Q&A with Dr Andrew Clark, consultant in paediatric allergy, who is leading the world's largest peanut allergy study

[GeraldineMumsnet]

Dr Andrew Clark is a consultant in paediatric allergy at Addenbrookes NHS Foundation Trust and he has been in the news because he's leading a £1 million NHS-sponsored study into peanut allergy.

We're very pleased that Dr Clark, whose other research and clinical projects focus on improving the care of children with food allergy, has agreed to answer your questions about children's food allergies.

We'll send over the questions on this thread to Dr Clark on 24 April and put up his answers during the first week of May.

Thanks to Dr Clark, and TIA for your questions.

Hope I may be allowed more than the usual one? If not priorities...

My nut-allergic teenager is rapidly approaching adulthood. Are there any plans to extend the trials to adults? (My teen might want to apply to Cambridge Uni.....)

We live too far from Cambridge to travel for frequent appointments, especially for a teenager doing exams. Do you have any idea when this might spread to other parts of the country?

And a general allergy question - I've always been told piriton is the fastest acting anti-histamine but came across some research suggesting benadryl might be. Which does act quickest on allergic reactions?

Hello,

I have a ds aged 3. He doesn't appear to have any allergies as such, but he does have a viral wheeze/asthma, which he has had on and off since summer 2009. We keep it under control by using his blue inhaler, are not on a preventative at the moment, and he has had about 6 visits to a&e in the last 9 months but has never been admitted.

He eats most foods with no problems, but recently if he has ever had peanut butter (which is rarely as he doesn't even like it!), he starts to cry and hold his throat, and then gets in a panic. It's almost as though he is about to start wheezing. He eats all sorts of other nuts normally (almonds, cashews) as well as flapjacks etc that probably contain then, and has no problem at all. We have no history of allergies in our family on either side.

What do you think? I really don't think he has an actual allergy, but there does sesem to be some kind of sensitivity going on here. Should I avoid peanuts to be on the safe side? Should I avoid all nuts to be on the safe side? And if he does have a reaction like that in the future, or even worse, how do I deal with it? With his inhaler? Or a dose of piriton?

Many thanks,

Hello Dr Andrew

My DD who has just turned 2 seems to have developed a reaction to banana, it started in Aug last year. Basically if she eats banana normally the next monring when she filled her nappy it would result in almost a burning of her skin. Before this she had eaten them without any reaction, and certainly never ate them excessively. Even a small taste of banana ice cream caused a reaction. Is this a common allergy as I had not heard of it before? Also I suffer from hay fever and wondered if this means she will be more likely to have alleries? What if anything should i do, apart from keeping her away from banans (if that is the right thing to do).

I also wondered if there is anything i can do with regards to hay fever, i would hate for her to suffer from this. My mum knows the exact moment that trigger my hay fever and I would like to avoid any thing like this for my dd.

Thanks in advance

My DD had an reaction to egg when she first had a small spoonful of scrambled eggs at about 10 months resulting in an itchy nettle type rash instantly across the mouth area. She has since eaten egg cooked in things like cakes with no reaction. She is now nearly 3, should I be trying her again with egg in forms such as scrambled?

HSh has had 2 other reactions to foods resulting in welts across the body and once with slightly swollen lips. GP was uninterested and said that they can't do tests for food allergies??! So I am not sure how to proceed.

TIA

how have the first batch of children coped with life after high tolerance level reached?

have they acepted the daily tolerance dose , and have any forgot and reduced their tolerance level?

how long will you moniter these children over the years, to confirm that the tolerance is life long, and stays at a high level?

do you think that these children would be able to give up carrying epi pens?

does the treatment have a positive knock on effect on thier other allergic diseases, such as asthma, or any other food allergies?

I have been told that this treatment , if sucessful will take some years before its widley avaliable, in about 20 -30 yrs, is this correct?

My daughter has a diagnosed peanut and nut allergy after suffering one reaction at the age of 18 months. She has recently turned 5 and had another RAST test which shows her sensitivity is decreasing (from 2.5 to 1.4). Is it likely this pattern will continue until she is not sensitive at all? (I have been practicing complete avoidance of all nuts and products which contain, may contain etc)

Is there any correlation in your view between sensitivity level and possible likely reaction to exposure?

Can she have ground nut oils (I have been told by an adult I know with a peanut allergy that processed oils are OK but since we have never been referred to a specialist I have not had an opportunity to ask questions and I do not like to experiment!)?

