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.

Hello Dr Clark,

My 5 yo son is allergic to cod (reacted at 16 months with vomiting and [2 hours later] hives, runny nose and eyes etc. When he was 3, he had a tiny bite of some cake with hazelnuts in it, vomited, and was covered in hives again.

Allergy tests classed his allergies as:
class 5: birch, hazelnuts
class 3: cod/plaice
class 2: peanuts, soya beans, and brazil nuts.
class 1: egg whites, almonds, tuna.

I don't let him eat any nuts, however, or any fish. I have read, and people have told me, that a nut allergy can be mild (hives) one time and result in anaphylactic shock the next - is this correct? This makes me extremely anxious most of the time that he's going to come into contact with some nuts and have a severe reaction.

We have also been warned of a cross-reaction because of the birch allergy - carrots, apples. He eats both carrots and apples - does a cross reaction mean that they can cause a problem together?

Sorry for such a long post and thank you for your time.

Dear Dr Clark,

I have many questions I'd like to ask outside the time-pressured appointments system which I suspect are largely irrelevant, but which occupy me nonetheless. If you have time to put me out of my misery I'd be most grateful, but otherwise please concentrate on the other more pressing questions on here. My background is as a lactose intolerant baby myself, DD1 was gluten intolerant as a baby (both through breastmilk and food) & dairy allergic (still is to some extent, but can tolerate enough to make it not much problem), DD2 is EBF and sensitive to dairy, soy, gluten, egg, nuts & oats in my diet.

My questions link in with:

PussinJimmyChoos & OkieCokie (where are these allergies/food intolerances coming from?). Is there any evidence/research being done that links them to environmental chemicals in the mother's bloodstream? What are your thoughts on something like leaky gut caused by Candida in the mother exposing BF babies to antigenic food molecules? (I haven't heard of anyone speak of this, but a friend had leaky gut and I'm just wondering what the effects on a BF baby may be)

icedcake (reflux and allergies)
Both my babies have/had reflux. Both also have swollen tummies and problems with wind. Do allergies cause reflux or is it as simple as pressure from swollen tummies exacerbating it? Why did DD1's swollen tummy only disappear when she stopped Pepti at the age of 3?

Also, does exposing babies to foods (through BM or weaning) to which they are allergic or intolerant do any potential long term damage? DD2 gets dark 'bits' in her nappies if I eat anything she doesn't agree with. If DD1 has too much dairy her face puff up and her nose streams. Am I sensitising them further?

Thank you for reading my drivel.

Another weaning question:

DD (now 6) is anaphylactic to cow's milk - the last reaction was severe(adrenaline, fluids, steroids, salbutamol - the works!) and she has probable allergies to sesame, egg and some tree nuts. She also has asthma and had eczema as a baby.

We are now weaning our 6 month old who has been exclusively breastfed up to now. I have been avoiding dairy and egg whilst feeding her and she has no eczema (a small patch on her ankle maybe that might become eczema but nothing like my elder daughter).

Do you feel there is an optimum 'window of opportunity' for introducing allergens? Should we be weaning slowly or be more confident that she seems less atopic than our older child? It feels odd to give her yoghurt in the near future given our history - should we wait until a year or is that likely to make things worse?

Thank you for your help!

My son is 14 and has various allergies to tree nuts (except cashew) and seseme seeds and seems to have had a reaction to poppy seeds and sunflower, so he avoids all seeds. Also has hayfever, animal allergies, plasters and insect bites.

His allergies appeared when he was 4 when in one weeked he had a reaction to seseme and pecan nuts and after that started having problem with peanuts etc

At 12 he was tested again and he has grown out of the peanut allergy but not the treenuts or seseme.

He now eats peanuts, is this wrong or can the peanut allergy return.
Also at this age is there any chance of him out growing the other allergies.

Also are these allergies inherited as my husband has similar allergies.

many thanks

Hi. I was just wondering if there was any possibility of the desensitisation process being applied to other allergies? I'm thinking particularly of dairy and egg, both of which trigger an anaphylactic reaction in my daughter and I suspect she won't grow out of this as it is such a strong reaction.
Many thanks

Is it true that giving formula to a newborn can increase the risk of allergy? My son had 10ml of formula in hospital shortly after he was born because he was screaming (in incubator) and wouldn't/couldn't feed, and subsequently turns out to have a serious dairy allergy. One paediatrician said that often children allergic to dairy had been given formula in hospital - is this right?

Dear Dr Clark,

I guess put simply my question is this:

Can a food allergy or intolerance cause constipation as opposed to diarrhoea ?

