Bureau of Circulation 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. Living with Allergies is an independent publication and is in no way affiliated with or endorsed by the charity Allergy New Zealand. © All rights reserved. No article in whole or part should be reprinted without permission of the Editor. 4 LIVING WITH ALLERGIES Spring 2013

D

ESPITE MAJOR

advances in modern medicine, it is a sad fact that people are still dying from allergies, be they from food, insects, medicine or allergic asthma. Nine-year-old Charlie’s story brought home just how unpredictable and deadly asthma can be. His story, told by mum Jane, had me in tears. She writes with such dignity and fortitude about his sudden death and the effect it had on the family in the hope that their experience will help others. Given the seriousness of some allergies, it is heartening to know that some of the world’s best scientists are working right here in New Zealand trying to find a cure. In this issue we look at a University of Otago study where pregnant women are taking a probiotic in the hope that it will stop their babies developing eczema and allergies in later life. Meanwhile, Professor Graham le Gros and his colleagues at the Malaghan Institute are carrying out ground-

breaking work into allergy cures. He explains the team’s breakthrough in pinpointing the cause of eczema. We have leapt into an early spring which is great for my vege garden but bad news for anyone whose life is made a misery by hay fever. Help is at hand. Check out Janet Luke’s article on how to create a beautiful low-allergy garden, while Dr Malcolm McKellar explains the ins and outs of itchy eyes. As part of our spring cleaning feature, I find out how easy it is to make your own eco-friendly cleaning products – the answer, by the way, is very easy! Last but not least, thank you for all your feedback and support, please keep it coming. Contact me with any ideas, suggestions and comments: editor@ livingwith allergies.co.nz. Happy spring cleaning!

Caroline Wood Caroline Wood Editor


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allergy aware

NEWS AND VIEWS Dampness link to asthma

Living in damp or mouldy homes increases a child’s risk of developing asthma, hay fever and eczema, according to a major international study, published in Clinical and Experimental Allergy. University of Otago researchers involved in the study say children who already have asthma are likely to have it more severely if they live in a damp house. Professor Julian Crane, of the University of Otago, said: “It is perhaps not surprising, given this data, that we have so much serious respiratory illness in children in New Zealand. We have such poor quality housing and so many children living in damp, cold, mouldy, poorly-heated, often rented, accommodation.”

Cat allergy hope

Scientists have shown how allergic reactions to cats are triggered, raising hope for new treatments for those with cat and dog allergies. The University of Cambridge team studied proteins found in particles of cat skin (dander). They found that when it met a common bacterial toxin, it activated a specific pathway in the body, triggering a large immune response in allergy sufferers, including coughing, wheezing, sneezing and a runny nose. The study was published in the Journal of Immunology. Lead researcher Dr Clare Bryant told BBC News: “By understanding the triggering mechanism, there are now drugs that are in clinical trials for other conditions, such as sepsis, that could potentially then be used in a different way to treat cat allergy and to prevent cat allergy.” 6 LIVING WITH ALLERGIES Spring 2013

Food allergies may restrict growth Children who have a milk allergy or those with more than two food allergies may not be getting the nutrition they need to grow normally, according to research presented at the 2013 American Academy of Allergy, Asthma and Immunology conference. University of North Carolina researchers compared the weight and body mass index of 245 food allergic children between the ages of one and 11 years with nonallergic children of the same age. They found that after two years of age children with any food allergy had a lower weight and BMI than those without allergies. Having a milk allergy in particular meant even less weight gain, as did having multiple food allergies. Dr. Brian Vickery, the study’s lead author, recommends that doctors should warn parents of the potential growthrelated risks of elimination diets and ensure they are excluding only the foods that are medically required.


Hay fever season starts early

A mild August brought with it copious amounts of pine tree pollen, causing many people to visit pharmacies to stock up on hay fever remedies. New Zealand’s pollen season lasts about 34 weeks, starting with pine-tree pollen in July/August and continuing into August/ September with deciduous trees, such as oaks, elm and birches. The major grass pollen season starts from October and carries on until Christmas. Weeds, such as plaintain, flower from October to February. For some people, who are allergic to trees, grass and weeds, the allergy season lasts from August through to March.

Fast food link to allergies

Children who eat at least three servings of fast food a week may increase their risk of severe asthma, eczema and hay fever. Children from New Zealand were part of the International Study of Asthma and Allergies in Childhood (ISAAC), which looked at the diet and health of more than 500,000 children from around the world. The study found that teens (aged 13-14) who ate three or more servings of fast food were 39 per cent more likely to suffer from severe asthma, while the risk was increased by 27 per cent in the younger age group (aged 6-7 years). Both age groups also had a greater risk of severe eczema and hay fever symptoms. The study also found eating at least three serves of fresh fruit a day was a protector against developing severe asthma.

Dairy tops food allergens in kids Dairy is the most common food allergy among New Zealand school children, according to early results of the nationwide CensusAtSchool project. Results from the first 2800 respondents show that 8.5 per cent of students aged 10 to 18 report having one or more food allergies. Dairy is top of the list (3.5 per cent) followed by peanuts (2.5 per cent) and eggs (2 per cent), then wheat, tree nuts, shellfish, fish and soy (each under 1.9 per cent). It was the first time a question about allergy prevalence was included in the CensusAtSchool project, now in its sixth year. Up to 30,000 students will take part and final results will be published when available.

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


cover story

Mum-of-two Amber Parry Strong is taking part in the clinical trial.

PROBIOTICS AND THE ‘ALLERGY FREE’ CHILD It sounds too simple to be true. Take a probiotic in pregnancy and protect your unborn child against eczema and possibly other allergic diseases, such as asthma and hay fever. Caroline Wood reports on ground-breaking New Zealand research.

W

ELLINGTON

mum Amber Parry Strong’s youngest child had eczema from the age of three months until he turned one. Amber still remembers the huge impact it had on the family trying to control the itchy rash with hydrocortisone cream, moisturisers and bath oils. Amber, 34, decided to take 8 LIVING WITH ALLERGIES Spring 2013

part in a New Zealand trial to see if taking a daily dose of probiotics during pregnancy can protect children from developing eczema and other allergies as they grow up. The mum-of-two, who is allergic to cats, grass and dust mites, said: “Our family’s experience made me aware of eczema and so when I heard about the trial I thought I

would give it a go and if it doesn’t help my baby, it might help other people’s children.” Amber is one of hundreds of pregnant mothers being recruited for the trial. Each volunteer will take a single capsule each day, starting when 14 to 16 weeks pregnant and continuing throughout the remainder of their pregnancy and for six months after


birth while breast feeding. Half the participants will take capsules containing the study probiotic – a particular strain of Lactobacillus Rhamnosus. The other half will receive a placebo. Researchers want to see if probiotics taken early in pregnancy can protect an unborn child by ‘turning off’ the baby’s immune response in the womb. The study will also look at whether probiotics protect mothers from gestational diabetes, a type of diabetes that occurs only in pregnancy, and some vaginal infections involving potentially dangerous bacteria, such as Group B Strep. Many studies have shown that allergic disease can progress from eczema to other allergic diseases – a phenomenon known as the ‘allergic march’. Researchers hope that by

switching off the skin allergy (eczema) in infancy, it may protect the child from going on to develop other allergic diseases as they get older. Principal investigator Dr Kristin Wickens, from the University of Otago, explains: “We want to see if we can stop the allergic march early on. We think probiotics, if taken early in pregnancy, may help the baby develop a healthy and balanced immune system with the potential to provide protection against allergic diseases, such as asthma and allergic rhinitis, as well as eczema.” “By starting early in pregnancy we may be able to have a big effect on someone’s underlying sensitivity to all allergens. Being atopic clearly puts you at risk of having other allergic diseases such as asthma and allergic rhinitis.”

The study involves the same probiotic strain used in research carried out in Wellington and Auckland in 2004. The incidence of eczema was half in the group taking the probiotic. Six years on and the rate is still nearly half. The group taking a second probiotic strain showed no reduction in eczema - suggesting that not all probiotics have the same effect in reducing eczema. The 2004 trial involved the mother taking the probiotic during her third trimester and the child being given the probiotic from birth until the age of two. In the current study the mother takes the probiotic (not the baby) and she takes it earlier from 14 to 16 weeks of pregnancy. Dr Wickens added: “The previous study showed that probiotics were effective

Volunteers needed for probiotic trial Researchers are looking for 400 pregnant women in Wellington and Auckland to take part in the trial. Women taking part in the study should be less than 16 weeks pregnant. One or both parents need to have a history of allergy (eczema, asthma or hay fever). The benefits of taking part in the study include: • Your child may not develop eczema and other allergic diseases (although there is no guarantee of this). • You and your family will get free allergy skin prick tests at the end of the trial. • You would be contributing to important research, which may help prevent allergic diseases in young children and other illnesses in pregnancy. For more information see www.otago.ac.nz/probiotic. You can contact 0800 NOALLERGY or email probiotics@otago.ac.nz to register your interest.

LIVING WITH ALLERGIES Spring 2013 9


cover story against eczema. Now we want to look at both eczema and the allergic tendency. We are not intervening directly in the infants – just the mother. We want to see if we can achieve the same effect through the placenta by turning off the allergic immune response early in pregnancy and later providing protection through breast milk.” The families will be tracked for one year after birth and will have skin prick tests at the end of the trial – to see if they have developed atopic sensitivity. Children will be checked for egg, peanut, milk, dust mites, cats and pollen. Parents will be tested for allergies to dust mites, cats and pollen. The study, which involves volunteers in Wellington and Auckland, is being funded with a $1.2m grant from the Health Research Council. Fonterra is providing the study probiotic, as well as a small research grant. The Auckland trial is being led by Prof Ed Mitchell.

What is a probiotic? The word probiotic is thought to come from the Latin ‘pro’ meaning for and the Greek ‘biotic’ meaning life. Probiotics are a type of live ‘good’ micro-organism that competes for space and food with ‘bad’ micro-organisms and may confer a health benefit on a host. Probiotics occur naturally in many foods, such as yoghurt, and in some fermented foods such as German sauerkraut and Korean kimchi. They are sold in capsule and powder form in health food shops, and are considered safe. There are many hundreds of different strains and not all probiotics have the same effects. Research studies are examining whether probiotics can help a range of health conditions, including intestinal inflammation, diarrhoea, urogenital infections, allergies, tooth decay and the common cold.

PREVENTION OF ECZEMA IN INFANTS AND CHILDREN Eczema affects millions of children worldwide, with around half the cases being diagnosed before the age of one. New Zealand has one of the highest incidence rates of eczema in the world. This disorder has a profound impact on the social, personal, emotional and financial perspective of families. At DuPont Nutrition & Health, scientists developed the probiotic strain HOWARU® Rhamnosus, otherwise known as Lactobacillus rhamnosus HN001™, as a safe and effective means to maintain the body’s immune system. Studies in both New Zealand and worldwide have shown that HOWARU® Rhamnosus has proven efficacy in reducing the severity of eczema and prevalence in infants from zero to two years and up to at least four years of age, even after treatment is completed. Expecting mothers should take GO Derma Protect containing HOWARU® Rhamnosus during pregnancy and breastfeeding to support their baby’s developing immune defences for allergen related skin issues and skin health. Mothers should start the treatment during the last trimester of their pregnancy and continue with the supplement while breastfeeding. The supplement may be mixed with milk formula or food after weaning. HOWARU® Rhamnosus is proven to be safe and well tolerated. It does not affect normal growth or gut and immune development when given to infants from birth. GO Derma Protect is available at major pharmacies and health stores throughout New Zealand.

www.gohealthynz.co.nz

10 LIVING WITH ALLERGIES Spring 2013


Human sensor

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environmental allergies

If you tend to get colds that develop suddenly and occur at the same time every year, it’s possible you actually have a seasonal allergy. Caroline Wood finds out how to tell the difference between a cold and an allergy.

IS IT A COLD OR AN ALLERGY?

