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Kids’ Food Allergies For Dummies®, Australian and New Zealand Edition

Table of Contents

Kids’ Food Allergies For Dummies®, Australian & New Zealand Edition

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THE INFORMATION IN THIS REFERENCE IS NOT INTENDED TO SUBSTITUTE FOR EXPERT MEDICAL ADVICE OR TREATMENT; IT IS DESIGNED TO HELP YOU MAKE INFORMED CHOICES. BECAUSE EACH INDIVIDUAL IS UNIQUE, A HEALTH-CARE PROVIDER MUST DIAGNOSE CONDITIONS AND SUPERVISE TREATMENTS FOR EACH INDIVIDUAL HEALTH PROBLEM. IF AN INDIVIDUAL IS UNDER A HEALTH-CARE PROVIDER’S CARE AND RECEIVES ADVICE CONTRARY TO INFORMATION PROVIDED IN THIS REFERENCE, THE HEALTH-CARE PROVIDER’S ADVICE SHOULD BE FOLLOWED, AS IT IS BASED ON THE UNIQUE CHARACTERISTICS OF THAT INDIVIDUAL.

About the Authors

Associate Professor Mimi Tang is a paediatric immunologist allergist at the Royal Children’s Hospital in Melbourne, Victoria. She is Director of the Department of Allergy and Immunology at the Royal Children’s Hospital, which sees more than 2,000 children with allergic disease each year. Mimi is also Head of the Allergy and Autoimmunity Affinity Group, and Group Leader of Allergy and Immune Disorders Research at the Murdoch Children’s Research Institute; she is also an Associate Professor in the Department of Paediatrics at the University of Melbourne, lecturing within the undergraduate science and biomedical science degrees.

Her research continues to focus on investigating immune mechanisms leading to allergic disease, and on evaluating probiotics and prebiotics as novel treatment or prevention strategies. She has published widely in the area of food allergy and anaphylaxis, and is committed to developing the next generation of clinicians and researchers in allergy and immunology through teaching and training.

Mimi is passionate about translating research into clinical practice and policy both nationally and internationally. As Chair of the Paediatric Committee of ASCIA, she led the development of national guidelines on ‘Prevention of Allergic Disease’ and ‘Infant Feeding Advice’ which are now widely adopted across Australia. She played a key role in developing the Anaphylaxis Guidelines and Policy for Schools and Children’s Services in Victoria, and contributed to the development of ASCIA national guidelines for Prevention of Anaphylaxis in Schools.

Mimi sits on several expert committees including the World Allergy Organisation (WAO) Communications Council, the American Academy of Allergy Asthma and Immunology (AAAAI) Adverse Reactions to Foods Committee, and the Australasian Society of Clinical Immunology and Allergy (ASCIA) Anaphylaxis Committee and Paediatric Committee. Mimi leads a busy life outside of work, with three children aged between 11 and 17 years.

Associate Professor Katie Allen is a paediatric gastroenterologist and allergist practising in the field of food allergy at the Royal Children’s Hospital, Melbourne. After completing her medical degree at Monash University and undertaking a research year at Cambridge University, UK, Katie spent two years as a Clinical Gastroenterology Fellow at the University of Chicago and then received a PhD from The University of Melbourne.

Katie is Director of the Environment, Genes and Health Research Theme at the Murdoch Childrens Research Institute and is group leader of the Gastro and Food Allergy research group. She is chief investigator on 6 NHMRC-funded cohort studies, which all seek to answer parts of the jigsaw with regards to population health and evolution of the new allergy epidemic. Katie has published extensively within the area of food allergy, has a prestigious Viertel Senior Medical Research Fellowship and was awarded the MCRI rising star award in 2008 for the most successful researcher within ten years of PhD completion at the MCRI.

Katie is the principal investigator of the HealthNuts study at the Murdoch Childrens Research Institute, which is the largest single-centre population-based study of food allergy in children ever mounted. She is a member of the Eosinophilic Gastrointestinal Disorders committee and Adverse Reaction committee for the American Academy of Allergy, Asthma and Immunology (AAAAI), and a member of both the Paediatric and Education committees for Australasian Society of Clinical Immunology and Allergy (ASCIA). She also teaches in the University of Melbourne Department of Paediatrics and currently supervises 6 PhD students. Despite this, she remains an active clinician in both the Department of Allergy and the Department of Gastroenterology at the Royal Children’s Hospital, Melbourne, and has four children.

Authors’ Acknowledgements

From Mimi: Firstly, I would like to thank all at John Wiley & Sons Australia who had a part to play in inviting me to author this For Dummies book. I appreciate this valuable opportunity and experience. I would especially like to thank Hannah Bennett and Rebecca Crisp for having faith in my ability to complete this task, despite having no prior experience in writing a book. Your guidance, helpful advice and encouragement throughout the project helped me to stay positive when the work seemed overwhelming, and I appreciated your support in negotiating the For Dummies writing format (as well as the occasional reminders to keep on going!). Your editorial input was most welcome, and I valued your counsel on how to develop the For Dummies style. Thank you also to Charlotte Duff for your expert editing that put the shine on our final finished product.