I have loads of questions but I expect some will be covered by others so I will leave it there for the time being.

Many thanks.

Dr Clark, I am very pleased to have this opportunity to ask some burning questions of you!

My ds (just 5yo) is allergic to Brazil nuts (identified through one clinical reaction - no breathing issues but mild swelling around the eye). He carries anapens for this. Skin prick tests show at present he is not allergic to any other tree nuts or peanuts. He doesn't have asthma or excema.

How likely is it that desensitization will become available for tree nuts?

In your opinion, should he be eating those nuts to which he is not allergic? At present we avoid all nuts like the plague, but I have heard differing advice/strategies. Same question for those annoying 'may contain' labels!

Once desensitisation occurs in the peanut trial, is it necessary to eat small amounts of nut everyday?

I look forward to hearing your answers (and to those other questions) - your work gives me and others great hope for the future!

Hi Dr Clark , I brought ds and dd to Cambridge for your star study about 3yrs ago I think , could be longer.
We were very pleased that ds could have eggs after the food challenge with a cupcake and now he frequently enjoys pancakes for breakfast -so thanks !

He has had a few slight reactions to some things with eggs though .
Once some homemade brownies that had loads of eggs in them , but cooked over 180deg for longer than 20mins, made his lips swell and throat itch.

Can the sheer amount of the allergen change the reaction?

Dr Clark,

Very interested in following the results and outcomes of your current research into desensitizing of children and food allergies.

Our son is 5, has allergies to sesame, tree nuts (but not sure which ones) and egg white as well as egg yolk.

He also had a significant amount of chemotherapy (vincristine, ifosfamide and actinomyscin D) between the months of 3 years 3 months and 3 years 11 months (for treatment of parameningeal alveolar rhabdomyosarcoma).

We had been told his allergies would go or at least decrease upon finishing chemo and his reactions on skin prick test have increased twice now since completion of his cancer treatment.

Any ideas if this means his allergies T1 / T2 cells are so in-bred in his allergies that he won't grow out of the allergies and indeed the chemo did not get rid of them?

Dr Clark, my son ate (home made) seafood risotto when he was around 9 months old (having already eaten prawns without problem before then) and the roof of his mouth swelled massively and remained swollen for 2 or 3 hours. Since then (he is now 18 months) we have not given him seafood again, except for prawns (which our GP advised we should do). The risotto also contained scallops, mussels and a little squid, together with fish stock from a stock cube.

My GP's simplistic approach to this is to say 'just don't give him seafood'. He has not referred him to anyone, but has given some steroids (prednisolone iirc) for us to administer in the event of another reaction.

My concern is that if he starts nursery in a few months time he may accidentally come into contact with seafood (parents provide packed lunches) and any action taken by the nursery might be too late .

Is there a better approach than the one offered by my GP, and if so, what is it?

Should we offer him some seafood sitting in the hospital car park? His sister likes crab sticks but hasn't been allowed to have them since in case he gets hold of them - could we try him with one of these?

(fwiw he also has a milk protein intolerance/allergy, but this is less severe than the reaction to seafood, and we are hoping that he will grow out of it like his sister did.)

Dr Clark,

My daughter aged 4 years is allergic to lentils, peas and soyabeans. She is to be tested for allergy to chick peas, other legumes and tree nuts all of which I currently avoid in her diet.

I have a 4 month old son who is currently exclusively breastfed, would you advise waiting until 6 months before weaning and then not introducing the foods that dd is allergic to until nearer one year or do you think that the overlap between breatfeeding and introduction of allergenic foods is more important? In which case I would introduce these foods earlier as I plan to stop breastfeeding when I return to work when ds is 9 months old.
I would also add that I am a vegetarian and the foods that dd is allergic to feature heavily in my diet and I probably introduced them to her diet when she was weaned at 6 months.

Thanks

LaDiDaDi

just thought of another question

Some gps seem to be very poorly informed informed about allergies as questions on this site sometimes refer to gps saving "nothing can be done" or "no tests are available" when it's clearly not true. Even paediatricians are not always well informed (had to give one information from the Anaphylaxis Campaign after being told a test was unavailable). So what can allergy consultants do to help educate them - maybe some articles for the British Medical Journal?

Hello,

My daughter wh is now 4 years old has a nut allergy, but has yet to have an allergy test or any confirmation. I have been referrred countless of times through my gp and via emergency hospital visits but still no tests.