M

ARK GETS A

‘cold’ that comes on suddenly with explosive sneezing, an extreme runny nose and stuffiness. Until recently he thought these episodes were a summer cold but was puzzled by how often they occurred between October and February. The father-of-two, 47, began to wonder if some of these episodes were symptoms of a seasonal allergy, rather than a common cold. He is allergic to cats, dust and some kinds of pollen. He has never been tested for specific allergens but as the problem worsens, he plans to take action. “I’m going to start keeping a record of when I get the 12 LIVING WITH ALLERGIES Spring 2013

symptoms, how long they last for and whether antihistamines help so I can try to work out whether it’s an allergy causing the problem. When I get these episodes, they really floor me and I find it hard to work. It’s something I’ve lived with all my life but I’ve decided I need to get properly diagnosed and treated.” Colds and seasonal allergies share many symptoms and experts say it can be difficult for patients to work out what is causing their symptoms. Viruses cause common colds, while seasonal allergies are immune system responses triggered by exposure to an allergen.

Dr Andrew Baker, of Waitemata Allergy Clinic in Auckland, says it is important to look for an overall pattern of symptoms to distinguish between a cold and an allergy. This can also help a doctor work out which allergen is involved. “For some people it can be hard for them to tell whether they are coming down with a cold or an allergy because a lot of the symptoms are very similar,” he says. “Dust mite allergy is something that gets missed because it’s a year-round allergy and is most likely to be confused with a winter cold. If you sneeze a lot first thing in the morning, it’s


more likely to be dust mites.” Dr Baker recommends patients keep a record of their symptoms and identify any patterns over a period of years. “Is it a year-round problem or does it get worse in spring or summer? If the symptoms are coming and going over most of the year, it’s likely to be an allergy to dust mites or cats and dogs. If it comes and goes between October and February, it’s probably a grass allergy. If it comes in August it’s likely to be a tree pollen allergy.” “Think about the pattern of sneezing, how it occurs over days and months. If you have a sneezing attack after mowing the lawn, that’s a pretty good indicator of a grass allergy.” If you seem to get colds all the time, you might want to consider seeing an allergy specialist or doctor with an interest in allergies for proper testing, diagnosis and treatment. Treatment of seasonal allergies may include overthe-counter or prescription antihistamines, nasal steroid sprays and decongestants, and the avoidance of exposure to allergens where possible. Dust mite and cat/dog desensitisation treatment is available in New Zealand and is extremely effective, with most patients finding it greatly improves their quality of life, adds Dr Baker.

Symptom check: Is it a cold or allergy? Symptom

Cold

Allergy

Itchy eyes

Rare or never

Common

Sneezing

Usual

Usual

Sore throat

Common

Rare

Runny nose

Common

Common

Stuffy nose

Common

Common

Fatigue

Sometimes

Sometimes

Fever

Sometimes

Never

Cough

Common

Sometimes

General aches and pains

Slight

Never

Duration

3-14 days

Weeks

*Adapted from National Institute of Allergy and Infectious Diseases, 2008

Try writing down your symptoms each time you get a ‘cold’ to help you and your doctor work out if it is a true cold or an allergy. Intense itchiness, especially around the eyes and nose, tend to be more common with an allergy than a cold, says Dr Baker. Itchy ears, throat and eyes are unusual for a cold. Sneezing can happen with either a cold or an allergy. If you have a sore throat or fever, you are likely to have a cold. Nasal mucous is normally clear with an allergy. If it is green and thick, it is more likely to be a cold. LIVING WITH ALLERGIES Spring 2013 13


environmental allergies

CREATING A NO-SNEEZE GARDEN Asthma, hay fever, contact dermatitis, rashes and blisters can be triggered by garden plants. Creating an allergyfriendly garden allows everyone to enjoy their outdoor spaces, writes landscape architect Janet Luke.

U

P TO ONE fifth of all New Zealanders react to pollen released by wind-pollinated plants. The worst time of the year is September and October when tree pollen reaches its peak. This is quickly replaced by grass pollen in November through to January. Trees and shrubs to avoid

14 LIVING WITH ALLERGIES Spring 2013

are those that have small, pale or insignificant flowers. These sort of plants use wind to spread pollen and they need to produce a lot of it. Generally showy, bee-pollinated trees and shrubs are better choices. Interestingly enough it is the boys that get up our noses! Plant lots of female trees and female shrubs. Not only will these not shed any pollen, they will also trap pollen, which has strayed from elsewhere. Think of these female plants as nature’s air cleaners. Male plants are often sold in nurseries as ‘seedless’ or ‘fruitless’ varieties but they all produce large amounts of allergenic pollen. Trees to avoid at all costs include wattles, ashes, elms, oaks, maples, pine, privet, willow and the large growing poplar or cottonwood.

Choose flowers that are large, scented and brightly coloured. These plants tend to be bee-pollinated. They attract with colour and scent. Their pollen is heavy and sticky so is not as irritating to humans. Lawns are great producers of irritating pollen. Just after dawn, fine pollen rises up to a metre above the lawn, waiting for wind or gardeners to disturb it. Mowing early, before the dew has dried can help, or if you aren’t concerned what the neighbours might think, wear a surgical mask! A better idea is to do away with lawn and replace with paving or decking. If you must have a lawn, choose groundcovers such as thyme or Mercury Bay weed. Be very careful with the use of insecticides, fungicides and herbicides. One single


heavy exposure can result in hypersensitivity, especially in someone whose antigens are on high alert anyway. Go organic as much as possible. If pests become a problem use natural homemade sprays as a first line of defence. Use lots of variety in your garden. A lack of plant diversity can cause overexposure to one particular antigen. As always diversity is good! If you have to have a particular high allergy plant in your garden because you love it so much, place it far away from the house and downwind if possible. Don’t plant high allergy plants near bedroom windows, next to patio areas, walkways or by the front or back door. If you have a tree or hedge that has high allergy potential keep it trimmed or clipped so that it flowers less. Use rock, stones or gravel for mulch instead of bark to cut down on mould spores in the garden. Plant only disease-resistant varieties of plants and varieties that grow well in your local conditions. Mildew, rust, black spot and other plant diseases produce spores and these spores can cause allergies. An allergy-friendly garden can still be a beautiful garden and a great space for everyone to relax and enjoy the outdoors, whatever the season.

The itchy, sneezy ones – avoid if you can -

The good guys – choose these for your garden

Aster Pussy willow Calendula Bamboo Daisies Ash Chrysanthemums Acacia Grasses Olive Walnut Privet Primula Plane Cupressus Ivy

-

Rhododendron Camellia Viburnum opulus Snapdragon Citrus Bay laurel Phlox Plum Apricot Hawthorn Pomegranate Cabbage trees Cherries Eucalyptus Gardenia Escallonia Cotoneaster Salvias

THE GOOD GUYS

Rhododendron

Salvia

Janet Luke is a landscape architect, who lives in sunny Hawke’s Bay. She has a passion for sustainable design, edible landscaping and permaculture and runs green living courses from her urban garden. For details see www.greenurbanliving.co.nz

LIVING WITH ALLERGIES Spring 2013 15


healthy home

TARGET ALLERGY

HOT SPOTS Deep cleaning your home regularly is essential for banishing allergens and reducing your family’s exposure to them. Caroline Wood offers some ideas for targeting allergy hotspots.

S

PRING IS A GREAT time for reviewing your cleaning regime and doing some of the heavy duty cleaning jobs that help keep potential allergens at bay. Lots of allergy nasties lurk in the family home including dust, mould spores and pet dander - the way to control them is to clean thoroughly and often. Allergens inside the home can trigger eczema, asthma and hay fever, along with general allergy symptoms of coughing, sneezing, itchy skin, watery eyes and runny nose. “If you have an allergy, avoid triggers, use your allergy treatments and reduce the allergens in your home. Reducing the allergens in your home will help keep your allergy under control,” says Dr Rob Hicks on www.nhs.co.uk.

16 LIVING WITH ALLERGIES Spring 2013


GIVEAWAY The new BISSELL PowerFresh™ steam mop makes quick and easy work of cleaning up sticky floors, plus it is approved by the Asthma Foundation’s Sensitive Choice programme. We have one PowerFresh™ mop (RRP $329.95) to giveaway. To be in to win, enter online at www.livingwithallergies.co.nz or email giveaways@ livingwithallergies.co.nz with BISSELL in the subject line. Entries close 15 November 2013. Keeping on top of house cleaning can be difficult (not to mention boring!) in the busy world we live in. Try creating a schedule of jobs that you will ideally do weekly, monthly, every three months and annually. Then you can get some satisfaction from ticking each one off and knowing you have it all under control. Not sure how to start? Check out Allergy UK’s interactive allergy house for the latest advice on how to tackle specific problem areas room by room. See www.allergyuk. org/allergies-in-the-home. Here are a few deep cleaning ideas to think about: Vacuum furniture, curtains and damp dust forgotten surfaces Experts recommend using a vacuum cleaner with a HEPA filter, which ensures the dust is trapped, and not released back into the air. HEPA filters need to be replaced or washed about once a year. See www.consumer. co.nz for more information about HEPA filters. Vacuum soft furnishings

and curtains. Pull out beds and heavy furniture for a thorough clean and damp dust the surfaces. Wipe down kitchen cabinets every two to three months. Wash duvets, pillows and children’s toys Allergy UK recommends washing duvets, blankets, pillows and curtains every three months in addition to washing sheets weekly at 60 degrees. Wash soft toys regularly and make sure you dry them thoroughly in a tumble dryer if you have one. Put soft toys in the deep freeze for at least 72 hours every four to six weeks to kill the dust mites, recommends Teresa Demetriou, of the Asthma Foundation.

Tackle mould and humidity levels Wash out the refrigerator regularly to make sure that mould does not gather in the corners. Get rid of mould in the bathroom and laundry by wiping the surface with vinegar and then scrub with a heavy-duty cleaning paste. Replace air filters monthly and empty dehumidifiers regularly. Consider buying a humidity gauge. Clean your pet’s area Wash their bedding regularly at over 60 degrees and consider an anti-allergy cover for pet beds. Groom them outdoors and wash them frequently to remove allergens. * See overleaf for tips on how to deal with dust mites.

LIVING WITH ALLERGIES Spring 2013 17


healthy home

DEALING WITH DUST MITES

An estimated 500,000 Kiwis have an allergy to dust mites, or rather are allergic to the proteins they and their faeces contain. Dust mites are tiny and cannot be seen without a microscope. They infest your bedding, carpet and soft furnishings no matter how clean you are.

Dust mites are part of the arachnid family making them a relative of spiders and ticks. They live on the dead skin of humans and pets and thrive in warm humid conditions making beds a perfect breeding ground. Symptoms of dust mite allergy include sneezing, itchy watery eyes, nasal stuffiness, runny nose, respiratory problems, eczema and asthma. Here are some simple steps you can take to reduce dust mites and the risk of allergy and asthma:

• Wash bedding weekly at over 60°C • Replace old mattresses and pillows • Consider a mattress protector • Keep soft toys and animals off the bed • Weekly vacuum with a HEPA filter • Damp dust weekly • Consider a ventilation system, or use a dehumidifier to keep household moisture levels low. * Source: Asthma New Zealand

Do you have asthma?

We are looking for volunteers to take part in a clinical study for a new medicine that is being developed to treat asthma.

If you have asthma and are: l Aged 18–75 years l In generally good health l A non-smoker or ex-smoker l On a stable dose of inhaled corticosteroid l With on-going asthma symptoms we would love to hear from you.

Tel: (09) 830 2031 Email: info@miteguard.co.nz Web: www.miteguard.co.nz

18 LIVING WITH ALLERGIES Spring 2013

For more information please contact: Carol Veale Study Coordinator Freephone 0508 919 919 Or email carol@nzrsi.health.nz


healthy home

ALLERGY-FRIENDLY CLEANING PRODUCTS More people are turning to natural cleaning products or making their own. Caroline Wood finds out why.

A

S WELL AS thinking about what and where to clean, consider how you are cleaning. Many cleaning products contain chemicals and strong fragrances that may irritate your skin or cause allergies. To save money and know exactly what ingredients are in your cleaning products, try making your own. Cheap items found in your kitchen, such as vinegar, lemon juice and baking soda, can be used to make a host of cleaning products. This kind of back-to-basics cleaning is becoming more popular, as New Zealand’s Green Goddess Wendyl Nissen has shown with her popular books. She has some great all-natural cleaning product recipes on her website, including a window cleaner, furniture polish and even a dishwashing powder. See wendylsgreengoddess. co.nz for details.

