The Allergy Epidemic Dr Adam Fox Consultant in Paediatric Allergy Guy’s & St Thomas’ Hospital

1. The Allergy Epidemic Dr Adam Fox Consultant in Paediatric Allergy Guy’s & St Thomas’ Hospital 16 October 2013

2. Ancient History

3. Modern History • Hay fever – Dr John Bostock first described in 1819 • Based on his own symptoms • Second paper on 28 cases - took 9 years to acquire

4. Modern History allos = "other" ergon = "reaction" An inappropriate, potentially harmful reaction by the immune system to a harmless stimulus. Clemens Von Pirquet 1874-1929

5. Allergic Diseases Eczema Asthma Allergic Rhinitis Food Allergy Drug Allergy Venom Allergy Latex Allergy

7. Proportion of the children with asthma, suspected allergic rhinitis, eczema and oral-gastrointestinal symptoms in combination with other allergic manifestations n= 1417 100 80 60 % at least 2 40 1 other Alone 20 0 Asthma Suspected all rhinitis Eczema Oral-gastro intestinal symptoms Wickman et al, Allergy 2004

8. Allergic Disease in 21st Century UK 40% of UK children have an allergic diagnosis Gupta et al Clin Exp All 2005

9. In a classroom of 30 primary school children 3-4 will have eczema but 12 will have suffered at some point

10. In a classroom of 30 primary school children 3 or more children are likely to have asthma

11. In a classroom of 30 secondary school children 4 or more children will be suffering from rhinitis

12. Impact of Allergic Rhinitis Juniper EF et al. Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol. 1994 Feb;93(2):413-23. Juniper EF et al. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998 Feb;101(2 Pt 1):163-70. Simons FE Learning impairment and allergic rhinitis.Allergy Asthma Proc. 1996 Jul-Aug;17(4):185-9 Walker S et al. Hayfever has a significant detrimental impact on national exam performance in UK teenagers: case control study. JACI 2007. • Significant decrease in Quality of Life • Effect on exam performance • 50% increased risk of dropping a grade from mocks to formal exam

13. In a classroom of 30 primary school children 1-2 children are likely to have a food allergy (although 10 may think they have)

14. Food allergy in the UK? Venter C et al. Allergy. March 2008 Community cohort of 969 children born 2001-2 Cumulative incidence of FA was 5.0% 33.7% of parents reported a food related problem (only 12.9% of these confirmed)

15. Is peanut allergy getting out of control? Rates of Peanut Allergic in UK Paediatric Cohorts

16. Allergy Service Provision Remains variable 27 adult & 20 Paediatric consultants identified in 2010 RCP report No significant expansion planned Est 2% of appropriate children receive IT (Vance. Clin Exp Allergy 2010)

17. Key UK Organisations

18. The future 2848 Australian infants SPT at 12months Prevalence of food allergy 10.4%

20. Summary Increasing pattern of disease Multisystem problem Relative lack of service provision Challenging future