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

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slide1
The Allergy Epidemic

Dr Adam Fox

Consultant in Paediatric Allergy

Guy’s & St Thomas’ Hospital

16 October 2013

modern history
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
modern history1
Modern History

allos = "other"

ergon = "reaction"

An inappropriate, potentially harmful reaction by the immune system to a harmless stimulus.

Clemens Von Pirquet 1874-1929

allergic diseases
Allergic Diseases

Eczema

Asthma

Allergic Rhinitis

Food Allergy

Drug Allergy

Venom Allergy

Latex Allergy

slide7

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

allergic disease in 21 st century uk
Allergic Disease in 21st Century UK

40% of UK children have an allergic diagnosis

Gupta et al Clin Exp All 2005

slide9

In a classroom of 30 primary school children

3-4 will have eczema but 12 will have suffered at some point

slide10

In a classroom of 30 primary school children

3 or more children are likely to have asthma

slide11

In a classroom of 30 secondary school children

4 or more children will be suffering from rhinitis

impact of allergic rhinitis
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
slide13

In a classroom of 30 primary school children

1-2 children are likely to have a food allergy (although 10 may think they have)

food allergy in the uk
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)

is peanut allergy getting out of control
Is peanut allergy getting out of control?

Rates of Peanut Allergic in UK Paediatric Cohorts

allergy service provision
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)

the future
The future

2848 Australian infants SPT at 12months

Prevalence of food allergy 10.4%

summary
Summary

Increasing pattern of disease

Multisystem problem

Relative lack of service provision

Challenging future