Wellington-based Maid by Me has developed simple kits to make it easier for people to mix their own healthier cleaning products, including a cleaning scrub and laundry gel. All the hard work is done as the ingredients are premeasured and supplied with easy-to-use instructions. Co-founder Rebecca Jackson said: “We started the company because we wanted home cleaning products that we felt comfortable using around our allergic children. A lot of people are interested in making their own cleaning products but didn’t know the measurements so we have created simple and easy kits with our proven recipes to help others.” See www.maidbyme. co.nz to find out more. If making your own cleaning products is not for you, check out the Sensitive Choice scheme for products approved by the Asthma Foundation as being allergy and asthma-friendly. For example Aware laundry products are fragrance free and don’t contain ingredients implicated in triggering skin allergies. See www. asthmafoundation.org.nz.

Make your own drain cleaner

Here’s a simple recipe from Allergy UK to clean drains. Make up a solution of 230ml vinegar with 75g of baking soda. Pour directly into the drain. Leave for 10 minutes then run clean hot water down the drain to clear grease and debris.

*We have a Maid by Me laundry kit to give away (RRP $25). It comes in a four-litre pail with three packs of pre-measured ingredients (borax, soda ash and soap) enough for 120 washes. Enter online at www. livingwithallergies.co.nz or email giveaways@livingwithallergies. co.nz with MAID BY ME in the subject line. Entries close 15 November 2013. LIVING WITH ALLERGIES Spring 2013 19


real life Nine-year-old Charlie Temel died suddenly from an asthma attack six years ago in 2007. His family is honouring his memory by raising awareness about the seriousness of asthma. Mum Jane Temel, from Wellington, tells Charlie’s story.

REMEMBERING CHARLIE

C

HARLIE HAD

had asthma off and on since he was about four years old. This included stays of up to five days in hospital and lots of trips to A&E in the middle of the night either in an ambulance or in our car. A popular, outgoing and sporty boy, he never let asthma hold him back. Charlie turned nine on July 11, 2007. He had been without asthma symptoms for the past 12 months and his specialist was starting to talk about reducing his medication because he’d been so good for so long. But that winter things changed. Charlie couldn’t shake a niggling virus and had

20 LIVING WITH ALLERGIES Spring 2013

a persistent dry cough. We were concerned enough to take him into A&E but both times he was checked and sent home again with directions to carry on the usual treatment. He was very fit – he loved rugby, cricket and mini ball – and was a strong boy who rarely complained. After one particular rugby practice he became upset by some minor incident. The niggling virus, plus the emotional upset, combined with – what we later realized was – a significant pollen increase, produced a rough night’s sleep and we kept him off school the next day to keep an eye on him. My parents were visiting from New Plymouth. They


Charlie stood up suddenly from what he was doing, said he couldn’t breathe and collapsed. It was that quick. have a lot of experience with asthma due to my brother, who is now 40, having severe asthma all his life. My husband Nick dropped our middle son off to Montessori school and left Charlie at home with his grandparents. I went off to work and said goodbye as if it were a normal day. Nick returned to see ambulances in the driveway and the paramedic staff, who we respect enormously, attempting to revive him. Charlie had got dressed and come down from his bedroom to have breakfast. He wanted to carry on with his class project and seemed quite OK. He wasn’t coughing or wheezing and wasn’t complaining of being uncomfortable. We thought he’d be fine just taking

it easy and proceeding with his usual asthma reliever. We now know that he must have been extremely tight in the chest. Charlie stood up suddenly from what he was doing, said he couldn’t breathe and he collapsed. It was that quick. My parents called an ambulance immediately and performed CPR. Charlie was on life support for about 24 hours but we knew we had to accept that he was gone. The specialists couldn’t believe that Charlie was taken out like that and said it is very unusual. They were also extremely surprised it took 12 hours of medication to unlock his chest. In the following months we reflected on all the things we could and should have done differently. We shouldn’t have

let him run around in the rain without a raincoat. We should have made sure he had a merino or thermal top in the cold weather. We should have made sure the medication spacers were better maintained and working properly. We should have been monitoring his peak flow for a more accurate measure of his breathing capacity. There are so many things we wish that we’d done for Charlie. We can’t bring our precious son back, but to honour his life and his memory we want to raise awareness of the seriousness of asthma. We recommend adhering closely to the asthma treatment plan and, if you are at all unsure or worried, always seek medical attention – don’t delay because asthma can be fatal.

There are so many things we wish that we’d done for Charlie. We can’t bring our precious son back, but to honour his life and his memory we want to raise awareness of the seriousness of asthma.

LIVING WITH ALLERGIES Spring 2013 21


ASTHMA ATTACK OR ASTHMA EMERGENCY? Asthma attack

WATCH FOR DANGER SIGNS AND ACT QUICKLY In New Zealand at least one person will die every week from asthma this year. Charlie’s asthma was well managed and his parents Jane and Nick Temel were well aware of the signs and symptoms. What would you like other parents to know?

We’d like to tell other parents how differently asthma can present. Charlie had no coughing and no wheezing – the only real change is that he was quiet. You can’t just look at external signs or rely on visuals, it is important to check more deeply. Strong children like Charlie don’t always communicate so you need other ways of checking them, for example using the peak flow as a tool to determine their breathing. If you have a rough night, phone the ambulance straight away - deal with it as soon as possible. The Wellington Free Ambulance staff were excellent, they always told us it is safer to call the ambulance than to take a child to A&E yourself. 22 LIVING WITH ALLERGIES Spring 2013

How has it changed you as a parent?

Our other sons Oskar and Ollie were also hospitalised with asthma many times when they were younger but Oskar (now 10) seems to have grown out of it and Oliver (now 7) is on a preventative regime and his asthma is well controlled. It has made me more vigilant, more proactive and aware of all the small things you can do to make a difference. For example taking your medication, making sure the spacers are working properly, monitoring peak flows and reinforcing the importance of communicating. I am also aware of the importance of having warm clothes against their skin and of changes in temperature. I have a greater awareness of the environment and triggers, especially the pollen factor. The night before Charlie died a big pollen rise was reported.

• You have increasing wheezing, coughing, chest tightness or shortness of breath • You are waking often at night with asthma symptoms • You need to use your reliever again within three hours. This is an asthma attack Asthma emergency • Your symptoms get worse very quickly • You have severe shortness of breath, can’t speak comfortably, or lips look blue • You get little or no relief from you reliever inhaler. Call an ambulance immediately – dial 111. Say this is an asthma EMERGENCY

For more information see www.asthmafoundation.org.nz * Make a fuss to keep your child safe. See p 52 for the latest figures on asthma hospital admissions.


eye allergies

WHY DO EYES ITCH? Itchy eyes are a common problem. In most cases the itch is mild and settles quickly but some people have severe or prolonged itching that requires treatment. Eye expert Dr Malcolm McKellar explains.

I

tching is part of an allergic reaction where the surface of the eye (conjunctiva) overreacts
 to things in the air around us. That’s why the condition is known as allergic conjunctivitis. There are many things that can cause an allergic reaction. Some people are allergic to just grass and tree pollens and only have itchy eyes at certain times of the year. Others are allergic to things like pets, house dust mites and moulds, and so suffer all year round. Some people also get red and watery eyes, eyelid swelling and sensitivity to light. In severe cases vision can be blurred. It’s common for people with itchy eyes to also suffer from other allergic problems such as asthma, eczema, and hay fever. They may also react to certain foods and medicines.

24 LIVING WITH ALLERGIES Spring 2013

Prevention Sometimes it can help to avoid the problem in the first place. Things that may help include: • Staying indoors and closing windows when pollen and dust levels are high • Dusting with a damp cloth to remove pollen and dust from surfaces • Washing pollens, dust and fur off your face after work and play • Delegating lawn mowing and gardening
 to someone else • Removing plants such as silver birch
 from your garden • Wearing goggles and wrap-around sunglasses when outside • Avoiding parks, forests and gardens in spring time • Fitting dust covers on pillows and mattresses • Exposing furniture and bedding to sunlight to kill dust mites
 • Removing or replacing carpet • Choosing ‘low allergy’ pets
• Moving to a drier house • Installing air conditioning and air filters.

Treatment Simple measures Rinse your eyes with artificial tears or solutions such as Optrex. Cold compresses can be very soothing; a wheat bag kept in a plastic bag in the fridge works well. Avoid rubbing your eyes: rubbing will make your itch worse. Use a cool compress instead. Non-prescription eye drops If you only get symptoms from time to time, ask your optometrist or pharmacist for antihistamine eye drops such as Livostin or Zaditen. You can use the drops when your eyes get itchy or take them just before you do something that you know is likely to cause your eyes to itch. People with frequent symptoms should try Cromolux. Cromolux is an effective treatment but takes three weeks to work and must be used continuously to keep working.


Prescription eye drops For more severe allergies your optometrist, GP or ophthalmologist can prescribe Patanol, non-steroidal agents such as Voltaren and Restasis, and steroid eye drops like Maxidex, Pred Forte and Predsol. These treatments are very effective but can have side effects. If you’re using steroid eye drops, you need to be under the care of an optometrist or ophthalmologist.

What about hay fever tablets? Tablets are good for hay fever but unfortunately not for itchy eyes. Could it be your eye drops? Talk to your optometrist or ophthalmologist if your eyes get itchy when you use your glaucoma or antibiotic drops. You could be allergic to the medicine or the preservative in the bottle.

*Don’t hesitate to ask your optometrist or ophthalmologist for more information about itchy eyes and allergic conjunctivitis.

About the author Eye surgeon Dr Malcolm McKellar is the only person in New Zealand trained as both an optometrist and an ophthalmologist. He is based in Christchurch. For more information on eye health go to: www.drmalcolmmckellar.co.nz.

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profile

SUPERNANNY, ANAPHYLAXIS AND ME Parenting expert and TV phenomenon Jo Frost has teamed up with the makers of EpiPen to mark the 25th anniversary of the auto injector. Jo has had life-threatening allergies all her life, as Caroline Wood reports.

B

RITISH NANNY

Jo Frost has become a household name helping frazzled parents with her no-nonsense approach to parenting and toddler taming. Her Supernanny show, which aired in the UK, New Zealand and the US, made the ‘naughty step’ a global phenomenon and was compulsive viewing for many parents with young children. Now Jo has hung up her trademark ‘no-nonsense’ Supernanny suits and specs but she continues to hand out invaluable advice through her childcare books and new TV show Family SOS. What many people may not know is that Jo Frost has had

life-threatening food allergies since she was four years old, when she ate a shrimp at a family get-together and had to be rushed to hospital and given adrenaline. She is still allergic to shellfish and peanuts and carries an EpiPen with her everywhere she goes. “For as long as I can remember as a little girl, I have lived with the burden of food allergies. Exposure to nuts and shellfish could send me to the hospital, gasping for air,” she says in her blog jofrost.com. “The fear is real; it always has been and will continue to be a daily reality. When you suffer from extreme food allergies like I do, it is hard to trust restaurants, waiters,

school cafeterias and even food packaging labels. This fear and lack of trust will remain with me like the memories of fighting for my life as each attack became worse.” Jo says she wants to help give a voice to those with similar food allergy issues ‘so they don’t have to grow up with that same fear instilled in them’. She has partnered with Mylan Speciality, the makers of EpiPen, for an allergy awareness and preparedness campaign to mark the 25th anniversary of the introduction of the auto injectors. For more details see www.25YearsofEpiPen.com.

GIVEAWAY

Mylan is giving away 15 EPIPEN educational kits, specially created for our readers. Each contains an Epipen training device, instructional DVD, handy instruction fridge magnet, a ‘Medikidz Explains Food Allergy’ kids’ comic and a product brochure. Enter online at www.livingwithallergies.co.nz or email giveaways@livingwithallergies. co.nz with EPIPEN in the subject line. Entries close 15 November 2013. LIVING WITH ALLERGIES Spring 2013 27


food allergy

PLANNING THE PERFECT (ALLERGY-FRIENDLY) BIRTHDAY PARTY It may seem daunting but organising an allergy-friendly birthday party for your child is easier than you may think. Mum-of-two Shari Hammond offers some great party food ideas that everyone can enjoy.