I would like to say a special thank you to Katie for agreeing to co-author this book with me. I thoroughly enjoyed working with Katie and can honestly say that it would not have been possible to finish this project without her help in sharing the workload. Katie — your focus and encouragement was always timed perfectly to help keep the work moving forwards. I think we pulled together an outstanding team effort.

I would like to say an enormous thank you to my family — to my wonderful, loving children, Callum, Elise and James, who remained interested and encouraged me to keep going when my work piled up, and to my ever-reliable, caring parents who were always ready to lend a helping hand. Your support and belief in me has been invaluable and made the difference between finishing the book and not getting there. Finally, thank you also to my patient and thoughtful friends who have put up with my prolonged absence for the months I was engrossed in writing.

Writing this book was certainly more fun than I expected but also a bigger commitment than I had imagined. I’m extremely proud of what Katie and I have achieved together and hope that our readers enjoy this book as well as finding it a useful resource to share with family and friends.

From Katie: I would like to thank all staff at John Wiley & Sons Australia involved in getting this book to print for making the process so enjoyable. They knew how to break down the tasks into achievable bite-sized chunks so that we could continue to make progress, despite both of us holding down busy clinical and research jobs and juggling housefuls of children. They had a sixth sense about when to ‘go easy’ but also when to crack the whip to help us reach those never-ending deadlines. And all the while they remained upbeat and positive. Those words of encouragement kept me going at the computer late at night when the rest of the family had gone to bed. Thank you specifically to Hannah Bennett and Rebecca Crisp for seeing the process through from start to finish and to Charlotte Duff for your magnificent editing of our sometimes sleep-deprived writing. I would also like to acknowledge Lindy Hayward for your words of wisdom in looking over early drafts of the book.

Importantly, I would like to thank Mimi for inviting me to co-author this book and trusting that we could get the job done. It has been an honour to work with Mimi and I think we really had a great team approach.

Finally, I would like to thank my family for their patience in getting this book written — to my constant husband, Malcolm, and my enthusiastic children, Monty, Jemima, Arabella and Archie. Thanks for being my guinea pigs for helping me simplify complex ideas — and thanks for believing in me.

Publisher’s Acknowledgements

We’re proud of this book; please send us your comments through our online registration form located at .

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial and Media Development

Project Editor: Charlotte Duff

Acquisitions Editor: Rebecca Crisp

Editorial Manager: Hannah Bennett

Production

Graphics: diacriTech

Cartoons: Glenn Lumsden

Proofreader: Jenny Scepanovic

Indexer: Don Jordan, Antipodes Indexing

The authors and publisher would like to thank the following copyright holders, organisations and individuals for their permission to reproduce copyright material in this book.

• Page 106, Figure 6-1a: Reproduced with permission, Australian Family Physician, 2008.

• Page 142: Reproduced with permission of Australian Food and Grocery Council.

• Pages 210–213, 219, 221: This information has been reproduced with permission from the Australasian Society of Clinical Immunology and Allergy (ASCIA), from the ASCIA website .

Every effort has been made to trace the ownership of copyright material. Information that enables the publisher to rectify any error or omission in subsequent editions is welcome. In such cases, please contact the Permissions Section of John Wiley & Sons Australia, Ltd.

Introduction

When we first started thinking about this book, we wondered whether we had enough information and practical advice to fill an entire book. Well, it turns out we have a lot of information that we think you’re likely to find both useful and interesting. So we hope that you enjoy reading Kids’ Food Allergies For Dummies, Australian and New Zealand Edition, as much as we enjoyed writing it. Most importantly, we hope that the information we provide here helps keep your child healthy and happy and enables your child to safely engage in all aspects of childhood.

About This Book

A rapid change in many aspects of food allergy has occurred over the last few years. Not only has food allergy become much more common in Westernised countries such as Australia and New Zealand, but the way that we as medical practitioners diagnose and manage food allergy has also changed dramatically — even in the last three to four years. So a book that examines all the issues, including the management and treatment of food allergy, is timely.

Although quite a bit of research in food allergy is still in progress worldwide, a lot of new evidence is available now that has helped allergists better understand how to manage and treat this condition — and ideas about how best to prevent kids from developing food allergy are also emerging. It’s a very exciting time to be involved in the field of food allergy research and enormously satisfying to be able to bring new evidence into practice in the discipline in which we work. More importantly, the studies being conducted now are already helping thousands of children around the world and are likely to be highly influential in the care of children in many future generations to come.