We have been treating her by avoiding all nuts and nut traces as it seems like she is very allergic (she once licked a dairy milk bar and had a very sever reaction). The problem is now that she is starting school in Sept and I ahve started to notice that she is having reactions to other foods and I am getting concerned that if we don't know 100% what she is allergic to that she may have a reaction at school.

Is there anything I can do to get a reliable allergy test that will tell us exaclty what she is allergic to and would we be prescribed with any emergency medicines (such as an epipen?) I am also 18 weeks pregnant and am very concerned about if I should be eating nuts or not? I ahave been told to both eat them and avoid them so I don't know what I should be doing.

Dear Dr Andrew

My daughter (18mths) had been skin prick tested at St Thomas' and has confirmed allergies to peanut, tree nuts (several but unconfirmed which ones), sesame, egg white and raw eggs (although she tolerate cooked egg as an igredient) along with eczema and wheezy breathing. There is very little family history of severe food allergies and neither myself, my husband nor our 3 year old have shown any allergic reactions. We have been told that she will have to use an epipen when she strrts nursery.

I have three questions:

1. What are the chances that she will outgrow any of these? She hasn't had a rection since 10mths.
2. I am currently pregnant with my third child. I am confused as to whether to avoid peanuts although I am as we have none in the house. Also, what can I do to avoid the new baby developing allergies? I breast fed my daughter and didn't introduce solids until 6 months but in hindsight my own consumption of peanut butter was causing her baby ezcema.
3. My daughters (Sainsburys own brand) nappy rash cream contained peanut oil and I used it on her at a few weeks with very sore nappy rash. Could this have sensitised her?

Sorry, posted too early. Thaks you for reading!!

Dr Andrew

What do you think is the cause behind the number of allergies that we are seeing in the modern generation? Do you think that the elimination of so many things for pregnant women is actually contributing to the problem? I appreciate that there are a number of factors to be considered but would be very interested in your view point

Dr Clark

My son had positive RAST test to sesame seeds and a year later to hazlenut, although skin prick tests show negative.

AT this time he was tested for all nuts which were negative beside hazlenuts, since then when he has tried anything with nut in it - brazil nuts, almond (generally in chocolate) he has a reaction which consists of itchy, hot throat, and he vomits if not given antihistamine.

Should we avoid all nuts just in case? Although he has had negative RAST test results for nuts is this because he had never eaten any of them before the tests?

I know it has probably been asked and answered but I would really like to know the answers to the following from his perspective/research -

1)Should you wait until 6 months OF BF/FF to introduce solids to a baby and why?

2)If you early wean before 6 months then what are the risks of allergies?

3. Is there any link between reflux in babies and allergies?

There is no history of food allergies on either my or my husbands side, although my husband suffers from hay fever. I often wonder why my son has multiple food intolerances and possible allergies to many things including wheat, egg, nuts, diary, oats.

I have 2 questions:

Is there more incidences of food allergies in rural or urban areas?

Is there any link between antibiotics being given to new borns and the subsequent development of food allergies and intolerances in babies/very young children.

Thanks

I think the questions I have have been asked already and I would just like to say loving your work - it is so exciting ! DS1 is allergic to peanuts and almonds and I am beyond excitement that at some point in his life he will probably be de-sensitised......I just hope it is before he enters drinking /takeaway food stage of teenager-dom which is where my worry is concentrated!

I said to him recently that there is a trial going on that may 'cure' him of his allergy and his response was " I don't want to be cured. I like my allergy. If there is something I don't want to eat, I just blame it on my allergy!". Its like he has read the Daily Mail.

Hello Dr Clark

I have a daughter of five who has a severe peanut allergy. Her pre-school skin prick developed a weal of over 10cm which took several days to disappear. I am enormously excited about the desensitization program and hope it makes it to Truro before she starts secondary school.

Have you researched alternative medicine wrt allergies? What is your opinion on kinesiology as a "cure" for allergies? I have a friend whose four year old son used to get terrible hives when he came into contact with the cold (hands/face in winter, whole body if he got wet and then cold) and she claims this was cured by a kinesiologist and she is badgering me to make an appointment.

Thank you

Thanks for the opportunity here, I have two burning questions, one of which Beggsie has already asked, so I repeat in the hope you'll have time to cover the subject:

Do you plan to widen the desensitisation programme to tree-nuts?

After extensive testing, my child's been diagnosed as iodiopathically anaphylaxic as no cause can be found for some of his reactions, can you see a time when we can simply stay the reaction of the body, irrespective of allergen trigger?

many thanks for all your good work and your time here