28 LIVING WITH ALLERGIES Spring 2013

F

IRST, HAVE A THINK

about what sort of food you find at the average kids’ birthday party. There’s the birthday cake, of course, plus cupcakes, lollies, fairy bread, biscuits, twisties, chips and dip, cheerios, sausage rolls, pizza, juice, lemonade, ice cream, fruit platter and perhaps a few veges like carrot and celery sticks to counteract the sugar overload. So how do we make these foods allergy friendly – that’s no gluten or wheat, egg, nuts, tree nuts, dairy or soy?

It’s simple once you start thinking about it. Here are some of my tips for popular and safe party foods to serve. Birthday cake and cupcakes – perhaps try my Chocado cake recipe on page 49, or purchase a premix cake such as The Angel Food Chocolate Cake (www.angelfood.co.nz). Lollies – check in the supermarket for items that use corn starch instead of wheat starch. For example marshmallows, jellybeans, lollipops and party mix.


Fairy bread – hmmm, a little trickier… I’m not sure the gluten-free bread with icing sugar and sprinkles will taste quite as good to the gluten/dairy/egg eaters. You could always try it though if you must have fairy bread. Otherwise, try using your favourite cookie recipe and ice them, or you could purchase allergy-friendly cookies and ice them with pink icing and hundreds and thousands. Biscuits – try substituting with chocolate crackles (everyone loves these, don’t they?). Use allergy-friendly rice bubbles, such as the Freedom (www.freedomfoods. com.au) foods brand and mix with a packet of melted Pam’s cooking chocolate chips, or similar, (contains soy lecithin so some children with soy allergies may be sensitive to this), fill your paper cases and place in the refrigerator to set. They taste best fresh, so make on the morning of your party – the kids will love them.

Make these yummy Chocado Cupcakes. See recipe on page 48 Twisties, chips and dip – you might have to skip the twisties and traditional Kiwi dip. Instead go with plain chips or natural nacho chips plus homemade hummus (blend one can of drained chickpeas and the juice from half a lemon), avocado guacamole (blend one avocado with a squeeze of lemon and a few slices of red onion), and some tomato salsa. You could also make your own popcorn or try Kettle Korn (www. kettlekorn.co.nz) or another allergy-friendly brand. Cheerios (little red sausages) and sausage rolls – try gluten-free sausages, cut into bite-sized pieces, threaded on to a tooth pick. You could also wrap bacon around them – delicious. And who needs sausage rolls when you can have oven fries and tomato sauce? Pizza – use one of the Venerdi (www.venerdi.co.nz )

pizza bases, add a little olive oil and bake for 5 to 8 minutes at 200°C. Fry up some streaky bacon. When the bases are ready, add guacamole, then the bacon – divine! Juice and lemonade – juice and lemonade! Ice cream – substitute with sorbet or jelly cups. Have a few mini lemonade ice blocks in the freezer if it’s a scorcher of a day. Fruit platter – seasonal fruit such as grapes, oranges, melons are great if you cut them into triangles and insert an ice block stick so they appeal to little hands. Vege platter – carrot, cucumber and celery sticks with your homemade dips on the side. There are loads of alternatives once you get thinking. Enjoy your day, the children sure will. They’ll be allergy-free too and they won’t even know it.

GIVEWAY We have 12 bags of Healtheries Kidscare Rice Wheels 10-packs to give away (RRP$5.29) – perfect for kid’s parties and lunchboxes! See www.healtheries.co.nz for the full Kidscare snacking range. To be in to win, enter online at www.livingwithallergies.co.nz or email giveaways@livingwithallergies.co.nz with RICE WHEELS in the subject line. Entries close 15 November 2013.

LIVING WITH ALLERGIES Spring 2013 29


food allergy

GIVEAWAY Hopper food decorations and colouring are 100 per cent natural and free from dairy, egg, nuts, gluten and soy. We are giving away a three-pack (RRP $25) of any of Hopper’s100’s and 1000’s, sprinkles or pearls range. Enter online at www.livingwithallergies.co.nz or email giveaways@livingwithallergies.co.nz with HOPPER the subject line. Entries close 15 November 2013. 94mm

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Booking a party venue outside the home I’ve found that many venues can be very accommodating if you give them enough notice and will happily cater for specific food allergy requirements.

Questions you might like to ask when booking a venue: • Do you cater for food allergies? Have you done so in the past? • Do you have an allergy-friendly birthday cake available or, if not, is it possible to bring your own birthday cake and cupcakes in to the venue? • Are customers able to specify brands of foods to purchase such as lollies, popcorn or oven fries or would they mind giving you the ingredient list for the products that they use? • What are the chances of cross-contamination of foods such as nuts, dairy, egg? • If the venue provides party bags or entertainment, what does that involve? For example if playdough or face paint is provided, do they use wheat-free products? Shari Hammond


eczema

ATOPIC ECZEMA Eczema occurs when the skin becomes dry, sensitive and inflamed causing redness and intense itching. It results from a variety of different causes and has various patterns.

E

CZEMA AFFECTS one

in five people at some time in their lives, according to the New Zealand Dermatological Society. The terms ‘eczema’ and ‘dermatitis’ are often used interchangeably. Atopic eczema is the most common type of eczema. Other types include allergic contact dermatitis caused by skin contact with nickel, perfume, rubber, hair dye or preservatives and irritant contact dermatitis triggered by handling detergents or harsh chemicals. Atopic eczema is a chronic, itchy skin condition very common in children but may occur at any age. Children often scratch until their skin is broken and bleeds, which can lead to secondary infections that weep and form crusts. It usually occurs in people with an ‘atopic tendency’. This means they may develop one or more of three closely-linked conditions: atopic eczema, asthma and hay fever (allergic

rhinitis). A family history of asthma, eczema or hay fever can be useful in diagnosing atopic eczema in infants. Atopic eczema affects 15-20 per cent of children but only one to two per cent of adults. Atopic eczema is often worst in children aged two to four but it usually improves after this and may clear up altogether by their teenage years. There is no known single cause for atopic eczema: it probably represents more than one condition. There are many theories regarding the underlying mechanisms and research is being carried out into the role of genes, the immune system, skin cell defects and skin microbes, such as viruses and bacteria. Atopic eczema cannot be cured but it can be managed. For more information on treatment options, see the New Zealand Dermatological Society’s website www. dermnetnz.org/dermatitis/ and www.itchykids.org.nz. LIVING WITH ALLERGIES Spring 2013 31


eczema

BREAKTHROUGH IN SEARCH FOR THE CAUSE OF ECZEMA

Researchers have discovered a new kind of immune cell in the skin, which they think could cause eczema. Caroline Wood talks to Prof Graham le Gros about the significance of the discovery and how he believes it could lead to a future cure for allergic disease.

S

CIENTISTS HAVE found a unique type of immune cell in the skin that could unlock a potential cure for eczema and other allergies, including asthma and hay fever. Researchers involved in the study say the discovery of the Dermal Innate Lymphocyte 2 immune cell forces a revision in current thinking of how allergic diseases arise in the first place. Researchers were able to see how the new immune cells move through the skin, what they interact with and for how long, says lead investigator Professor Graham le Gros, from the Malaghan Institute of Medical Research. He said: “Critically we have been able to show that these cells have the potential to cause skin allergy in experimental models. By being able to link this new cell type to skin allergy, there is a greater possibility we can now find ways to stop the 32 LIVING WITH ALLERGIES Spring 2013

onset of allergic disease.” Numerous studies have shown that allergic disease can progress from one form to another throughout a child’s life – a phenomenon known as ‘allergic march’. Allergic march now affects 15-30 per cent of children in Western countries. Skin allergy is usually the first sign of allergic disease in young infants and is often associated with an underlying food allergy. These children are more likely to develop respiratory allergies, such as asthma and hay fever, as they get older. “We believe that prevention of allergic disease early in life is critical, to halt progression along the allergic march. Since allergic disease is immunemediated, the most obvious target for new therapies is the earliest stages of the allergic immune response, added Prof le Gros. “These newly discovered skin immune cells might just be the ‘Holy Grail’ we have been searching for.”

The study was a transTasman partnership between researchers at the Malaghan Institute of Medical Research in Wellington and the Centenary Institute in Sydney, Australia’s leading dermatology research facility. US researchers from the US National Institutes of Health also supported the research. “This has been a huge effort involving scientists from New Zealand, Australia and the USA. It is really motivating to be involved in something so exciting and potentially important,” added Prof le Gros. Future research will focus on learning more about the immune skin cells and how they could be exploited to stop allergic disease. “Cutaneous immunosurveillance and regulation of inflammation by group 2 innate lymphoid cells” by Roediger B, et al. Nature Immunology, April 2013.


Study authors (from left): Dr Elizabeth Forbes-Blom, Ryan Kyle and Professor Graham le Gros from the Malaghan Institute of Medical Research

Malaghan Institute of Medical Research The independent charitable trust is New Zealand’s leading vaccine and immunology research centre and is based at Victoria University in Wellington. Researchers are working to develop innovative ways to harness the strength and potency of the immune system (the body’s own natural defence against disease). They hope to find ways to prevent and treat cancer, asthma, allergies, arthritis, multiple sclerosis and infectious diseases. For more information see www.malaghan.org.nz.

LIVING WITH ALLERGIES Spring 2013 33


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treatment

PREPARING FOR A SPECIALIST APPOINTMENT

Visiting an allergy specialist for the first time can be a little daunting. Planning ahead will help you get the most out of the appointment, says Sarah Maxwell, who has taken her children to see six specialists in the past five years.

L

ET YOURSELF FEEL

a sense of relief when you receive your specialist appointment. It can be the start of a positive phase in your life. Your first visit is likely to take from 30 minutes to two hours depending on the number of tests required. The length of your visit should be stated on your appointment slip, call to ask if it isn’t. It is good to know how long it will be, especially if you are taking a child with you. Preparing beforehand for the visit will help you get the most out of your meeting with a specialist. Make a list of questions A quick internet search about the specialist you are seeing can help you understand their experience. They may have written scientific papers, which can provide useful background information on your condition. Questions may start to form from this research. Write these down, along with any others you already have and

36 LIVING WITH ALLERGIES Spring 2013

prioritise them to discuss during your appointment. There is a lot of information to digest in a short period of time and it is all too common to remember a critical question two hours after the appointment. Tick your questions off as you cover them with the specialist, then at the end you can go back and check any unasked questions. Be realistic about what you are likely to achieve in the first visit. Symptoms and treatments Write down your symptoms and what you are already doing to treat them. A bullet point list is a great way to do it so you can quickly refer to them. It will also be important to have a list of medications, vitamins or supplements you are taking, and any other health conditions, even those you think are unrelated. This can also include personal information about major stresses or recent life changes.

Family history Specialists will be interested in any relevant family history of allergies. If you feel comfortable, ask your close relatives. Go back to them after they have had plenty of time to think about it. The term ‘allergy’ is fairly new, so your relative may have been diagnosed with something else when they were young, such as irritable bowel. It is worth noting this. If you are taking a young child for a consultation, you may be asked about their birth, so have a think about this and make a note of any injections they have had. Take your child’s Plunket book and record of immunisations with you. Food/exposure diary It is a good idea to do a food/ exposure diary for at least a week before your visit (see overleaf for an example). Take this to your specialist appointment. It could be an extremely useful tool for you and your specialist.


Quick tip Think carefully about what entertainment you are going to take for your child and plan when you are going to take it out of the bag. For example, it may be better to hold off on a computer game, new book, or treat until the appointment has started so you can concentrate on what the specialist is saying.