Note: The information provided throughout this book is current at the time of writing. Because research into causes and treatments of food allergy is continuing, guidelines and recommendations outlined in this book may change in the future, in line with new research.

This book isn’t intended as a replacement for your child’s doctor but as a supplement to help you navigate medical care of your child and to provide the safest and most positive environment for your child with food allergy to grow up in.

We hope that the information in this book

check.png Provides you with the information you need to more effectively team up with your health-care providers to arrive at an accurate diagnosis and obtain the most effective medical treatments.

check.png Empowers you and your child to work together to take control of your child’s food allergy by presenting practical, plain-English advice, tips and strategies for living well with food allergies at home, work and school, while dining out or on school camps or holidays.

check.png Helps make your child’s life as safe as possible without excessive restrictions on your child’s lifestyle by giving you information that allows you to make decisions that best suit you, your child and your family.

check.png Gives you information that helps you explain to your family and your child’s friends how best to keep you child with food allergy safe.

What You’re Not to Read

Some people love to read books from cover to cover and digest all of the facts in a sequential order. Certainly, we know plenty of our colleagues in medical school who swear this is a tried and tested way to pass exams. However, neither of us finds this an easy way to access information, and retain that information in a meaningful way — unless you have hours of study time to commit to the task.

Certainly, very few parents have hours of idle time to read a book sequentially — not with the chaos of kids to deal with. Also, even though we’re fascinated by this topic — enough to spend our lives seeing patients, doing research in the field and even writing a book — we know that most people really just want to have their burning questions answered.

This book has been divided into bite-sized chunks that let you dip in and out of the subject as you please. The table of contents is your best guide to pointing you in the direction you need, while the index obviously helps with a more focused search.

To help to prioritise key information, we’ve put information that’s less critical in grey shaded boxes called sidebars. So although these boxes contain interesting asides, facts and case studies they’re not essential to understanding the basics. Perhaps look at them as the icing on the cake — they’re not essential but they certainly make your reading of the topic more digestible.

Foolish Assumptions

The title of the book kind of gives it away. This book is for people relatively new to the subject — not for experts. Of course, the most informed people are often those prepared to ask the questions that may appear foolish. We know of some people who are particularly good at asking probing, important questions in an ingenious way. For example, they may say ‘If blind Freddie were to have a question, he might ask . . .’. So, although we don’t assume you have any prior technical knowledge, we do assume that you’re an inquisitive reader wanting answers that will help make life easier for you and the child you know who has food allergy.

We also make a few other assumptions. We figure that your situation matches one of more of the following scenarios:

check.png Your child has symptoms that you think may be related to food allergy and you want to know what your next step could be.

check.png Your child has just been diagnosed with a possible food allergy and you want to know more about the tests being discussed as a next step.

check.png Your doctor has diagnosed your child as having a food allergy and you’re avoiding the foods diagnosed as being a problem, but your child’s still experiencing symptoms.

check.png You’re a parent or caregiver of someone who has food allergies and you want to know what you could and should be doing to help with all aspects of living with a food allergy.

check.png You’re a grandparent or close friend of a child with food allergy and you want to make sure you can provide a safe, secure and supportive environment when you care for that child.

check.png You’re a teacher, childcare worker, or school or childcare administrator who wants some definitive answers about food allergies so that you can more effectively discern real risks from overblown claims and put an effective and reasonable food allergy policy into place.

check.png You own a restaurant or run a school camp or after school club and you want to know more about how to support children with food allergy who visit your facility.

check.png You’re a medical professional who underwent training before food allergies were as common as they are now and you want to learn more about food allergies in order to diagnose, treat or refer your patients more effectively.

check.png Your child has a friend with food allergy and you both want to know how to better support that friend.

check.png You are just plain curious since an epidemic of food allergy seems to be occurring!

Conventions Used in This Book

We don’t like to think of our book as conventional — hopefully you find it stimulating and full of interesting facts — but we’ve used a couple of standard ways of presenting material that you may need to know when reading this book.

Conventions used are as follows:

We understand that not just parents and guardians look after children with food allergies — extended family, friends, and childcare and school staff are among those who may need to care for children with food allergies and ensure appropriate management and treatment plans are in place. Where we’ve used ‘your child’ throughout this book, you can take this to also mean ‘the child in your care’.

check.png When we introduce a new concept — particularly if it’s a technical term — we italicise the term. If you see an italicised word that you don’t understand, you can turn to the glossary section to find a more detailed explanation of the medical jargon.

check.png Websites appear in a different font and are never hyphenated even if they run longer than a line of text — you can simply type the line into your web browser.

How This Book Is Organised

We wrote this book so that you can approach it in two ways. You can either read the book from cover to cover or you can pick up the book and flip to any chapter for quick, stand-alone information on a specific food allergy topic. To help you navigate the book, we’ve divided the 17 chapters into five parts. Here we provide a quick overview of what we cover in each part of the book.