The reason I ask is as follows, (sorry is quite long)

My DD was born at 34 weeks. She was initially fed EBM and and passed nice breast milk stools. The day before her discharge, supplies ran out and she was discharged on SMA prem 2. This led to immediate constipation. After 2 weeks we were advised to change her milk to Neocate (the doctor seemed to latch onto the fact that I have eczema and am allergic to animal hair). We changed to Neocate and things did not improve. We gave lactulose and water, still no improvement. After 6 weeks we changed to Aptimil first milk, after 4 feeds, a wetter poo (yellow, toothpaste).
However, my DD still is constipated, by this I mean she passes yellow, very hard "adult like" stools ranging from rabbit poo, to paste, to hard marbles, to playdough. Lactulose seems to work occassionally, water helps slightly.
DD had subsequently been diagnosed with reflux, also.
I was advised to try Neocate again, but am reluctant to as it seemed not to help, and DD is due to be weaned in around 4 weeks. I am also worried about weaning, as i'm sure this will help with the reflux but make the constipation worse.

As food intolerances/ allergies usually cause vomiting and diarrhoea I was wondering if in your experience you have seen them cause constipation?

DD is thriving, now 22 weeks, 16 corrected, weighs 6kg, her skin seems ok, flaky in patches but not eczematous, no blood in stools, no nappy rash, although erythematous skin around her anus. She rarely vomits. She is also incredibly windy, both ends and her farts often cause her to cry. She sleeps poorly due to farts. She also appears to have a lot of crampy type tummy pain in addition to her reflux pain. Her tummy constantly gurgles.

I know "on line" consultations are ill advised, but GP and hospital are of little help or support and we have been pretty much left to it. As a doctor myself I finding it very distressing and hoping time will sort these problems. If you have come across anything similar that pointed to an allergy I would appreciate a little advice.

Many thanks. Sorry if slightly inappropriate.

Hi , My daughter (age 9) had blood tests at age 7 for her allergies and showed very low levels of IGE eg almond 0.49, peanut 1.1, walnut 1.47, sesame 0.83, as these were all over the negative classification of 0.35, she was classed as having allergies. However, the consultant said that you can still show high IGE levels, but have grown out of the allergy.

She was initially diagnosed as being allergic when she was 5 (not allergic before this), where scratch tests were highly positive (peanut 12mm. hazlenut 3mm). She has had three reactions where her face has puffed up (no anaphalaxis).

The 12mm scratch test for peanut aged 5 does not correlate with the ige level of 1.1 when age 7.

However, she has not had a reaction for a couple of years now (perhaps because we are very careful).

The consultant had suggested oral challenges, but neither we or our daughter are comfortable with this. When we asked if could repeat scratch tests first, he said that this would still not confirm if she was still allergic or not, as they can be falsly positive.

To make it more confusing, though we didn't ask them to thay also tested non nuts and she showed positive Ige levels for milk (0.42), egg (0.53) and wheat (0.79), but she eats all these with no problems at all!!!!

More recently, daughter now seems to have developed allergy to pineapple, cherry and peaches (lip goes a bit puffy).

Question is - is it possible that scratch and ige tests can be so different or is she growing out of allergy, two years have passed should we have more scratch ot ige tests to decide whether to go for the oral testing or not????

Another low-priority theoretical question here. Sorry, but it's not often you get the chance to ask the experts.

If a mother has an immune response to a type of food molecule (e.g. undiagnosed coeliac or similar), she raises antibodies against it. If the antibodies enter breast milk and therefore her baby, does the baby then suffer the effects of the immune response too?

LoveBeingAMummy: "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."

Bananas also give my son (now 4) an allergic-type reaction - swelling around the face, rashes, the sore bum + loose poos you describe, and I strongly believe they trigger his asthma. They didn't show up as an allergy trigger on the skin-prick tests he had done (unfortunately he also has several severe food allergies). I took him to a dietitian and through her we followed this elimination diet:

www.sswahs.nsw.gov.au/rpa/allergy/resources/foodintol/sed.cfm

(We were living in Australia at the time). It seems bananas contain chemicals called amines that people can develop a food intolerance to, and he did react to the amine challenge. The dietitian said he could have cheese, chocolate and bananas (i.e. foods that contain amines) in small doses. I kept him off bananas because I don't want to risk anything that might trigger his asthma but I did give him a little bit of chocolate occasionally. This Easter holidays, he had an Easter egg + some mini eggs and I let him have cheese a few times. Oh dear. His skin was raging with eczema within a day. He's now off chocolate and cheese and his skin is returning to normal. I've had doctors (not specialists) say that food intolerance doesn't exist but I know what I see before my eyes!

In your view is it justifiable or sensible for schools to have a blanket ban on nuts (or even just peanuts)?

hope you don't mind additional questions - feel free to ignore if you do.

Several people have already mentioned testing but some of have experienced problems with the accuracy of skin prick/ RAST tests. Can I ask you about progress on developing more reliable tests e.g.
more accurate test? and whether you consider skin prick or RAST tests the most reliable? Also whether there is any chance of ever developing a test that will predict not only who will react but how severe that reaction might be.

Also a comment - as the parent of a non-asthmatic child who has had an anaphylactic reaction I am extremely grateful that we saw an allergy consultant who believed in prescibing epipens to all those with postive nut allergy tests. Instead of sitting and praying medical help would reach us in time (as I had to do with their first reaction) I was able to deal with the reaction promptly. We can't keep our children away from all allergens, although we can limit the frequency of reaction. I hope you are not one of the consultants who restricts adrenaline to the asthmatic.