Outcomes Think about what you want to get from the appointment. For many of us the next steps are unknown but for some there will be particular tests and/or medicines that you may want to discuss with your specialist. If you are prescribed medicines, ask about known side effects and whether there are alternatives. If you have a baby, you may want to discuss the milk replacement formula subsidy offered by the government. You need a specialist’s approval to get access to this. You may talk about an action plan, particularly if your allergies are critical. Write it down and and check with the specialist that you have the correct information. Ask them whether they can give you any written information to take home with you. Remember to ask if you need another appointment and what to do if you need to talk to someone in between. LIVING WITH ALLERGIES Spring 2013 37


diagnosis

KEEPING AN ALLERGY DIARY If you suspect an allergy or food intolerance, try keeping a diary of your symptoms to see if you can see a pattern. You can take it with you to your next GP or specialist appointment. Here is an example of a simple diary. TIPS

1 Making a note of

the brand is important as different brands use different ingredients. Take a look on the label to see if there is anything in the product that you can identify as a potential allergen. 2 You can use it for food or, if you think there is something in the environment that is affecting you, you can write when you were exposed to it. It is often hard to relate symptoms to something in particular, so simply write down what you are consuming/doing, and how you are feeling without making connections. 3 If you can see a clear link between something you are using or eating and a symptom, stop using it and write the results in your diary. 4 Remember that symptoms can present up to 72 hours after you have consumed something. 5 A diary does not provide a diagnosis, but it does suggest which foods or potential allergens could be the culprit(s), allowing further tests. Take the diary to your next specialist appointment. It could be an extremely useful tool for you and your doctor. Sarah Maxwell 38 LIVING WITH ALLERGIES Spring 2013

Date/time

What I ate/used

Symptoms and time they started

Sat 3 August, breakfast, 8am

White {insert brand} bread with {brand} butter and {brand} raspberry jam

Sore stomach (8.30am) Eczema on back of leg (10pm)


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food allergy

FOOD LABELLING Q&A: WHAT ALLERGENS MUST BE DECLARED? Those of us with allergies spend a lot of time checking labels on packaged foods. Lorraine Belanger, of Food Standards Australia New Zealand, which sets the rules, explains the ins and outs of food labelling. WHAT ALLERGENS MUST BE DECLARED ON THE LABEL IN NEW ZEALAND? ost food allergies are caused by nine main food allergens and these must be declared on a packaged food label, however small an amount is present. These are: peanuts; soybeans; tree nuts; milk; eggs; sesame seeds; fish; crustacea (e.g. shrimp, crayfish); wheat.

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Sources of gluten also need to be declared on the label so people with coeliac disease can identify these products. Other than wheat, gluten is present in rye, barley, oats, spelt and their hybridised strains. Sulphite preservatives must also be declared on the label if added at 10 (or more) milligrams per kilogram of food. This is the level that may trigger asthma attacks in some asthmatics.

WHAT ARE WARNING OR ADVISORY STATEMENTS? Only food containing the bee product royal jelly is required to have an allergen warning statement. This is because royal jelly has been reported to cause severe allergic reactions and, in rare cases, fatalities, especially in asthma and allergy sufferers. Advisory statements are required on some foods that contain less well-known allergens,

Example food label: Chocolate hazelnut biscuits

Ingredients: Wheat flour, vegetable oil, sugar, cornflour, cocoa solids, hazelnuts, salt, milk solids, sesame, raising agents (E330, E341, E500), yeast, emulsifier, egg. Contains: wheat, hazelnuts, milk, sesame, soy and egg May contain: traces of peanut

40 LIVING WITH ALLERGIES Spring 2013

Allergenic ingredients are listed in bold Type of nut is specified Summary statement will list all allergenic ingredients starting with ‘contains’ or ‘may contain’


or may be a health risk for particular population groups or to some sensitive individuals. Such statements are required on foods that contain bee pollen or propolis. WHAT DOES ‘MAY CONTAIN’ MEAN? Some food labels say ‘may contain’ certain allergens, such as nuts. It is not required by law but manufacturers may want to warn consumers about possible cross-contamination. For example a manufacturer may be concerned that traces of nuts might be present in the food unintentionally, if, for example, the food is prepared on the same equipment as products that contain nuts. It is up to consumers to decide what merit such warnings have. Allergy consumer support groups are working with industry to make these labels more helpful to allergy sufferers. WHAT ABOUT HIDDEN ALLERGENS? Sometimes ingredients derived from known allergenic foods are not clearly identified in the ingredients list, for example soy might be listed as ‘textured vegetable protein’, or peanut oil may be called groundnut oil. Allergy consumer groups are working with the food industry on industry guidelines to provide more meaningful information in plain English.

Voluntary allergen labelling

Some companies have added voluntary allergen labelling on their products over and above what is required by law. For example Nestlé decided in 2010 to progressively include three additional allergens – lupin, mustard and celery. These allergens were already labelled in Europe but it decided to extend this to all its products worldwide, including those in New Zealand.

What is lupin?

Lupin is a legume related to peanuts and soy that is increasingly valued as a nutritious food. Lupin and lupin products have been used in Europe for many years and recently in Australia. In 2004 the Medical Journal of Australia reported three cases of allergic reactions after eating products containing lupin. Food Standards Australia New Zealand is gathering information on lupin allergy in Australia to be considered in consultation with allergy experts.

Why celery and mustard?

Components and products of mustard seed, (such as mustard powder) and celery (celery root and spice) have been shown to provoke allergic reactions, particularly in Europe. Nestlé says there is evidence that celery and mustard allergies are cross-related to birch pollen allergies.

WHAT FOODS DON’T REQUIRE A FULL FOOD LABEL? In some circumstances food is exempt from labelling requirements. This means some or all of the label components can be left out. Foods that don’t require any labelling at all include unpackaged food; food packaged in front of you (such as deli food); and takeaway food. Specific health and safety information, including

mandatory advisory statements and declarations about allergens, must be displayed nearby or the information made available if you ask for it. * Food Standards Australia New Zealand has a useful food allergy section with links to food allergen cards developed by Allergy & Anaphylaxis Australia. They give a full list of ingredients that may be harmful to someone who has an identified food allergy. For more information go to www.foodstandards.gov.au/ consumerinformation/foodallergies/ LIVING WITH ALLERGIES Spring 2013 41


food allergy

FOOD ALLERGY A GLOBAL ISSUE Food allergy is increasing in every country around the world. Here are 10 facts you may not know, courtesy of the World Allergy Organisation, which highlighted the issue during World Allergy Week 2013. Food allergies are increasing in developed and developing countries – especially among children. Globally up to 520 million people may suffer from food allergy.

FACT

An estimated five to eight per cent of children have a food allergy, compared with one to two per cent of adults.

FACT

The severity and complexity of food allergy is increasing. It significantly affects the quality of life of sufferers (mainly children).

FACT

Food allergies FACT are complicated by other allergic diseases, such as asthma and atopic eczema.

The main reported food allergens vary by country. For example among US children the most common allergies are to milk, egg and peanuts. In Korea the main allergens are pork, fruit, mackerel and chicken.

FACT

Food allergy can be fatal and appropriate diagnosis is essential. The most common causes of anaphylaxis in Australia are dairy, egg and peanuts. In Singapore they are bird’s nest, seafood, egg and milk.

FACT

Over the past decade more people have been developing multiple food allergies, rather than an allergy to a single food.

FACT

Children are taking longer to grow out of food allergies. About 80 per cent of children used to grow out of food allergies by the age of five or six years. Recent studies suggest this level is now not being achieved until the mid-teenage years.

FACT

No country has reported a decline in food allergies over the past 10 years – most have reported an increase in a recent survey conducted by member societies of the World Allergy Organisation.

FACT

There is a need for food labelling worldwide, as well as more clinical knowledge and resources to diagnose and treat food allergy.

FACT

*All facts are from the World Allergy Organisation, for more information see www.worldallergy.org 42 LIVING WITH ALLERGIES Spring 2013


interview

GOODNESS ME IT’S GLUTEN FREE

The Hudsons developed a successful business and penned an award-winning cookbook after several family members were diagnosed as gluten intolerant. Caroline Wood reports.

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T’S A LABOUR of love that has paid off. The Hudson family from Tauranga has always loved cooking and eating great food. Then, a few years ago, three family members were diagnosed with coeliac disease and various degrees of gluten intolerance. Frustrated about the options available to make delicious satisfying glutenfree food, Mary and Vanessa Hudson (pictured above) set out to make a difference. First the mother and daughter team established a family business in 2008 called Goodness Me Ltd, which made gluten-free bread and baking mixes, and then established an online shop to sell them. Mum Mary brought decades of experience as a laboratory scientist to the business, ensuring the culinary

success of the baking mixes – for example their breads rise like store-bought loaves. Daughter Vanessa has travelled widely and brought her global food knowledge, photography and marketing skills. Over the years they developed so many tasty gluten-free recipes they decided that writing a cookbook was the best way to share their culinary secrets. They self-published Goodness Me It’s Gluten Free, which went on to win the Best First Cookbook in New Zealand, and the third best Health Cookbook in the World, at the Gourmand World Cookbook Awards in France earlier this year. Vanessa said: “When I was first diagnosed as gluten intolerant, eating became an ordeal, always making sure I avoided all the deliciouslooking gluten-containing foods, while trying to stomach the crumbly, cardboard- or brick-like gluten-free bread and baking that was on offer at the time. “As a frustrated foodie,

I was determined to find ways of making delicious, satisfying recipes that are as much as a joy to cook as they are to eat.” Goodness Me it’s Gluten Free features easy to follow recipes. It is full of every day favourites, including bread, pizza, pastry, cakes, cookies and muffins. All the recipes are free from gluten, wheat, soy, potato and nut flours. Many are dairy free and can be made egg free too. *Order online at www.goodnessme.co.nz, RRP $29.95.

LIVING WITH ALLERGIES Spring 2013 43


babies & allergies

COW’S MILK ALLERGY IN INFANTS

Experts estimate about 1 in 50 babies are allergic to cow’s milk, making it one of the most common food allergies in infants. Caroline Wood talks to one mum about her experience.

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ILK allergies can

make life miserable for children and their parents. It is one of the most common allergies among infants and the symptoms can be distressing for caregivers especially if they occur in a very young child. It is thought about two per cent of infants have a milk allergy – their immune system reacts to the protein in milk. Most children have mild symptoms but a small minority experience severe reactions, including anaphylaxis.

44 LIVING WITH ALLERGIES Spring 2013

William was seven months old when he had an anaphylactic reaction to his first bottle of infant formula. Mum Nicola Scotland, from Wellington, remembers vividly what happened next: “We were about to go to the UK for a holiday and I wanted to try William on formula so we could go to a Madonna concert while we were there. My husband was

giving him his first bottle of formula, I came into the room and thought his face looked very odd, inflamed and red, it looked like hives. I said he’s having an allergic reaction and we rushed him to our local medical centre round the corner. “On the way I noticed his breathing was becoming laboured, his head was very swollen and the glands on the back of his head were massive. I started freaking out. We ran into the reception and I said ‘my son’s having an allergic reaction, we need a doctor’. The GP came and immediately gave him adrenaline and antihistamine and that instantly helped him to breathe. “We were referred for a blood test, which came up as negative, but then he had a skin prick test and that showed he was allergic to dairy. We removed all dairy from William’s diet but I was able to keep on breastfeeding him. We saw a dietitian at the hospital and she was really helpful.”


Nicola found the experience of dealing with an allergic toddler very stressful: “I felt like a helicopter mum, constantly hovering in case he picked up a crumb of food, knowing it could become problematic very quickly, ” she added. It is important to get a reliable diagnosis if you suspect your child has a milk allergy. It is usually obvious in people with an immediate reaction to dairy products but it can be confirmed by your doctor using allergy tests (skin prick or blood allergen IgE (RAST) tests. Some infants may also be allergic to other foods, such as egg or peanuts. The only treatment is to eliminate milk from the child’s diet – and this might include mum’s diet if she is breastfeeding. The Australasian Society of the Clinical

Study of Allergy and Immunology (ASCIA) warns that the elimination and reintroduction of cow’s milk and dairy products should only be undertaken with advice from a medical specialist, particularly in cases of severe symptoms. Advice from a dietitian should also be sought. Most children grow out of their milk allergy by the time they are four years old. Symptoms in adults are very rare. William, now five, never had another anaphylactic reaction but broke out in hives several times when he came into contact with traces of dairy, for example on a high chair or once while playing with an empty clean milk bottle. He was tested again at 18 months old and found to have grown out of his dairy allergy.

GIVEAWAY

Go Derma Protect probiotics are clinically tested and safe to take in pregnancy to support mum and baby’s immune system. We have 10 packs (RRP $29.90) to give away. To be in to win, enter online at www.livingwithallergies.co.nz. or email giveaways@livingwithallergies.co.nz with GO DERMA in the subject line. Entries close 15 November 2013.