Part I: Introducing Food Allergies

This part provides a nice and compact overview of the whole book. So if you’re pressed for time, this part gives you the short version of what’s in this book. It also provides some basic definitions of the main terms and jargon surrounding food allergy, and helps you understand what other parts of the book you might wish to explore more. We also look at the rising rates of food allergy in Westernised countries, and what may be behind these rises. We then provide some information on possible ways to prevent food allergies in children.

Part II: Defining Food Allergies

This part really covers what food allergy is and how best to diagnose it in its various guises. We explain the different types of food allergies, how they’re different from food intolerances, how they usually present as well as how diagnosis is confirmed through different types of tests.

Part III: Living with Food Allergies

This part outlines the four key steps to helping your child with food allergies stay safe and healthy. We explain how to avoid the food your child is allergic to (including providing some tips on interpreting ingredient labels), how to identify and manage high risk situations, how to treat allergic reactions should they happen and how to best optimise asthma management. We also look at the various places your child may need to manage their food allergies outside the home, including school and child care, friends’ houses, other carers’ houses, camps and restaurants. This part is for anyone who cares for a kid with food allergy — it provides important information and special tips to make the whole process safer and easier.

Part IV: Looking To the Future with Allergies

In this part, we look at whether or not your child is likely to grow out of food allergy. We also look at therapeutic options that are on the horizon.

Part V: The Part of Tens

This part presents key information that you won’t want to miss. Here you discover key lessons to teach your child with food allergy, common food replacements for children avoiding certain foods, myths, misperceptions and falsehoods that you may have heard about food allergy and top allergy websites that provide useful further information to help you care for your child with food allergy.

Icons Used in This Book

Throughout this book we’ve sprinkled icons in the margins to highlight different types of information that call out for your attention. Here are the icons included and a brief description of each.

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We use this icon to highlight really important flags for when you should call your doctor for further help with your child. Food allergy is a very serious condition — particularly if a severe reaction such as anaphylaxis occurs. Although we hope this book helps make life much easier for you and your child, it’s no substitute for correct medical advice — this book is simply a supplement to the advice that your doctor can give you.

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If you remember nothing else in a particular chapter, remember anything that’s marked with one of these icons.

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When we drift off and start using more doctor jargon than usual or provide in-depth technical information about a particular food allergy topic, we warn you by marking the text with this icon. We do, however, try our best to present the more technical material in plain English. After all — if we can’t explain to our patients and their parents how to care for themselves in easy to understand language we’re not doing our job properly!

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Tips provide insider insight from behind the scenes. When you’re looking for a better way to do something, check out these tips.

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In our opinion nothing is like a true story to really help people to understand something that we’re trying to explain. After all, the things we’re talking about happen to real people. We may have changed some of the details of the true stories to protect anonymity of our patients and friends but the facts are correct. Of course, anecdotes are not necessarily evidence-based facts, but these stories do reflect our experience as clinicians and researchers — and also as mothers!

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In some cases, you should be very careful about the way that you deal with a situation. We try to highlight when this is the case using these icons.

Where to Go from Here

Kids’ Food Allergies For Dummies is written in modular format — which is basically a fancy way of saying that this book is structured so that you can open it to whatever topic interests you at a particular time rather than having to read it from front to back. Having said that, you may find that reading it in just that way works best for you.

If you’re looking for a quick overview of food allergies along with their diagnosis and management, go straight to Chapter 1. Chapters 4 and 5 are key to understanding how different food allergies present and how they can be distinguished from intolerances. If you want to know more about the best tests for food allergy, don’t miss out on Chapter 6. Chapter 11 is vital for anyone at risk of anaphylaxis and, if your child is due to go on camp in the next school year, you’re likely to find Chapter 9 essential reading.

When you need some quick tips to pass along to your kids or caregivers, Part V is the place to go. Here you can also find a list of dietary replacements and food allergy websites.

Of course, you can dip in at any time to pick up something you missed or to refresh your memory on a specific topic. Most of all, we hope you enjoy what we’ve written and find it useful in your everyday life while you help a child you know navigate a life with food allergy.

Part I

Introducing Food Allergies

Glenn Lumsden

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‘Our little boy just read his first food label!’

In this part . . .

Australia and New Zealand have some of the highest rates of allergic diseases worldwide and food allergies are no exception. Food allergies affect up to one in ten children and rates are rising rapidly. Recent studies have discovered that allergy problems are more common in Westernised countries, and less common in developing countries.

In this part, we introduce the different allergic diseases (including food allergies), and look at the different rates of the allergic conditions around the world. We discuss some theories on why the allergic diseases are more common in some countries as compared to others, and explain how a person’s genes and the environment can both contribute to allergy problems. We then look at some things you can do to prevent your child from developing an allergic problem such as food allergy.