The Allergy Epidemic Dr Adam Fox Consultant in

The Allergy Epidemic Dr Adam Fox Consultant in Paediatric Allergy Guy’s & St Thomas’ Hospital 16 October 2013 29 September 2010

Ancient History 2

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 3

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 • Eczema • Asthma • Allergic Rhinitis • Food Allergy • Drug Allergy • Venom Allergy • Latex Allergy 5

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 40% of UK children have an allergic diagnosis Gupta et al Clin Exp All 2005 8

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

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

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

Impact of Allergic Rhinitis • Significant decrease in Quality of Life • Effect on exam performance – 50% increased risk of dropping a grade from mocks to formal exam 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.

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? 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? Rates of Peanut Allergic in UK Paediatric Cohorts 2. 0% 1. 9% 1. 8% 1. 6% 1. 4% 1. 2% 1. 0% 0. 8% 0. 6% 0. 4% 0. 2% 0. 0% Venter 2005 Hourihane 2007 du. Toit 2008

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) 16

Key UK Organisations 17

The future • 2848 Australian infants SPT at 12 months • Prevalence of food allergy 10. 4%

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