Symptoms of a cow’s milk (dairy) allergy The following symptoms may occur if your child has a milk allergy: Immediately (within minutes or up to one hour after having a small amount of cow’s milk): • Hives • Eczema • Face swelling • Vomiting • Diarrhoea • Noisy breathing or wheeze. Severe allergic reactions (anaphylaxis) may cause floppiness in babies. Delayed (several hours after having moderate amounts of cow’s milk) • Vomiting • Diarrhoea • Sometimes blotchy rashes or worsening eczema. After a day or several days after having normal amounts of cow’s milk • Eczema • Vomiting • Diarrhoea • Asthma. *Source: the Australasian Society of the Clinical Study of Allergy and Immunology. For more information on cow’s milk allergy see: www.allergy.org.au.

LIVING WITH ALLERGIES Spring 2013 45


recipes

CHILD-CENTRED RECIPES FOR ALL THE FAMILY

Featuring 100 nutritionally-balanced recipes for babies and children, YUM! Top tips for feeding babies and kids with allergies offers practical tips and advice for feeding kids with allergies. Written by a team of experts from Sydney’s Westmead Children’s Hospital, it is Australasia’s first allergy recipe book aimed specifically at children.

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DUCATION and accurate advice for parents is the key to dealing with the rising tide of food allergies among children, says Professor Andrew Kemp, head of Paediatric Allergy and Immunology at Sydney’s Westmead Children’s Hospital. “When there is a risk of severe allergic reaction, it naturally causes a lot of anxiety. Sometimes children have to avoid multiple allergens – milk, eggs, wheat, soy, fish and nuts etc. Not surprisingly some parents who come to the allergy clinic are concerned about whether they are going to be able to cope,” Prof Kemp writes in the preface to Yum! Top Tips for Feeding Babies and Kids with Allergies.

YUM! is Australasia’s first child-centric allergy recipe book. One of its co-authors is former New Zealand dietitian Barbara Dennison, who worked for 30 years in Wellington specialising in food allergies. Barbara relocated to Sydney in 2002 and started working at Westmead Hospital, the largest paediatric hospital in the southern hemisphere. Barbara found many of the parents she was helping were desperate to know what to feed their children. But she didn’t have the tools she needed to help so the idea for a recipe book was born. YUM! contains lots of advice for parents whose children are newly-diagnosed and who may be feeling overwhelmed by the challenges of cooking for

them and the rest of the family. It has easy-to-understand information on food allergies, diagnosis, anaphylaxis, shopping and food preparation, as well as advice on how much food children need to grow. Nutritionist Fiona Wedding was asked to develop recipes for the book, which covers all ages and stages. from babies to older kids. All the recipes are designed to meet children’s specific nutritional needs. The book is written for parents with diagnosed IgEmediated food allergies. The authors stress self-diagnosis can be dangerous and warn that children’s diets should not be restricted unless under medical advice. Here are two simple child-friendly recipes from the book.

GIVEAWAY We have 12 bags of Healtheries Simple Wheat & Gluten free Baking Mix to give away (RRP$9.49). See www.healtheries.co.nz for more delicious gluten-free recipe ideas. To be in to win, enter online at www.livingwithallergies.co.nz or email giveaways@livingwithallergies.co.nz with BAKING MIX in the subject line. Entries close 15 November 2013.

46 LIVING WITH ALLERGIES Spring 2013


HOW TO CRUMB CHICKEN AND FISH Prep time: 10 minutes Cooking time: 10 minutes Cooking times may vary depending on the size of the chicken or fish pieces. Chicken (any cut but should be skinless) or fish (any type) Gluten-free plain/all-purpose flour Rice drink Gluten-free breadcrumbs* or gluten-free cornflakes, crushed (*If using commercial versions, check they don’t contain egg or milk) Method: 1. Preheat oven to 180°C. 2. Cut chicken or fish to desired size, e.g. nugget size or thin strips for finger food. 3. Place the flour, rice drink and breadcrumbs/cornflake crumbs in 3 separate plates or containers. 4. Roll each piece of chicken or fish in flour, dip in milk then roll in crumbs. 5. Place on a greased baking tray and cook for 10 minutes.

SWEET AND SOUR CHICKEN OR BEEF Prep time: 20 minutes Cooking time: 25 minutes This is a great ‘do ahead’ meal. Serves 4 2 tablespoons / 40ml olive oil 500g trimmed chicken or beef, diced 3 cups / 400g raw mixed vegetables 1 teaspoon / 5g chicken stock powder 1 cup / 250ml water 2 tablespoons / 40ml vinegar 2 teaspoons / 10g brown sugar 2 tablespoons / 40ml tomato sauce / ketchup ½ cup / 200g drained crushed pineapple 2 tablespoons / 30 g cornflour mixed with 2 tablespoons / 40 ml water

Method: 1. Heat oil in a large frying pan. 2. Add chicken or beef and cook until brown. 3. Add the mixed vegetables and continue cooking on medium heat until the meat is cooked. 4. Add the chicken stock powder, water, vinegar, brown sugar and tomato sauce and simmer for 5 minutes. 5. Add crushed pineapple. Add the cornflour and water mixture and stir until boiling. Serve with cooked rice.

*Copyright © Barbara Dennison, Fiona Wedding, Dr Preeti Joshi 2013. Extracted from: YUM! Top tips for feeding babies and kids with allergies, published by Hachette New Zealand, RRP $39.99

Do you have a favourite recipe to share? Email editor@livingwithallergies.co.nz LIVING WITH ALLERGIES Spring 2013 47


real life Shari Hammond spent several months testing chocolate cake recipes to find the best allergy-free version for her son Zac’s first birthday. Now the mum-of-two wants to share her experience (and successful recipe) with other families. Caroline Wood reports.

SEARCHING FOR THE PERFECT CHOCOLATE CAKE

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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.

48 LIVING WITH ALLERGIES Spring 2013

AKING a birthday

cake for your little treasure’s birthday is stressful at the best of times but when your child is allergic to a heap of different foods, it becomes an almost impossible feat, as Shari Hammond, 36, from Tauranga, knows only too well. Shari wanted to make a ‘normal’ chocolate cake for her son Zac to celebrate his first birthday with friends and family. But Zac has a lot of allergies so his cake had to be gluten and wheat free; dairy free; egg free; nut free and soy free. Shari, who is also mum to three-year-old Stella, spent

four months testing recipes and searching the internet for ideas. She struck gold with her Chocado cupcake recipe (see right) – it’s simple to make, free from most food allergens and tastes delicious. Zac was referred to an Auckland allergy specialist last September. He blood-tested positive for severe allergies to nuts, tree nuts, egg, wheat and dairy and moderate allergy to sesame. Shari and her husband Paul bought an adrenaline pen in case Zac suffers a severe allergic reaction. Shari explained: “Basically Zac’s has had trouble from birth, firstly skin problems – eczema, cradle cap, skin


infections – in the first five weeks and he was unsettled at night. He would wake up three times on a good night and on a bad night I would be up with him between four and five hours. “I breastfed Zac for a further two months and excluded allergens from my diet and his. It meant we were living on fruit, veges, meat, rice and corn products. It sounds quite limiting but there are loads of alternatives. It just takes a lot of preparation and reading the back of packets. “It sounds silly, but one thing I wanted to do was to create a tasty and perfect chocolate cake for Zac’s first birthday. It took months of research and testing but mission accomplished! We celebrated Zac’s birthday with a party earlier this year, and the ‘Chocado’ cupcakes and birthday cake were a hit with the children and parents. No one realised when tasting them, that they were allergen free. “It would be great if I could get this recipe out to as many households, schools, child care centres, caterers, cafes and restaurants as possible, so they can try it for themselves.” *See page 28 for Shari’s article on how to organise the perfect child’s birthday party.

CHOCADO CUPCAKES Makes 12 cupcakes. Free from wheat and gluten, egg, nuts, tree nuts, dairy and soy. 1 large ripe avocado ¼ cup of rice bran oil or sunflower oil 2 ‘eggs’ (Orgran ‘no egg’ natural egg replacer or suitable egg replacer) ²� 3 cup white sugar ²� 3 cup brown sugar 1¾ cup Healtheries Simple Wheat and Gluten-free Baking Mix (or 1¾ cup of a mix of gluten free flours such as rice, sorghum, millet, maize) ¾ cup Fairtrade organic cocoa 1¼ tsp Hansells gluten-free baking soda ¹� 8 tsp salt 2 tsp of vanilla essence 1½ cup Vitasoy rice milk Method: Place the avocado, oil, egg replacer and sugar in a bowl and beat with electric mixer until combined. Combine sifted baking mix, cocoa, baking soda and salt. Add the vanilla essence to the rice milk. Alternate adding the ‘flour’ mix and the ‘milk’ mix to the avocado mixture using a spoon or spatula. Beat to combine. Heat the oven to 180 degrees. Line a muffin or mini-muffin tray with paper cases. Three-quarter fill the cases and bake for 20–25 minutes (or 9–12 minutes for mini muffins).* Ice with 1½ cups of Chelsea rich chocolate icing sugar combined with two tablespoons of boiling water. Or use 1.5 cups of glutenfree white icing sugar, two tablespoons of boiling water and two drops of vanilla essence. You can add a dairy and soy-free spread to make a creamier consistency. Decorate with jelly beans, marshmallows or hundreds and thousands. Many sweets use wheat starch but some use corn starch – just check the ingredients on the back of the packet. *To bake a cake using the mix: Grease a medium-sized cake tin and bake at 170 degrees for around 35 minutes. Bake the cake long and low to ensure the mixture cooks in the middle. Check by inserting a skewer at 25 minutes and lower the heat if necessary.

Check out the Healtheries Baking Mix giveaway on page 46 LIVING WITH ALLERGIES Spring 2013 49


anaphylaxis

HOW ANAPHYLAXIS GOT ITS NAME The word ‘anaphylaxis’ was coined over 100 years ago by a French scientist called Charles Richet. Caroline Wood delves into the history books.

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HE PHENOMENON

of anaphylaxis has been around since ancient times and was described in ancient Greek and Chinese medical literature. It is said that the first documented case was pharaoh Menes, who died in 2640 BC from a wasp sting. According to hieroglyphs on his sarcophagus and tomb, a wasp can be seen near the fallen pharaoh (LA Waddell, 1930). The word ‘anaphylaxis’ has its origins in more modern times. To understand how ‘anaphylaxis’ came to mean a severe or fatal allergic reaction, we need to go back more than a century. In 1901 a French scientist called Charles Richet was asked to join a cruise on board a yacht, which was owned by Prince Albert of Monaco. The Prince asked Richet and his friends Paul Portier and Georges Richard to study the poison of the Physalia (the Portugese man-of-war jellyfish). This work was to lead Richet to the most important scientific discovery of his lifetime.

50 LIVING WITH ALLERGIES Spring 2013

On board the yacht, Richet successfully isolated the toxin from Physalia and by dissolving it in glycerol found he could inject it and reproduce the symptoms of someone stung by the jellyfish.

Richet’s research helped shed light on hay fever, asthma and other allergic reactions to foreign substances and explain some previously not understood cases of sudden death. On Richet’s return home, he ran out of Physalia poison and decided to continue his work using a closely-related toxin from Actinia sulcata, a sea anemone. He wanted to determine the lethal dose of the toxin in dogs. Some of the dogs survived the experiments. Richet decided to use the same dogs for a new experiment. He thought they would be protectively immunised by their previous exposure to the poison but was surprised when

subsequent injections led to sudden fatal reactions. As he describes in his Nobel Lecture, in December 1913: “An unexpected phenomenon arose, which we thought extraordinary. A dog when injected previously, even with the smallest dose, say of 0.005 liquid per kilo, immediately showed serious symptoms: vomiting, blood diarrhoea, syncope, unconsciousness, asphyxia and death.” Richet proposed the term aphylaxis indicating a lack of protection from the immunisation with the toxin. He later changed it to anaphylaxis, because it sounded better and was easier to pronounce. “This neologism I invented 12 years ago on the assumption...that a new idea calls for a new word in the name of scientific precision of language,” Richet explained. “Phylaxis, a word seldom used, stands in the Greek for protection. Anaphylaxis will thus stand for the opposite. Anaphylaxis, from its


Etymological origins

Greek etymological source, therefore means that state of an organism in which it is rendered hypersensitive, instead of being protected.” Richet’s research helped shed light on hay fever, asthma and other allergic reactions to foreign substances and explain some previously not understood cases of sudden death. The discovery that immunisation could cause damage, rather than protection, subsequently

led to the creation of the term ‘allergy’ by Clemens Freiherr von Pirquet in 1906. While the term ‘anaphylaxis’ was coined over 110 years ago, a consistent definition of anaphylaxis has proven more difficult, say Stephen Boden and Wesley Burks in their paper ‘Anaphylaxis: a history with emphasis on food allergy’. Today the most common causes of anaphylaxis are certain foods, insect stings and medications.