I only have a question, when are these trials expected to be completed, results provided and if successful, is there any timescale about how and when this treatment can be made available to other areas?

ORANGINA avoid peanuts until he is cleared off via testing, what you describe looks very much like a proper allergic reaction, check this website:
www.anaphylaxis.org.uk/information/basic-facts.aspx

(I know that Dr Clark will have a look at your question but just thought of advancing some of the info in the mean time )

Penthesilea - thanks for that, so far no issues with cheese or choc here. There's just so much we don;t know isn't there. I know that when she had some banana ice cream, it was literally two spoons and it effected her.

Arachis oil is in many baby products. I found out this is the Latin name for peanut oil. Could overuse of these oils and creams in the past have contributed to the prevalence of peanut allergies now?

Dear Dr Clark

I am expecting our first baby in 10 days. I have a severe allergy to all nuts and pulses (my principle allergy is peanuts but i have reacted to other nuts as well as soya, lentils, chickpeas etc) and have been hospitalised on about half a dozen occasions. I carry adrenalin pens, anti-histamine and steroids with me.

What are the chances that our baby will also have a food allergy and what should I do about having her tested? At what age should we consider tests for her?

I have found in the past that GPs are simply not knowledgeable enough about this condition (this is not a criticism as i realise it is a specialist area) and am worried that early signs may be missed (as they were when i was a baby!)

Many thanks

Helen

Hi Dr Andrew,

I had skin prick tests done for my hayfever last year, and they said the result was '8' but I am confused as to what '8' means - is it on some sort of scale?

Also, what would this indicate to you about my hayfever?

Thanks

.

Dear Dr Clark

My daughter has a purported peanut allergy. She's seven but was diagnosed at 18 months after blood tests taken to analyise allergies due to a cows milk protein allergy, and a skin reaction to peanut butter.

We have carried an epipen around with us ever since. I dont especially want to put her through any more tests than necessary, because she has various other health complications which means she's poked and prodded enough as it is. How likely is it that she will grow out of this allergy, like she has with the cows milk protein one?

That said, she hasn't really had any follow-up care/review for her allergies, and I wondered what sor of care you thought should be carried out with children who suffer allergies severe enough to have to have an epipen?

Many thanks.

Hi there,

My son is allergic to egg and sesame and quite possibly nuts although I am not certain.
He first reacted to scrambled egg at nine months old and had a severe hive reaction on his hands and face before throwing up. He also had hives in his nappy area the next day.
He then reacted to sesame in hummus at 13 months and went anaphalactic needing anti histamines, steroids, oxygen and adrenaline.
He was under a paediatrician for a few years but has never had any tests as he was deemed to be too young.
He has avoided sesame, eggs and nuts since then and carries epipens and piriton.
He is now nearly five and I would obviously like to move things forward for him. What do you think our next step should be? I live in South Wales and do not know of any specific allergy clinics nearby.
Thanks very much

Dr Clark.
Well done for your excellent work in Cambridgeshire. I wish we lived near you!
Thank you so much for agreeing to answer some of our questions. As you can see there are so many of us here with allergic children, all needing more information than we are being given by our own health care professionals.

I have 3 children.
My eldest daughter was dairy intolerant as a baby. Tummy pains and excema linked to it. She also developed a Pistachio nut allergy when she was about 5. Following two anaphalactic reactions. Second one I nearly had to take her to A&E. Piriton just about kept it under control. She is now 10.5 and has an epipen.
Gp refuses to refer for testing as they are not reliable apparently.
My youngest son is 18 months and he is allergic to dairy and soya. But not peanuts as he eats them quite happily.

I would like to ask.
Is there a blood test that can be done which actually measures the immune system response accurately? If so why is this not offered to children?

Are my children suffering because I have developed allergies to dust, dust mite, Birch, cat & dog, since entering my 20's?

Does a mother pass on an immumne response problem via the placenta?

Thank you very much for your time.

Dear Dr Andrew ,
my son has egg allergy is this potencially a problem for him when recieving his vaccinations as i understand that some of them are cultured in egg protein
Many thanks

My DD is 13 and has anaphalatic reactions to both peanuts and sesame seed both requring an epipen to be used. She has been retested several times (at 5 and 10) and we were told that she will have this condition for life and there is no hope for her in terms of growing out of her life-threatening allergies.

But I read about these de-sensitization trials ( as did DD) and wonder what the future holds as it is promising. But when we both mentioned the UK trials to her allergist doctor (in Canada) he said she was not a candidate for these trials and would not discuss it further.

My questions, is a desenstizaton trial out of the question for her and why ( does it only work for some candidates)? Is it only that the UK is leading in this area and it has not spread to countries like Canada? Is there hope that over time these trials may become more available to all with life-threatening allergies or do we just get on with living with them?