The term anaphylaxis comes from the Greek words ἀνά ana, against, and φύλαξις phylaxis, protection.

References: Charles Richet’s Nobel Lecture Anaphylaxis see: www. nobelprize.org/nobel_prizes/ medicine/laureates/1913/richetlecture.htm “History and classification of anaphylaxis” by Ring, J; Behrendt, H, de Weck, A (2010) Chemical Immunology and Allergy. “Anaphylaxis: a history with emphasis on food allergy” by Stephen R. Boden and A. Wesley Burks (2011) Immunology Review.

GIVEAWAY

The OZONE Anti-Itch™ roll-on stick is a portable easy-to-use applicator that soothes insect bites and stings. We have 20 sticks (RRP $12.99) to give away. To be in to win, enter online at www.livingwithallergies.co.nz or email giveaways@livingwithallergies.co.nz with OZONE in the subject line. Entries close 15 November 2013.

LIVING WITH ALLERGIES Spring 2013 51


asthma

SOMETIMES YOU NEED TO MAKE A FUSS Sometimes parents need to make a fuss to keep their children out of hospital, according to the Asthma Foundation. Caroline Wood reports.

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T IS ESTIMATED that

every year in New Zealand 550,000 school days are lost due to asthma. One in four of our tamariki (children) have the condition, and one in six adults – the second highest rate of asthma in the world after the UK. New figures from the University of Otago confirm there were 8,000 hospital admissions for asthma in 2011. Fifty-seven per cent of these admissions (4,540) were children under 15 years old. Of these 38 per cent, or 1,724 children, were Maˉori. The prevalence of asthma is similar for Maˉori and nonMaˉori children. However

52 LIVING WITH ALLERGIES Spring 2013

Maˉori children tend to have more severe symptoms, require hospitalisation for asthma almost twice as often as non-Maˉori children, and require more time off school because of asthma. Dr Tristram Ingham, medical adviser to the Asthma Foundation, suggests high

Dr Tristam Ingham.

By the numbers • • •

About 800,000 Kiwis are affected by asthma and other respiratory conditions. People still die from asthma – 65 deaths in 2008, 61 in 2007 and 79 in 2006. New Zealand’s economic burden of asthma is conservatively estimated to be more than $800,000 per year.

Source: The Asthma Foundation


“Don’t wait until asthma is out of control to do something about it. You know your child best – have confidence to take your child to the doctor and be seen before it is an emergency, because sometimes you need to make a fuss.” DR TRISTAM INGHAM

hospitalisation rates for asthma are a failure of primary care. He said: “Particularly troubling is that Maˉori are less likely to have been given a peak flow meter or asthma action plan by their health professional, and fewer are prescribed preventative treatment with regular inhaled corticosteroids.” He says that the cost of doctor visits and medicine can mean some families only take their child at a time of immediate need or when they are very sick. The Asthma Foundation recommends people keep using their medication as prescribed and parents fill out a child asthma management plan with a health professional. This will help them manage their child’s asthma and recognise when it is deteriorating, before it becomes an emergency. “Don’t wait until asthma is out of control to do something about it. You know your child best – have confidence to take your child to the doctor and be seen before it is an emergency, because sometimes you need to make a fuss,” adds Dr Ingham.

Dangers of asthma highlighted At least 52 people a year die from asthma, despite many people thinking it is mild disease. The fact that asthma can still be life-threatening was reinforced in August, when Year 12 student Wiremu Rawiri died after a severe asthma attack in Hawke’s Bay. The 17-yearold was a boarder at Te Aute College and suffered the attack at its boarding hostel. He was able to tell staff he was having an asthma attack and an ambulance was immediately called. But paramedics were unable to revive him. The Asthma Foundation said it was saddened to hear of the death of another young person from asthma. “People are surprised to learn that asthma can kill – many people regard asthma as a mild disease that causes the odd episode of wheezy breathing,” says Dr Tristram Ingham, medical adviser at the Asthma Foundation. The Foundation has been stressing the seriousness of asthma for a long time. Its figures show that at least 52 people every year die from the condition. “At least one death per week every year from asthma is too many. The Asthma Foundation is focusing on prevention. To support this we will continue to fund research into treatments and educating on best practice,” said Angela Francis, chief executive of the Asthma Foundation. Dr Ingham added: “We are asking New Zealanders who have children with asthma to make sure they keep using their medication as prescribed and keep their asthma under control at all times. We recommend parents consider getting a child asthma management plan. ” LIVING WITH ALLERGIES Spring 2013 53


gluten–free living

MAINTAINING A SAFE KITCHEN Gluten-free chef and food blogger Jimmy Boswell gives some tips on how to avoid cross-contamination in the kitchen.

I

T CAN BE VERY

daunting when people are confronted with an allergy in the family. I remember when I was diagnosed with a gluten intolerance and a soy allergy. The combination landed me in hospital on more than one occasion. It took me a few months of worrying about what I couldn’t eat until I realised I should focus on what I can eat and what I need to do to keep myself safe. Cross-contamination occurs when a food is tainted with an allergen during food preparation, cooking, storage, or serving. It can occur at home, restaurants, or on manufacturing lines. We are very lucky in New Zealand because of our strict labelling laws. Any product that contains an allergen, or may have been made on a production line where allergens have been used, has to be clearly labelled. Learning to read labels is a must to stay safe. Avoiding all processed foods is also a good way of maintaining a safe kitchen.

54 LIVING WITH ALLERGIES Spring 2013

The easiest way to avoid cross-contamination at home is to have no allergens in the home in the first place. While this may not be practical in some families, the more you can remove allergens, the easier it will be to live safely. Plan ahead Make a list of the family’s favourite meals and group them into allergencontaining and allergenfree meals. Then look for ingredient replacements that will make your meals suitable for everyone. Plan your daily menu over a whole week. I suggest you do this on a Sunday when you have the flyers from supermarkets with weekly specials. This will assist in budgeting. Have a look at your pantry and write a shopping list. Keep the list handy when you are out and about. You never know when you will see something that’s on it. Beware of buying from bulk containers in shops. The

scoops are at high risk of cross-contamination. In the kitchen For those new to dealing with allergies and intolerances, there are a few things we need to look at in the kitchen when we are adjusting to the necessary changes. This is the first place to start and it is one of the most important areas to focus on. When starting out, here are some of the key things I recommend to make your food and kitchen safe:

1

Prepare allergen-free foods first in a clean kitchen and store in dedicated containers.

2

Use containers with different colour lids to store safe and non-safe foods. This is also great if you have people looking after your kids when you are not there. You can leave a colour-coded chart on the fridge that identifies which containers are safe for specific individuals.


Use containers with different colour lids to store safe and non-safe foods

3

Reserve special preparation areas and utensils for making any food that contains allergens. Thoroughly clean all food surfaces that have touched allergens as soon as you’re finished using them.

4

Many cross-contamination accidents can occur because knives, cutting boards, spoons and utensils were not washed in between different foods. Washing with hot soapy water can prevent this. Wash any dedicated allergen-free utensils, plates, cups and containers first.

5

Never allow the sharing of drinking cups with allergic individuals. Ensure the individual with an allergy has their own cup and make sure it is protected.

6

Teach family members to wash their hands before touching the nonallergenic foods. Even small traces of allergens can be transferred from your hands and cause a reaction.

Cooking outside the home Toasters, waffle cookers, grills etc are a highrisk source of crosscontamination, so avoid using them unless you are sure they are safe. If I am at a BBQ or event where shared food is being served and there’s a risk of cross-contamination, I take my own tinfoil and/or baking paper. I advise the host that I need to be first to cook due to the risk of crosscontamination. Do not be shy in telling people the nature of the situation and the effects that can be caused from eating a particular allergen.

The Gluten-free chef’s meal planner Use Jimmy’s chart to help you plan and shop for the week.

n The Glute

ʼs Free Chef

Meal Plan

ner www.

ell.com jimmybosw

You can download the chart from Jimmy’s website: http://jimmyboswell.com/ GFS_Meal_Planning.pdf

GIVEAWAY

Jimmy is giving away two copies of his recipe book The New Zealand Gluten-free Cookbook – see overleaf.

LIVING WITH ALLERGIES Spring 2013 55


gluten–free living

SO DELICIOUS YOUR GUESTS WILL NEVER KNOW (SHHH) IT’S GLUTEN FREE… The New Zealand Gluten-free Cookbook is chock full of mouthwatering recipes with a Kiwi feel. Author and chef Jimmy Boswell, who has a mild gluten intolerance, set out to cook and entertain at home without his guests knowing the food they were eating was glutenfree. Here are two recipes from the book.

GIVEAWAY

We have two copies of The New Zealand Gluten-free Cookbook by Jim Boswell (RRP $44.99) to give away. Enter online at www.livingwithallergies.co.nz or email giveaways@ livingwithallergies.co.nz with cookbook in the subject line. Entries close 15 November 2013. 56 LIVING WITH ALLERGIES Spring 2013

TOMATO FOCACCIA A delicious Italian-style flat bread – great to serve as a starter with dips. Makes 1 × 30-cm loaf 15 g active dry yeast 180 ml warm water 2¼ cups gluten-free plain flour mix (see page 24) 1 tsp salt 10 fresh cherry tomatoes, halved 6 large fresh basil leaves, shredded 6 tbsp olive oil coarse sea salt Method: In a small bowl, dissolve the yeast in 120 ml of the warm water and set aside for 10 minutes until frothy. In a large mixing bowl, combine flour mix, salt, yeast mixture and remaining water and mix thoroughly with a wooden spoon. The mixture may be quite sticky so add a little more flour mix if needed. Bring the dough together with your hands, transfer to a floured work surface and knead well for a few minutes until smooth and elastic. Place in a well-oiled bowl, cover with plastic wrap and leave in a warm spot for about 1–1½

hours or until doubled in size. Preheat oven to 220 °C and lightly oil a baking tray. Turn the dough onto a floured surface, punch down and knead for a few minutes. Place the dough on the oiled baking tray, pulling it into an oval or circle about the size of a dinner plate. Dimple the surface with your fingertips or knuckles, then space the tomato halves across the surface and sprinkle the basil leaves over the top. Drizzle with the oil and sprinkle generously with sea salt. Bake for about 20 minutes or until lightly golden – don’t expect the bread to ‘brown up’ in the oven like ordinary focaccia. The surface may crack during baking and this is okay. Serve bread warm or at room temperature.


ROAST CHICKEN TORTILLA WRAP Wraps make a great alternative to sandwiches and are perfect for a light, healthy snack or lunch. I often make these wraps with leftover chicken from a roast the night before. Serves 4. 1½ tsp olive oil, plus extra for drizzling 1 small red onion, thinly sliced 1 small clove garlic, minced 2 cups shredded roast chicken 1 tsp balsamic vinegar pinch dried oregano salt and freshly ground black pepper, to taste a floured work surface and TOMATO FOCACCIA 10 cherry tomatoes, cut into quarters knead well for a few minutes A delicious Italian-style 6 sun-dried tomatoes in oil, until smooth and elastic. Place flat bread – great to drained and chopped in a well-oiled bowl, cover serve as a starter with dips. 8 basil1 leaves, torn Makes × 30-cm loafinto pieces with plastic wrap and leave in 4 tortillas (purchase gluten-free tortillas a warm spot for about 1–1½ mydry recipe on page 24) hours or until doubled in size. 15org use active yeast 2 cups shredded 180 ml warm watericeberg lettuce Preheat oven to 220 °C gluten-free mayonnaise, taste and lightly oil a baking tray. 2¼ cups gluten-free plain to flour Turn the dough onto a mix (see page 24) and surface, punch down floured 1 Method: tsp salt Heat oil in a small frying pan sauté red onion for 2 minutes. Add garlic and knead for a few minutes. 10 fresh cherry and chicken and sauté for 2–3 minutes until Place the dough on tomatoes, halved the chicken is warmed through. Add balsamic the oiled baking tray, 6 large fresh basil leaves, vinegar and oregano and season with saltit into an oval pulling shredded and pepper to taste. Set aside to cool. or circle about the size of a 6 tbsp olive oil In a sea small tomatoes, coarse saltbowl, mix together cherry dinner plate. Dimple the surface sun-dried tomatoes and basil. Drizzle olive with your fingertips or knuckles, oil on top add a pinch of blackthen pepper. Method: In aand small bowl, space the tomato halves Once the chicken mixture has cooled, dissolve the yeast in 120 ml of across fill the surface and sprinkle each tortilla with of lettuce. the Divide the warm water anda bed set aside basil leaves over the top. and the tomato mixture forthe 10chicken minutesmixture until frothy. Drizzle with the oil and sprinkle evenly between the 4 tortillas. Top with generously with sea salt. In a large mixing bowl, combine mayonnaise tortillas up tightly. Bake for about 20 minutes flour mix, salt, and yeastwrap mixture It’s a good idea to wrap one end of and remaining water and mix oreach until lightly golden – don’t tortilla in foil wrap so that the the bread to ‘brown thoroughly withora plastic wooden expect filling The doesn’t fall out spoon. mixture maywhen be it’s eaten. up’ in the oven like ordinary quite sticky so add a little focaccia. The surface may Tip Don’t shred the chicken too fine. more flour mix if needed. crack during baking and this I like to use a mix of breast and leg meat. Bring the dough together is okay. Serve bread warm with your hands, transfer to or at room temperature. *Extracted from The New Zealand Gluten-free Cookbook by Jim Boswell, published by Penguin Books. RRP $44.99.

Photos: Sean Shadbolt

LIVING WITH ALLERGIES Spring 2013 57


Brease The low allergy floor you’ve been searching for

For people with asthma and allergies Brease carpet is a breath of fresh air. Recognised by The Asthma and Respiratory Foundation of New Zealand’s sensitive choice programme, this premium carpet has been specially developed for asthma and allergy sufferers.

For more info contact us on Ph: (03) 366 9839 Or view our ranges at www.robertmalcolm.co.nz


Allergy Guide

ADVICE, BENEFITS & CHOICES

Alpha Keri with lanolin – a natural choice

Have asthma?

Alpha Keri, with lanolin, is a trusted everyday treatment specifically formulated to relieve problems associated with dry, sensitive and itchy skin. Lanolin is a 100% naturally derived moisturiser that penetrates deep to replenish, repair and protect skin. No wonder people have trusted lanolin for generations. Available in supermarkets and pharmacies.

Can you help? We are looking for volunteers to take part in a clinical study for a new medicine that is being developed to treat asthma. If you have asthma and are: • Aged 18–75 years • In generally good health • A non-smoker or ex-smoker • On a stable dose of inhaled corticosteroid • With on-going asthma symptoms … then we would love to hear from you.

Fast relief from eye allergy Naphcon-A® provides fast relief and 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. Always read the label and use only as directed. If symptoms persist, see your healthcare professional. Active ingredients: naphazoline hydrochloride, pheniramine maleate. For info call 0800101106. Available from pharmacies. TAPS PP2440

Unique roll-on anti-itch stick OZONE Anti-Itch™ Insect Bite & Sting Care – a unique new application roll-on stick that: • calms the irritation • soothes dry, itchy skin • helps neutralise the bite area. Pharmacist-recommended formula to support in the fast and effective management of bites and stings associated with most insects including mosquitoes, bees, wasps, mites and sandflies. RRP $12.99 Available from Pharmacies nationwide.

See giveaway on page 51

For more information please contact: Carol Veale Study Coordinator Freephone 0508 919 919 Or email carol@nzrsi.health.nz

GO Derma Protect – for skin health Clinical trials undertaken in New Zealand show that adults supplementing with Lactobacillus rhamnosus (strain HN001) supports the body’s immune response to allergens, which often cause skin complaints, and helps to protect against flare ups. Expectant mothers should take GO Derma Protect Probiotic rhamnosus during pregnancy and breastfeeding to support their baby’s developing immune defences for allergen-related skin issues and skin health. GO Derma Protect: RRP: $29.90 (30 VegeCaps) RRP: $42.90 (60 VegeCaps). Available at major pharmacies and health stores nationwide. www.gohealthynz.co.nz

When you need fast allergy relief… Do you suffer from hayfever and other allergies? Lora-Tabs provides fast acting, non-drowsy treatment for hayfever, perennial allergic rhinitis, hives and other allergic skin disorders. Available in packs of 30 and 60 from all good pharmacies. Lora-Tabs is a pharmacy medicine used for the relief of allergies. Each tablet contains loratadine 10mg. Always read the label carefully and use strictly as directed. If symptoms persist or you have side effects, see your health professional. Mylan NZ Ltd, Auckland. TAPS DA0713JL-11

LIVING WITH ALLERGIES Spring 2013 59


Allergy Guide

ADVICE, BENEFITS & CHOICES

Medibands save lives Medibands® provide peace of mind – when the unexpected happens, critical medical information can be conveyed to emergency personnel. • Insure against incorrect diagnosis & treatment • Raise awareness of medical conditions • Provide vital medical & contact information in emergencies. Caters for: diabetes and epilepsy, drug allergies, food allergies. Custom made bracelets are available. Bracelets can be linked to the MedibandPlus web-based medical database where you can store vital medical information for easy access. Mediband® wristbands are comfortable, fun to wear and look great! Find out more at www.mediband.co.nz

Safe to sprinkle! Hopper 100% natural food colours, sprinkles and 100’s and 1000’s are free from artificial colours, flavours and preservatives. They are also gluten free, dairy, egg, nut and soy free. They look great on ice cream, cakes, and fairy bread to name a few. Just let your imagination run wild. Bulk and retail sizes available. For further information visit www.hopperfoods.com.au or call 613 8317 8565

Nasal irrigation

USE FOR: Post nasal drip and nasal dryness from occupational and house dust, fumes, animal dander, grass, pollen and smoke. ADVANTAGES: • It’s soothing, with no burning or stinging – Large Volume & Low Pressure™ system for saline nasal irrigation, moisturisation and daily nasal hygiene • Preservative, drug, iodine, BPA, gluten and latex free • Pack contains 30 premixed packets of USP grade sodium chloride and sodium bicarb • Pulsatile flow • Suitable for use after sinus surgery and during pregnancy. Available nationwide.

Jane Iredale Longest Lash Mascara Natural ingredients such as sea minerals condition and thicken lashes to encourage growth and sweet almond oil softens and moisturises. Features and benefits: • Well-defined, longer-looking lashes and volume! • Contains 50% more product than most mascaras. • A blend of seaweed lipids to condition, moisturize and protect. www.janeiredale.co.nz

For a healthier fresher home Fujitsu’s clean air filters are the most advanced in New Zealand. The filters give you a healthier, fresher home environment because they absorb minute dust particles and the common allergens such as pollen, dust mite carcasses, even bacteria from the air. You can check out the information on their website www.fujitsugeneral.co.nz

Helping your family breathe easy The Nilfisk Extreme Complete is the world’s only domestic vacuum with a HEPA 14 filter which captures 99.995% of all dust particles bigger than 0.3 micron (1/500 the diameter of a human hair). Extreme filtration so you and your family can breathe easy. www.nilfisk.com.au

www.neilmed.com

TO ADVERTISE CONTACT DEBBIE DAVIS ON (09) 589 1054 OR 021 340 360 60 LIVING WITH ALLERGIES Spring 2013


Inc P&P


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Living with asthma and allergies? Make a Sensitive Choice® MA COUNC

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RAL I A Z)

(N

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www.asthmafoundation.org.nz/sensitive-choice/ www.facebook.com/SensitiveChoiceNZ

Your Healthy Food Store

• Gluten Free • Dairy Free • Nut Free • Certified Organic Produce Open 7 days except Public Holidays Shop 9, 215 Rosedale Rd Albany, Auckland 0800 567 888 www.naturallyorganic.co.nz

62 LIVING WITH ALLERGIES Spring 2013

IL

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TH

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AS

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Eco Laundry Ball – save your skin, The Environment and money at the same time!! For more information or to order go to www.eco-laundryball.co.nz

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When life beckons.

BECONASE®. A Proven name in allergy relief. Pharmacy Medicine. Beconase® Allergy and Hayfever nasal spray contains 50mcg of beclomethasone dipropionate per spray. Always read the label and use only as directed. If symptoms persist or you have side effects, contact your healthcare professional. For further information see your healthcare professional. Aspen Pharmacare C/- Healthcare Logistics, Auckland. TAPS PP4172.

Advertisers! You can get your products and services in this section for as little as $150 + GST. Call Debbie Davis on 09 589 1054 or 021 340 360 Email debbie@livingwithallergies.co.nz www.livingwithallergies.co.nz

Paint without the headache Don’t put up with nasty odours and high VOC paints next time you redecorate. Make a healthy choice and choose from a full range of Environmental Choice approved paints from your local Resene ColorShop. Come in and see us for help with your decorating project.

0800 RESENE (737 363) www.resene.co.nz

LIVING WITH ALLERGIES Spring 2013 63


endpoint

WHAT IS THE ALLERGIC MARCH? Allergic march affects up to one in three children in developed countries, according to the American Academy of Allergy, Asthma and Immunology. Scientists believe new treatments, or even a cure, can be discovered by studying the progression of allergic diseases in childhood.

Asthma Rhinitis Food Allergy

Typical age of onset 64 LIVING WITH ALLERGIES Spring 2013

s yea r 15

s 7y ear

s 3y ear

s 2y ear

1y ear

th ont hs

Eczema Bir

The allergic march (typical age by which children develop allergic diseases). Adapted from graphic produced by the LEAP Study. For more information see www.leapstudy.co.uk

in a large proportion of children (see graphic below). “These may overlap so that they suffer from more than one at a time, or one allergy may subside as another starts,” says Allergy UK. The allergic march usually begins with eczema – a dry, red, scaly rash that causes considerable itching and discomfort. Eczema is most commonly diagnosed within the first few months of life. In one-third to one-half of children, eczema is associated with an underlying food allergy. Food allergies generally

3m

T

HE TERM ‘allergic march’ refers to the typical progression of allergic diseases throughout a person’s life, starting with eczema in infancy and progressing to food allergy, allergic rhinitis (hay fever) and then asthma. Not all children with eczema will go on to have serious allergic diseases but it does mean they have an increased risk of following the allergic march. Research has shown the pattern (the type of disease and age at which they occur), is similar

begin to appear within the first three years of a child’s life. As children age further, the allergic march may proceed to the development of rhino-conjunctivitis (hay fever) and/or asthma. “This pattern does not apply to every child, and it is hard to predict how one child with an allergy will experience this progression compared to another,” adds Allergy UK. Many children, who do follow the pattern, grow out of their allergies in early adulthood, it says. Scientists, such as Prof Graham le Gros, from the Malaghan Institute, believe the prevention of allergic diseases early in life may halt progression along the allergic march.


NOWBLE G ILA AVA LEADINS M IE FRO RMAC PHA

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for big flare-ups LING K C TA EMA ECZ RIASIS O & PS ETHER TOG

for little squirts Greasy and effective, new Epaderm 3-in-1 ointment is the ideal choice for tackling severe flareups. Also, new Epaderm 2-in-1 cream - is a lighter, more cosmetically appealing formula that is absorbed quickly and easily into the skin. Kids love its simple pump-action pack and there’s even a handy 50g size to encourage application on the go. The Epaderm range is suitable for all ages, even babies, and with no fragrances or colours they’re kind to already sensitive skin. Good news, all round, for problems big and small.

consumer Customer Service: 0800 658 814

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Living With Allergies Spring 2013

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